are you at risk for breast cancer?

1. Are all women at risk to get breast cancer?

Yes. About 1 in 8 (13%) women will get breast cancer at some point in their lives.[8] However, the actual risk for an individual depends on both family history and personal risks.

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2. Are there different causes of breast cancer?

In most cases breast cancer happens sporadically (by chance).[1] About 30% of breast cancer runs in families.[1] To learn more about the different types of breast cancer, please click on the pie chart below.

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3. How do I know if I am at higher risk for a Hereditary Breast Cancer Syndrome?

These families may have multiple family members who have had breast cancer or other cancers at a young age. This type of breast cancer is caused by a change in a single gene, such as BRCA1 or BRCA2. Having one of these gene changes can raise a woman's chance of getting breast cancer from 13% to as high as 85%. Women with a change in BRCA1 or BRCA2 also have an increased risk of getting ovarian cancer.2 Men with a change in the BRCA2 gene have a 6% chance of getting breast cancer.11 Screening, medication, and surgery to remove the breasts and/or ovaries can lower a person's risk of getting cancer.2 A person with one of these gene changes has a 50% chance of passing the change and risk of cancer on to his or her children.

You may be at risk for hereditary breast cancer if [4,12]:

• You or a first or second degree relative had breast cancer before the age of 40
• You or a first or second degree relative had both breast and ovarian cancer.
• You or a first degree relative had breast cancer in both breasts.

OR if you have:

• Two first or second degree relatives with breast cancer, and one of these relatives got breast cancer before the age of 50.
• Three or more first and second degree relatives with breast cancer.
• Two or more first or second degree relatives with ovarian cancer.
• Breast and ovarian cancer among your first and second degree relatives.
• Ashkenazi Jewish background and a relative who got breast cancer before the age of 50.
• Ashkenazi Jewish background and a first or second degree relative with breast or ovarian cancer.
• A male relative with breast cancer.
• First or second degree relatives with other cancers at or before the age of 50.

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4. How do I know if I am at higher risk for Familial Breast Cancer?

Familial Breast Cancer runs in families. These families may have one or more family members who have had breast cancer. This type of breast cancer is thought to be caused by the interaction of multiple genes and shared lifestyle factors among family members. Women in these families are at least 2 times more likely than the average woman to get breast cancer.[4]

You may be at risk for familial breast cancer if you have:[4]

• Two first degree relatives diagnosed with breast cancer between ages 51 and 60.

OR

• One first-degree relative and one second-degree relative with breast cancer whose ages at diagnosis add up to < 118 years. View example.

OR

• One first-degree or one second-degree relative diagnosed with breast cancer between the ages of 41 and 49.

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5. Are there things that can increase my chance for getting breast cancer?

There are risk factors that can increase your risk for getting breast cancer. Some risk factors are out of your control. These include:

• Your Gender: Being female puts women at greater risk than men to get breast cancer. This is because women have more breast tissue than men. But, men can get breast cancer too.[7]
• Having "Denser" Breasts: Women with dense breasts are more likely to be diagnosed with breast cancer than women with less dense breasts.[12]
• Your Race/Ancestry: Caucasian women have a higher chance of getting breast cancer than African American and Hispanic women.[7] Women of Jewish ancestry may also have a higher chance of getting breast cancer.[6]
• In the general population, about 1 in 300 to 1 in 500 people carry a gene change in BRCA1 or BRCA2 that increases their chance of getting breast cancer.[2]
• People of Ashkenazi Jewish ancestry are more likely to carry a gene change in BRCA1 or BRCA2. About two percent (2 in 100) of the Ashkenazi Jewish population carries one of these gene changes that increases the chance of getting breast cancer.[6]

• Increasing Age: The chance of getting breast cancer increases with age.[7] Two out of 3 breast cancer cases occur in women over the age of 55.[14]
• Menstrual Periods: If you started your period before the age of 12 you have a slightly higher chance of getting breast cancer.[7]
• Having Children Later in Life or None at All: Having your first child after the age of 30 can increase your risk for breast cancer. Your risk is also increased if you have never had children.[7]
• Menopause: If you went through menopause after the age of 55, you have a slightly higher chance of getting breast cancer.[7]
• Personal History of Breast Cancer: If you have had cancer in one breast, you have a higher chance of getting cancer in the other breast.[1]
• Breast Changes Found with Biopsy: Precancerous changes in the breast increase your risk of breast cancer.[1]
• Family Health History: A family history of breast or ovarian cancer may increase your chance of getting these types of cancer.[3]
• Your genes: About 30% of breast cancer runs in families. About 5-10% of breast cancer is caused by a change in a single gene like BRCA1 or BRCA2.[1]
• Radiation Exposure: If you had radiation treatments as a child or young adult, you may have a higher chance of getting breast cancer.[1]

Some risk factors that may be in your control include:

• Drinking Alcohol: Women who drink 2 or more alcoholic drinks a day have a higher chance of getting breast cancer. The more you drink each day, the higher the chance of breast cancer.[9]
• Being Overweight: Being overweight after menopause may increase your risk of breast cancer.[10]
• Hormone Replacement Therapy: Taking hormones to treat the symptoms of menopause may increase your risk for breast cancer.[7]

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6. How can I lower my chance for getting breast cancer?

