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• In-Office Ultrasound
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High Risk Evaluation
• Risk Factors for
   Breast Cancer

• Genetic Testing
• Lobular Carcinoma
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Care of the Breast Cancer Patient

• After Surgical Treatment
  of Breast Cancer
• Lumpectomy
• Mastectomy
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• Axillary Lymph Node
• Lymphedema
• Breast Reconstruction
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High Risk Evaluation

Risk Factors for Breast Cancer

All women are at risk for breast cancer. Two of every three women who develop breast cancer have no family history. As a women ages, her risk for developing breast cancer increases as well.

Risk factors include:
· Age over 50
· Never having children
· First child after age 30
· Early menstruation (before 13)
· Late menopause (after 55)
· Family history of breast cancer in a first degree relative
· Personal history of breast cancer
· BRCA 1 or BRCA 2 gene mutation

What are fibrocystic changes in the breast?
Women who have fibrocystic breasts often describe them as feeling lumpy all over. Sometimes this diffuse lumpiness can be associated with pain and tenderness that increases or decreases at various times of the month. These changes sometimes are part of the normal hormonal changes that women experience throughout the month as part of their menstrual cycle.

Lumpiness is normal for some women. It is usually helpful for women to learn breast self-examination so they can become familiar with their breast tissue. Most fibrocystic lumps are multiple, soft, and mobile and may come and go with the menstrual cycle. Discreet lumps and thickenings that do not change with your cycle, are new, or a change in what is normal for you should be evaluated. Most breast findings are not breast cancer; however it is important to determine that it is not cancer.

Occasionally, when a breast biopsy is performed and the result is benign (no cancer) we find cells that indicate “atypia” meaning the cells are not cancer but are changing. We consider this to be a higher risk condition, especially when combined with a family history of breast cancer.

I was told that I am considered "high risk", what does that mean and how should I be followed by my physician?
How you were determined to be high risk will determine some of the options for your follow-up. High risk means that you are in a category of women that have a higher than normal risk for developing breast cancer. Some women overestimate their risk simply because they know someone in their family had breast cancer. The Gail Model was developed as a means of determining risk, taking into account several variables such as age, age at birth of first child, number of first degree relatives with breast cancer, number of biopsies, and biopsies with atypical findings. Once this information is calculated, it can give us an accurate assessment of your current and lifetime risk, compared to a woman the same age.

All women (40 and over) should start with a yearly mammogram. Depending on the risk level, some women benefit from close follow-up with a breast specialist (usually a breast surgeon) who examines their breasts twice a year and reviews their yearly mammogram.

For other women with higher risk levels, the breast specialist may recommend an MRI in addition to mammography. Gene testing or Tamoxifen (a drug that has been shown by clinical trials to prevent breast cancer) may be recommended.

I am considering genetic testing, but I am still unsure. Should I have it done?
If you are considering genetic testing you should speak with a counselor who is professionally trained in genetics. The counselor will review your family history of breast and ovarian cancer and other familial cancers, discuss the advantages and concerns of testing, and discuss some of the potential options for a person who tests positive. After your counseling session, you can take the time to think about your decision and decide whether you will have the blood test done.

What other factors may increase my risk of developing breast cancer?
Some of the following factors have been found through research to contribute to the risk of developing breast cancer:

· Hormone Replacement Therapy – The results of the Women’s Health Initiative Study (WHI) recently indicated that a woman’s risk of developing breast cancer increased with the use of hormone replacement therapy (HRT) especially when used for a long time. Some women who have severe discomfort from the symptoms of menopause may still choose HRT but the risks and benefits of HRT should be carefully discussed by you and your physician.

· Birth Control Pills (Oral Contraceptives) – Some studies show a slight increase in risk for women who have taken birth control pills for a long time or who began using them at an early age. Birth control pills have been shown to decrease a women’s chance of developing ovarian cancer.

· Dietary Fat – There have been mixed results in the literature as to whether or not a high fat diet increases the risk of breast cancer. It is not yet known whether a low fat diet will lower risk. The American Institute for Cancer Research advises lowering fat to 30 percent or less of daily calories. They also recommend that you eat at least five 1/2 cup servings of vegetables and fruits. ”Phytoestrogens” found in soy and other plant foods may lower hormone production and risk for breast cancer.

· Alcohol – There have been some studies that have shown that alcohol use of greater than three drinks per day can increase the risk of breast cancer.

· Exercise – There have been mixed results in the studies that have looked at the relationship between exercise and breast cancer risk. However, some have suggested that in women 40 and younger, regular exercise may decrease breast cancer risk.

· Environmental Factors – There are ongoing studies evaluating the effect of occupational, environmental, or chemical exposure on the risks of developing breast cancer. The Sister Study, funded by the National Institute of Environmental Health Sciences, is a national effort to learn about the environmental and genetic causes of breast cancer. Women are eligible for this study if they have never had breast cancer themselves, are between the ages of 35-74 and have a sister (related to you by blood) who has had breast cancer. To find out more or to enroll in the sister study go to www.sisterstudy.org or call toll free 1-877-4Sister (1-877-474-7837).

If you would like more information about breast cancer risk, breast self examination instruction, or scheduling a genetic counseling session; please call us at 847-797-9000.

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