How do you know if you are at high risk for breast cancer?
The average woman has a 1 in 8 chance of getting
breast cancer in her lifetime.1 That means that for every 8 women, 1 will get breast cancer
sometime during her life and 7 will not.
But those numbers don't
apply to women who have a
strong family history of breast cancer. For these
women, the chances of getting breast cancer are much higher.
your risk of getting breast cancer is high, there are some steps you can take
that may lower that risk. Some of them are very serious steps, such as having
your breasts removed. The choices you have and make will depend on how high
your risk is, as well as your health, your age, and your personal feelings.
It's important to remember that none of these choices can prevent all breast
You can't begin to decide what steps you should take to
prevent breast cancer until you know how high your personal risk is. If you
don't know whether you are at high risk, talk to your doctor. He or she will
help you find out.
If you have breast cancer in your family, your
doctor can help you figure out how much that affects your chances of getting
it. Some women have a high risk because they have what is called a family
history. That means they have a number of relatives with breast cancer.
Your risk depends on what kind of
family history you have. For example, having one relative with breast cancer
gives you a family history. But if you have two close relatives-like your
mother and your sister-with breast cancer, and one of them was diagnosed before
age 50, your family history is stronger and your risk of getting breast cancer
A few women are at very high risk because they have
gene change that makes them very likely to get breast
cancer. The only way to find this out is to have a breast cancer gene test. The
test looks for changes, or mutations, in two genes that are related to breast
and ovarian cancer. The two genes are called BRCA1 and BRCA2 (BRCA stands for
BReast CAncer). Changes in these BRCA (say "BRAH-kuh") genes are rare, but
having one greatly increases your chances of getting breast and ovarian cancer.
These women usually have a strong family history of breast cancer.
To understand the effect that a family history of breast cancer can have
on your chances of getting the disease, consider the numbers below. It’s
important to remember that everyone’s case is different, and these numbers may
not show what will happen in your case.
- Out of 100 average women, about 12 will get
- Out of 100 women with a family history of breast
cancer, between 24 and 60 will get breast cancer, depending on how strong the
family history is.2 To put it another way, having a
family history makes you 2 to 5 times more likely to get breast cancer than the
- Out of 100 women who have inherited a breast cancer
gene, between 36 and 85 will get breast cancer.3 To
put it another way, having a BRCA gene change makes you 3 to 7 times more
likely to get breast cancer than the average woman.
Should I have a gene test for breast and ovarian cancer?
Sometimes women think their risk is higher than it really
is. These women may end up having drastic surgery that they don't need. That's
why it's very important to know how high your personal risk for breast cancer
is. Talk to your doctor.
What are your choices if you're at high risk?
you know how high your risk is, you can begin to think about what steps you
want to take-if any-to prevent cancer. These are the choices:
Extra checkups and testing. Having checkups and testing more often may help find the cancer
earlier, when it's easier to treat.
Medicines. Taking certain anti-cancer drugs may help some women prevent breast
Surgery to remove both breasts. This
operation helps prevent most breast cancer.
Surgery to remove the ovaries. This operation helps prevent both ovarian and
The choices will be different depending on how high your
risk is. For example, a woman with a BRCA gene change may want to think about
having both of her breasts and her ovaries removed because she is at much
higher risk. But surgery may not be a good choice for a woman who has a family
history with no gene change. Her risk is not as high, and surgery might be too
drastic for her.
What does it mean to have extra checkups and testing?
All women should have regular checkups and tests for breast cancer. But
if you are at high risk, you may need to do this more often. This is sometimes
called "intensive surveillance" or "intensive screening." The goal is to find
breast cancer as early as possible so that it can be treated.
