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Ellie Proussaloglou. MD
Breast cancer is the second most common cancer in American women. But cancer risks are not one-size-fits-all. Some women have a greater chance of developing breast cancer than others. But just what does it mean to be high risk?
When calculating breast cancer risks, doctors take several factors into consideration, according to Ellie Proussaloglou, MD, a surgical oncologist who specializes in breast surgery at Smilow Cancer Hospital and is an assistant professor of Surgery at Yale School of Medicine. Dr. Proussaloglou sees patients in Waterford and New Haven.
“Your risk is due to a combination of factors, but the main things that influence your chances of developing breast cancer are your age, female sex, family history, prior abnormal breast biopsies and genetic causes,” she said.
Why is it important to know your genetic and family history? If you have a strong family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you may have a higher risk of getting breast cancer. According to the Centers for Disease Control and Prevention, approximately 50 out of 100 women with a BRCA gene mutation will get breast cancer by the time they turn 70 years old, compared to only seven out of 100 women in the general United States population.
“For women with average risks of breast cancer, the American Society of Breast Surgeons recommends starting screening with mammograms at age 40. But for our high-risk patients with genetic variants, we can now start screening as early as age 25,” Dr. Proussaloglou said.
If you have a family history of breast, ovarian, uterine or colorectal cancer, you may have a higher risk for developing these cancers. Talking with your doctor about your family health history also helps you and your doctor decide if genetic counseling or testing may be right for you.
“If you have multiple family members who had a breast cancer diagnosis, especially at a young age, what does that mean for your overall risk? We can use a tool to calculate your risk. And we often recommend starting breast screening more regularly for people with a significant family history of breast cancers and related cancers, even if they test negative for a gene mutation,” she said.
For patients who are at increased risk of breast cancer, the Breast Cancer Genetics and Prevention Program at Smilow Cancer Hospital provides comprehensive risk assessment, education and screening with a multidisciplinary team of genetic counselors, nurse practitioners and physicians.
New federal regulations require that all women must be notified whether their mammography reports show dense breast tissue – a diagnosis shared by about half of the women in the United States. Breast density is a measure of how much fibrous and glandular tissue is in your breasts compared with the amount of fatty tissue, as viewed on a mammogram.
Why is it important to know your breast density? According to Ellie Proussaloglou, MD, dense breasts can make it more difficult for doctors to evaluate a mammogram, and so they may require additional imaging to detect tumors.
“Having dense breasts has been associated with an increased likelihood of breast cancer, though the majority of that risk is due to the difficulty in screening,” she said. Because dense breast tissue – like tumors – looks white in mammogram images, it can be difficult to see small or precancerous lesions.
If you have dense breasts, you might need additional imaging, like a breast ultrasound, said Dr. Proussaloglou. Consult with your doctor about the best screening plan for you.
Your risk of breast cancer increases as you get older. According to the American Cancer Society, women over 55 are more likely to develop breast cancer. That's because even though the cells in our body divide all the time to replenish tissue and organs, sometimes cell division can go wrong especially as we grow older. As we age, our bodies are less capable of repairing genetic damage, leading to conditions such as cancer.
While you can't stop the aging process, the lifestyle choices you make can help reduce your risk, “Overall healthy behaviors such as exercising regularly, trying to eat plant-based or Mediterranean-based diets, maintaining a healthy weight and minimizing tobacco exposure are all within our control,” Dr. Proussaloglou said.
Another recommendation? Reduce your alcohol intake. “Even moderate intake for women, which is considered one drink a night or seven drinks per week, has been shown to be associated with increased risk of breast cancer,” she said.
“It’s important to note that most people do not carry a gene that increases their breast cancer risk. Only about 10 percent of breast cancers are truly hereditary or genetic, and perhaps 20 percent are associated with family history,” Dr. Proussaloglou added. “So, about 70 percent of breast cancers happen randomly. It’s vital to continue being as active and healthy as you can to decrease the risk even further.
Having certain risk factors does not guarantee you’ll have a diagnosis of breast cancer. In fact, some women (and men) will get breast cancer without being aware of any additional risk factors. The good news is that most breast cancers are caught early.
“Early screening and early detection are really the keys to making sure that breast cancer is identified when it's small, treatable and localized. We're very fortunate now to have good screening tools to help identify it,” she said. “What it really comes down to is breast self-awareness, knowing your family history and getting your regular mammograms,” she said.
The word “cancer” is a scary one. A Gallup poll shows that people fear a diagnosis of cancer more than any other health condition. Understanding your own cancer risk factors, especially when combined with genetic testing and screening recommendations, can help alleviate anxiety and guide personalized medical decisions.
“It’s important to know what the likelihood is that you may develop cancer so your doctors can be proactive about any cancer screenings,” said Carson Nestler, a certified genetic counselor at Smilow Cancer Hospital. “Screening tests can help detect cancer at an early stage before symptoms occur – and when the cancer may be easier to treat. In fact, screening tests can sometimes help prevent cancers from developing in the future.”
Read more about understanding cancer risk
While you can’t change your genes, you can take proactive steps to manage your health.
Experts with the Cancer Genetics and Prevention Program at Smilow Cancer Hospital recommend the following lifestyle tips that can help reduce your risks of developing cancer ...
Read more about steps to reduce cancer risk
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