Table 1. Risk of Breast Cancer Diagnosisa continued...
The cumulative lifetime incidence decreases with advancing age because the longer a woman lives without a breast cancer diagnosis, the lower her lifetime risk compared to a younger woman who might develop breast cancer at a younger or older age. The commonly quoted risk of one in eight women who will be diagnosed with breast cancer is based on lifetime risk of a diagnosis (not death) starting from birth and does not account for the woman's current age.
Breast cancer mortality increases with age. For a 40-year-old woman without a breast cancer diagnosis, the chance of dying from breast cancer within the next 10 years is extremely small, but for a woman older than 65, it is about 1%. For a woman older than 70, the risk of dying of breast cancer is even higher, but the risk of dying of any cause is higher yet.
Personal history of breast cancer
Women with a personal history of invasive breast cancer, DCIS, or lobular carcinomain situ also have an increased risk of being diagnosed with a new primary breast cancer. Recommendations for subsequent mammograms vary, but evidence for various strategies is scant.
Prior radiation therapy
Women treated with thoracic radiation before the age of 30 years have a 1% annual risk of breast cancer, starting 8 years after the irradiation and for the rest of their lives.[7,8] Annual screening with magnetic resonance imaging has been proposed in such women, beginning 8 years after treatment or by age 25 years, whichever is later. Because this population is small, there are no studies to confirm the benefit of this recommendation.
Dense breast tissue
Women with radiologically dense breasts (heterogeneously dense or extremely dense in the terminology of the Breast Imaging Reporting and Data System [BI-RADS]) [10,11,12,13] have a threefold to sixfold increased risk of breast cancer compared with women who have fatty breasts.
Other risk factors and risk prediction models
Other risk factors for breast cancer include an inherited predisposition (BRCA1 or BRCA2, and others); early age at menarche and late age at first birth; and previous breast biopsies showing benign proliferative breast disease.[15,16,17] Menopausal hormone use, obesity, lack of physical activity, and alcohol intake are associated with an increased risk of breast cancer. (Refer to the PDQ summaries on Cancer Prevention Overview and Breast Cancer Prevention for more information.) Several models estimate an individual woman's risk based on these and other factors.[18,19,20,21]
- American Cancer Society.: Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society, 2013. Available online. Last accessed March 13, 2013.
- Altekruse SF, Kosary CL, Krapcho M, et al.: SEER Cancer Statistics Review, 1975-2007. Bethesda, Md: National Cancer Institute, 2010. Also available online. Last accessed January 10, 2013.
- Johnson A, Shekhdar J: Breast cancer incidence: what do the figures mean? J Eval Clin Pract 11 (1): 27-31, 2005.
- Haas JS, Kaplan CP, Gerstenberger EP, et al.: Changes in the use of postmenopausal hormone therapy after the publication of clinical trial results. Ann Intern Med 140 (3): 184-8, 2004.
- Kerlikowske K, Salzmann P, Phillips KA, et al.: Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness. JAMA 282 (22): 2156-63, 1999.
- Houssami N, Abraham LA, Miglioretti DL, et al.: Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA 305 (8): 790-9, 2011.
- Goss PE, Sierra S: Current perspectives on radiation-induced breast cancer. J Clin Oncol 16 (1): 338-47, 1998.
- Henderson TO, Amsterdam A, Bhatia S, et al.: Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer. Ann Intern Med 152 (7): 444-55; W144-54, 2010.
- Saslow D, Boetes C, Burke W, et al.: American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57 (2): 75-89, 2007 Mar-Apr.
- ACR BI-RADS Breast Imaging and Reporting Data System: Breast Imaging Atlas. Vol. 1: Mammography. 4th ed. Reston, Va: American College of Radiology, 2003. Also available online. Last accessed January 10, 2013.
- Ma L, Fishell E, Wright B, et al.: Case-control study of factors associated with failure to detect breast cancer by mammography. J Natl Cancer Inst 84 (10): 781-5, 1992.
- Goodwin PJ, Boyd NF: Mammographic parenchymal pattern and breast cancer risk: a critical appraisal of the evidence. Am J Epidemiol 127 (6): 1097-108, 1988.
- Fajardo LL, Hillman BJ, Frey C: Correlation between breast parenchymal patterns and mammographers' certainty of diagnosis. Invest Radiol 23 (7): 505-8, 1988.
- Harvey JA, Bovbjerg VE: Quantitative assessment of mammographic breast density: relationship with breast cancer risk. Radiology 230 (1): 29-41, 2004.
- London SJ, Connolly JL, Schnitt SJ, et al.: A prospective study of benign breast disease and the risk of breast cancer. JAMA 267 (7): 941-4, 1992.
- McDivitt RW, Stevens JA, Lee NC, et al.: Histologic types of benign breast disease and the risk for breast cancer. The Cancer and Steroid Hormone Study Group. Cancer 69 (6): 1408-14, 1992.
- Jacobs TW, Byrne C, Colditz G, et al.: Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med 340 (6): 430-6, 1999.
- Gail MH, Brinton LA, Byar DP, et al.: Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81 (24): 1879-86, 1989.
- Bondy ML, Lustbader ED, Halabi S, et al.: Validation of a breast cancer risk assessment model in women with a positive family history. J Natl Cancer Inst 86 (8): 620-5, 1994.
- Spiegelman D, Colditz GA, Hunter D, et al.: Validation of the Gail et al. model for predicting individual breast cancer risk. J Natl Cancer Inst 86 (8): 600-7, 1994.
- Amir E, Freedman OC, Seruga B, et al.: Assessing women at high risk of breast cancer: a review of risk assessment models. J Natl Cancer Inst 102 (10): 680-91, 2010.