• Diet: Diets low in fat and high in fruits, vegetables, fiber, and complex carbohydrates may lower your risk for breast cancer.[10]
• Exercise. The American Cancer Society recommends that women be active for 45-60 minutes, 5 days a week to reduce the risk of breast cancer. Exercise includes walking, biking, doing housework, and gardening.[8]
• Maintain a healthy weight for your age and height.
• Limit the number of alcoholic drinks to less than 2 a day.

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7. What should I do if I think I have a higher chance of getting breast cancer?

• Collect your family health history. This is the first step to assess your risk for breast cancer.
• Share your family health history with your doctor. Your history may help your doctor decide if you need to be screened more often or at an earlier age for these cancers. If your risk is high, your doctor may refer you to a genetic specialist.
• Talk with your doctor about ways to lower your risk. If your doctor thinks you have a higher chance of getting breast cancer as a result of your family health history, he or she may suggest:[1]
• Earlier or more frequent screening
• MRI screening
• Joining research projects aimed at reducing the risk of breast cancer
• Taking medications such as Tamoxifen
• Preventive surgery such as removing the breasts or ovaries
• Genetic testing. However, genetic testing is only useful in a small number of cases.
• Talk to your family about your risk. If you are at risk for breast cancer, your family members may be too. Talk to them about the information that you find.

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8. Is there a test that can tell me if I have a higher chance of getting breast cancer?

Yes, genetic testing can sometimes tell you if you have a higher chance to get breast cancer, but Genetic testing is not for everyone!

• Only a small number of people have a change in a single gene that greatly increases their chance of getting breast or ovarian cancer.
• Your doctor may refer you to a genetic specialist to find out if Genetic testing is right for you.

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9. Are there tools on the internet that can estimate my chance of getting of breast cancer?

The National Cancer Institute has a Breast Cancer Risk Assessment Tool. This tool uses a woman's medical and family history to estimate her risk of getting breast cancer. It does not asses the risk for women under the age of 35.[15]

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10. Breast Cancer Resources

1. www.breastcancer.org
2. www.facingourrisk.org
3. www.getbcfacts.com
4. www.nationalbreastcancer.org
5. www.komen.org
6. www.y-me.org

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References

1. Korde LA, Calzone KA, & Zujewski J. (2004). Assessing breast cancer risk: Genetic factors are not the whole story. Postgrad Med 116(4):6-20, 34.
2. Nelson HD, Huffman LH, Fu R, et al. (2005). Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine 143(5):362-379.
3. Beral V, Bull D, Doll R, et al. (2001). Familial breast cancer: Collaborative reanalysis of individual date from 52 epidemiological studies including 58 209 women with breast cancer and 101 986 women without the disease. Lancet 358(9291):1389-1399.
4. Hampel H, Sweet K, Westman JA, et al. (2004). Referral for cancer genetics consultation: a review and compilation of risk assessment criteria. J Med Genet 41(2):81-91.
5. Basham VM, Lipscombe JM, Ward JM, et al. (2002). BRCA1 and BRCA2 mutations in a population-based study of male breast cancer. Breast Cancer Res 4(1):R2.
6. Struewing JP, Hartge P, Wacholder S, Baker SM, Berlin M, McAdams M, Timmerman MM, Brody LC, Tucker MA (1997). The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med 336(20):1401-1408.
7. American Cancer Society. Breast Cancer Facts & Figures 2005-2006. Atlanta: American Cancer Society, Inc. Available at www.cancer.org/downloads/STT/CAFF2005BrF.pdf Accessed December 13, 2006.
8. American Cancer Society: www.cancer.org Accessed May 1, 2007.
9. Hamajima N, Hirase K, Tajima K, et al; Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Alcohol, tobacco and breast cancer - collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer 87(11):1234-1245.
10. McTiernan A. (2003). Behavioral risk factors in breast cancer: Can risk be modified? Oncologist 8(4):326-334.
11. Ford D, Easton DF, Stratton M, et al. (1998). Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 62:676-89.
12. National Comprehensive Cancer Network: Guidelines for detection, prevention, & risk reduction of cancer. www.nccn.org/professionals/physician_gls/ f_guidelines.asp?button=I+Agree#detection Accessed May 1, 2007.
13. Breast Cancer Organization: www.breastcancer.org Accessed May 1, 2007.
14. Hulka BS & Moorman PG. (2001). Breast cancer: Hormones and other risk factors. Maturitas 38(1):103-113.
15. National Cancer Institute: www.cancer.gov/bcrisktool/about-tool.aspx#gail Accessed December 15, 2006.

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