How Women Can Lower Their Risk for Breast Cancer

Certain risk factors, such as age or gender, can’t be changed, but healthy habits can help.

Women wearing pink ribbons for breast cancer awareness

Medically reviewed in September 2021

After lung cancer, breast cancer remains the second leading cause of cancer death in women in the United States. Over 260,000 women are expected to face a new diagnosis of invasive breast cancer in 2018 and an estimated 40,920 will die from this disease, according to the American Cancer Society.

Experts say that there is often no sure way exists to prevent all breast cancers, as certain risk factors, such as advancing age and gender, are beyond a woman’s control. But there are certain steps women can take to reduce their risk of a breast cancer diagnosis. Dr. Tara M. Breslin, a surgical oncologist, director of the comprehensive breast cancer program at St. Joseph’s Mercy Health System, Ann Arbor, Michigan, takes us through 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 woman can take to reduce her individual risk. Among them are:

  • Maintaining a healthy weight.
  • Staying physically active.
  • Refraining from 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 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. Nearly 90 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 12.4%, or roughly a one-in-eight chance during their lifetime. Screening mammography may pick up signs of a cancerous mass before symptoms occur. According to the U.S. Preventive Services Task Force (USPSTF), women of average risk for breast cancer should make an informed decision with their doctor about when to start screenings between 40-49 years of age. Your doctor can also help you decide whether to continue screening annually or every other year.

The American Cancer Society (ACS) recommendations differ from the USPSTF, suggesting women ages 40 to 44 should consult their doctor about starting annual breast cancer screening with mammograms. Women age 45 to 54 should get mammograms every year, switching to every other year at age 55.

In her own practice, Breslin says she follows the guidelines of the American College of Radiology (ACR), which recommends most women begin screening at age 40. In some cases, though, if a woman’s risk is average or lower. “It’s not unreasonable to go for mammography screening every other year,” she notes.

Steps to take if you’re at a higher risk
Guidelines are uniformly more rigorous for high-risk women, though varied. The ACR urges women at higher-than-average risk to begin screening as young as age 30; undergo clinical exams every six months after age 45; and annual mammography screening with magnetic resonance imaging, or MRIs.

Women 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 40-80 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 high risk women. But a woman’s decision to remove her breasts in a mastectomy depends on patient preference,. Breslin says. While 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 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. Doctors 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 doctor can help you develop an individualized schedule for screenings, as well as help you to work which prevention techniques may be right 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. Many of these women feel guilty enough, believing they did something to increase their risk, so she 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.”

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