Updated on July 19, 2023.
After lung cancer, breast cancer is the second leading cause of cancer death in women in the United States. An estimated 297,790 women are expected to face a new diagnosis of invasive breast cancer in 2023 and an estimated 43,700 will die from the disease, according to the American Cancer Society.
Experts say there is no sure way to prevent all breast cancers, as certain risk factors (such as advancing age and sex), are beyond a person's control. But there are certain steps women can take to reduce their risk of a breast cancer diagnosis. Tara M. Breslin, MD, a surgical oncologist with Trinity Health IHA Medical Group in Ypsilanti, Michigan, explains who is at risk as well as the factors we can and can’t control.
Controllable breast cancer risk factors
There are several widely accepted steps that a person can take to reduce their risk. Among them are:
- Maintaining a healthy weight
- Staying physically active
- Refraining from drinking alcohol
- Quitting smoking
- Breastfeeding your children, if possible
- Limiting radiation exposure from medical imaging tests, if not medically necessary
Not surprisingly, some of these same strategies lessen the risk for other health concerns, as well, says Dr. Breslin.
“Reducing overall body weight does lower the risk for certain types of breast cancer,” she says. “But, it also can reduce the risk for cardiovascular disease, the number one killer of women in America.”
If detected early, breast cancer has a high rate of survival. Overall, roughly 99 percent of women live five years or more beyond diagnosis when the disease is localized to the breast.
Screening guidelines for women of average risk
Average-risk women are those whose estimated risk for developing breast cancer is about 13 percent, or roughly a one in eight chance during their lifetime. Screening mammography may pick up signs of a cancerous mass before symptoms occur.
The American Cancer Society (ACS) advises that women can start screening between ages 40 and 45 if they choose. Beginning at 45, the ACS recommends mammograms every year. At 55, getting screened every one or two years is recommended as long as you are healthy and expect to live at least another decade.
Guidelines from the United States Preventive Services Task Force (USPSTF) differ somewhat from those from the ACS. In a draft recommendation statement published in May 2023, the USPSTF advises that women begin screening at age 40, having mammograms every other year until age 74.
In her own practice, Breslin says she generally follows the guidelines of the American College of Radiology (ACR), which recommends most women begin screening at age 40.
Steps to take if you’re at a higher risk
Guidelines are uniformly more rigorous for high-risk women. The ACR, for example, urges women at higher-than-average risk to begin screening as young as age 30, depending on their health profiles.
People at the highest risk for breast cancer include:
- Women with family histories. Having a mother, sister, or daughter diagnosed with breast cancer, especially before age 50, may double the lifetime risk. Having a close male blood relative with breast cancer also elevates a woman’s risk.
- Personal history of breast cancer. Women who have had breast cancer are more likely to be diagnosed with a second occurrence.
- Genetic mutations or alterations. Less than 15 percent of women have known genetic changes, but carrying a mutation in either the BRCA1 or BRCA2 gene can raise the risk for breast cancer between 45 to 85 percent. “It’s a wide estimate,” concedes Breslin. “But that’s because some mutations are associated with a higher risk than others.”
Surgery is the most obvious risk-reduction measure for people at high risk for breast cancer. But the decision to remove one's breasts with a mastectomy depends on patient preference, Breslin says. A younger woman in her 30s, finished with childbearing, might opt for surgery, “knowing they have 30 or 40 years ahead of benefit,” she says. A woman in her 70s or 80s, on the other hand, might choose otherwise.
Risk-reduction strategies also can involve medications, such as tamoxifen and raloxifene, to block estrogen, which can fuel cancer growth in premenopausal women. HCPs may also prescribe aromatase inhibitors, another class of drugs that can slow estrogen production in women after menopause.
If you are at a high risk of developing breast cancer, your HCP can help you develop an individualized schedule for screenings, as well as work with you to determine which prevention techniques may be best for you.
After a breast cancer diagnosis
Once a woman has breast cancer, risk-reduction talks need to take a different tone, according to Breslin. Some women may feel as if they did something to increase their risk, so Breslin tries to avoid any blame.
Losing weight often poses considerable challenges, either because of the time of life when most breast cancers occur or from weight gain related to treatments. Still, Breslin encourages weight loss following treatment, as it’s associated with a lower rate of recurrence. If a patient smokes, quitting may also improve survival.
“I guess my overall message is to keep enjoying life after a breast cancer diagnosis,” she says. “Use it as a ‘teachable’ moment to change things going forward to improve overall health.”
