Breast cancer is the most diagnosed cancer among women in the WORLD.  It is a leading cause of cancer death, second only to lung cancer.  However, if breast cancer is detected and treated in an early stage, there is a 98% survival rate.

Risk Factors: Multiple risk factors have been identified as influencing a woman’s risk for breast cancer. A risk factor may increase or decrease a person’s risk for disease.

The following factors may increase a woman’s risk for breast cancer:

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Gail Model
The National Cancer Institute developed a model (the Gail Model) to estimate the probability of a woman with given risk factors to develop breast cancer over a specified period of time. This model considers more than one risk factor and assigns a weight to each risk factor which may vary in the presence of other risk factors.

The Gail Model  evaluates the following risk factors to assess a woman’s risk for breast cancer:

1. Current age
2. Race
3. Age of onset of menstruation
4. Number of breast biopsies
5. A breast biopsy revealing atypical hyperplasia (an overgrowth of abnormal cells)
6. Number of first degree relatives (parents, siblings, offspring) diagnosed with breast cancer

This model was based on follow up data of white women at least 40 years of age participating in the Breast Cancer Demonstration Project. Several risk factors are not analyzed in the model that may increase risk such as ionizing radiation or that may decrease risk such as diet and exercise. The model may underestimate risk for inherited susceptibility since it does not examine second degree relatives with breast cancer, age at diagnosis or ovarian cancer in first or second-degree relatives (examples of second degree relatives include grandparents, aunts/uncles, and nieces/nephews.) Therefore, interpretation of the Gail Model risk assessment should be done by a trained professional. To estimate your breast cancer risk using the Gail Model, please refer to the National Cancer Institute.

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Increased Risk

Some women may be at increased or high risk for breast cancer and may benefit from consultation in the High Risk Breast Cancer Clinic:

• Persons with a previous breast biopsy revealing atypical hyperplasia
• Persons with a previous history of ductal carcinoma in-situ or lobular carcinoma in-situ
• Persons with a family history of breast or ovarian cancer in 2 or more 1st or 2^nd degree relatives.
• Persons with breast or ovarian cancer who have one blood relative with breast cancer which developed before the age of 45 years
• Persons with breast and/or ovarian cancer with multiple primary cancers or bilateral disease
• Relatives with documented mutations in the BRCA 1 or 2 gene
• Ashkenazi Jewish Women (Jewish women from eastern Europe)
• Women with breast or ovarian cancer who have a male blood relative with cancer
• Persons with breast and/or ovarian cancer which developed before the age of 45 years.

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Lifestyle Modifications To Reduce Risk

Signs and Symptoms:

Early detection is the key to the successful treatment of breast cancer, and therefore, of survival. The following warning signs may be indicators of breast cancer:

• A lump in the breast

• An unusual increase in the size of one breast

• A change in the shape of a breast

• A puckering of the skin of the breast

• A new dimpling or change in the skin of the nipple

• An unusual swelling of the upper arm.

• An enlargement of the lymph nodes

• Any unusual discharge from the nipple

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American Cancer Society Screening Guidelines For Persons At Average Risk

• Age 20 to 39: monthly breast self-examination and breast exam by a health care provider every 3 years

• Age 40 and older: monthly breast self-examination, annual mammogram and  breast examination by a health care provider

It is recommended that the clinical breast examination occur prior to mammography and there should be a short interval between the 2 examinations

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Surveillance Guidelines For Persons at Increased Risk

Women with a family history of breast cancer should discuss with their health care providers about initiating screening at an earlier age.  Many experts recommend screening begin 5-10 years earlier than the age of diagnosis of the youngest affected relative.