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Mammogram Guidelines ~
Self Exam ~ Clinical Breast Exam
General Prevention ~
Risk Assessment
While there are well-established risk factors that affect the development of breast cancer, there exists no consensus as to what causes the disease. The major risk factor is increasing age. Another major risk factor is family history. If a woman has a mother or a sister who has had breast cancer, especially if that family member had early breast cancer in each of her breasts, the woman’s risk increases dramatically.
In assessing the possibility of the presence of an abnormal breast cancer gene, a family history of either breast cancer or ovarian cancer in either the mother’s or father’s side is important. Ethnic heritage is important as well as women of Ashkenazi Jewish descent may carry specific genetic abnormalities that could increase their risk.
Specific pathologic findings in a breast biopsy may also be associated with an increased risk of developing breast cancer. Such abnormalities include atypical cells in the ducts or lobules of the breast or a finding called lobular carcinoma in situ (LCIS). While LCIS contains the word carcinoma in its name, it is not cancer. The presence of this pathologic finding is associated with a 1 ½ % per year increased risk of developing breast cancer.
Other factors that are important in determining a woman’s risk include reproductive factors, such as age at first menstrual period (older than 12 is better), and age at first full term pregnancy (younger than 30 is better than older than 30 or never having had children). A person’s race may also affect her risk.
The best way to determine a person’s risk for developing breast cancer is to complete a formal risk assessment. There are several models used to determine the risk of developing breast cancer. One model is the Gail Model. This is a method used to determine a woman’s estimated lifetime risk of developing breast cancer and can be found on the web site for the National Cancer Institute or your physician may use this model to calculate your risk.
Information from a risk assessment will help to determine if that risk is great enough to warrant an intervention to attempt to lower that risk. Interventions include: (1) close observation with monthly breast self exam, annual mammography, and twice yearly examinations by a physician; (2) the use of annual Tamoxifen, for five years; (3) participation in the STAR trial which is comparing Tamoxifen to Raloxifene in post-menopausal women; or (4) prophylactic bilateral mastectomy.