For high-risk women, this means:
- Going to the doctor for checkups 1 or 2 times
- Having a
mammogram every year, even if you are younger than
- Letting your doctor know if you notice anything unusual in your
Depending on your situation, your doctor may also want you to
have an annual
MRI scan. MRIs may do a better job at finding breast
cancer early, especially in women who have inherited a changed BRCA gene or
have two or more close family members who have had breast cancer before age
50.4 MRI may also be used to check the other breast
in women diagnosed with breast cancer.5
Benefits and risks of extra checkups and testing
- You may be able to find breast cancer
early, when it is more likely to be cured.
- Testing sometimes does not find breast
cancer early. Cancer that is not found early is more likely to spread to other
parts of the body. Breast cancer that has spread is much harder to
- Sometimes tests can be wrong, saying that you have a problem
when you don't. That can lead to even more testing and a lot of worry. The more
often you have testing, the more likely this is to happen.
How can medicines prevent breast cancer?
(say "tuh-MOK-suh-fin") is a medicine that blocks the effect of
estrogen on breast cancer cells and normal breast
cells. Studies show that taking tamoxifen for 5 years greatly lowers the chance
of breast cancer in women who are at high risk because of family history, age,
and other factors. But there is not enough information yet to show if this drug
helps prevent cancer in women who carry a BRCA gene change.6
Another medicine, raloxifene, has also been
shown to reduce the risk of breast cancer.7 Raloxifene
is only for use in postmenopausal women. Tamoxifen or raloxifene should not be
used by women who have or had blood clots in the legs, lungs, or eyes.
Benefits and risks of taking medicine to prevent breast cancer
- Taking tamoxifen or raloxifene lowers
the risk of breast cancer in high-risk women.
- Taking tamoxifen or raloxifene may
increase the risk of some other serious diseases, including
blood clots in veins and
in the lungs. Tamoxifen may also increase the risk of
- Tamoxifen may not work
as well in women who have a changed BRCA gene.
- Taking tamoxifen
doesn't work as well as removing the breasts.
- Tamoxifen and
raloxifene have side effects, including the increased risks of blood clotting.
How can having your breasts removed prevent breast cancer?
Having your breasts removed lowers your chances of
getting breast cancer a lot, because it removes almost all of the breast
An operation to remove a breast
is called a
mastectomy (say "mass-TEK-tuh-mee"). When both breasts
are removed, it is called a bilateral mastectomy. Bilateral means "both sides."
Some women have their breasts reconstructed during the same
operation. Breasts can also be reconstructed later.
breasts removed does not guarantee that you won't get breast cancer. This is
because no operation can remove every bit of breast tissue.9
Benefits and risks of having surgery to remove your breasts
- This surgery greatly lowers your
chances of getting breast cancer.
- Losing your breasts could make you feel
bad about your body. But many women do have their breasts
- You will not be able to
- Surgery can cause other problems, such as infection,
bleeding, or a reaction to the anesthesia.
How can having your ovaries removed prevent breast cancer?
Having your ovaries removed lowers your chances of
getting breast cancer.10, 11 The
ovaries produce a woman's eggs as well as certain
hormones, like estrogen. Estrogen seems to increase a
woman's chances of getting breast cancer. That may be why having your ovaries
removed lowers your chances.
This operation may be recommended for
women who carry changed BRCA genes. Women who carry these genes have a much
higher chance of getting cancer in the breasts and the ovaries.
The surgery to remove the ovaries is called an oophorectomy (say
When your ovaries are removed, you can
no longer have children. Also, your body's supply of those hormones will end
and you will go into early
Menopause symptoms include
hot flashes and vaginal dryness. Although many women in menopause take
hormone therapy to control these symptoms, hormone
therapy is not recommended if you are having your ovaries removed to help
Benefits and risks of having surgery to remove your ovaries
- This surgery lowers your chances of
getting breast cancer a lot.
- If you have a BRCA gene change, it
also lowers your chances of getting ovarian cancer.
- You will no longer be able to have
- You will start menopause early.
- You could
still get breast cancer.
- Your risk of getting
osteoporosis will be higher. This disease makes your
bones thin, brittle, and more likely to break.
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