How do I know if I am high-risk?
Did you know that the American College of Radiology recommends that every woman has a breast cancer risk assessment by age 25?
Many people who are at increased risk of breast cancer do not know that they have an elevated risk because there are many different factors that combine to impact risk. In fact, you may be at high risk for breast cancer even if you do not have a history of breast cancer in your family! Your doctor or other healthcare provider can help you figure out your personal estimated lifetime risk using information from your personal and family health history, or you can do this yourself by using the Tyrer-Cuzick lifetime risk calculator (https://ibis.ikonopedia.com/). While for some patients there are additional considerations beyond the factors included in the calculator, this is a useful tool to get a snapshot of breast cancer risk for most women. If you are have a personal history of breast cancer, are male, or transgendered there is additional information that is necessary to fully evaluate your breast cancer risk. Many factors contribute to cancer risk; Increasing age and being a woman are the two biggest risk factors for breast cancer, but family history, breast density, menstrual history, and lifestyle factors all play a role in breast cancer risk.
About 1 in every 8 women, or just under 13%, will be diagnosed with breast cancer during their lifetime. If your chance of breast cancer is thought to be 1 in 5 (20%) or higher you are considered to be at increased risk for breast cancer and it is recommended that you start screening for breast cancer earlier. While breast cancer screening programs are individualized, a good rule of thumb for high-risk patients is to start with a breast MRI sometime between ages 25 -30 and to start yearly mammograms at age 30. Just like screening mammograms, for high risk patients screening breast MRIs find the most cancers when they are done every year. It is recommended that high-risk patients do their yearly screening mammogram and yearly screening breast MRI 6 months apart from each other so that a doctor can evaluate the breast tissue twice a year.
All cancers result from a harmful change to a gene. Our genes are like the instruction manual for a cell telling the cell how to work and grow. While changes happen frequently to genes, they are often repaired or not harmful. However, if there is a harmful change, called a mutation, that change can result in the cell becoming cancerous. There are three ways that cancerous changes can happen: they can be sporadic, familial, or inherited.
Sporadic Cancer: The gene mutation causing the cancer happened by chance. Sometimes lifestyle or environmental factors may be the cause of a chance mutation. Most cancers, including breast cancer, happen this way.
Familial Cancer: These cancers are likely caused by a combination of genetic and environmental factors. Usually there are one or more family members with a similar diagnosis, but there is not a clear pattern of a gene mutation being passed down the generations.
Inherited Cancer: Cancer is considered hereditary when a gene mutation is passed down from parent to child. This is often seen in the setting of multiple cancer diagnoses in the same family with people being diagnosed at earlier ages.
You can be considered at increased risk for breast cancer without being at increased risk for having a hereditary or inherited cancer gene. The opposite is also true- you may be at increased risk for a gene mutation or hereditary cancer without meeting the criteria to be considered at high risk for breast cancer. Strange, but true! This is due to two factors; First, there are many different factors that go into breast cancer risk. Second, gene mutations, including those known to increase the risk of breast cancer, can be expressed in different ways. The most well known breast cancer associated gene mutations, BRCA1 and BRCA2, can result not just in breast cancer but also in ovarian cancer, prostate cancer, pancreatic cancer, and melanoma. Individuals with a breast cancer gene mutation can have up to an 87% chance of receiving a breast cancer diagnosis during their lifetime! This is why at GRACE we have a comprehensive breast cancer risk assessment program that looks at both breast cancer risk and genetic mutation risk.
If your personal factors or family history of cancer indicates you may be at higher risk for cancer, you will be offered the opportunity to speak with a Certified Genetic Counselor at the time of your mammogram appointment. A conversation with a genetic counselor includes discussion of the benefits and limitations of genetic testing, the value of risk assessment, and typically an evaluation of your personal risk. Talking to a genetic counselor does not mean you have to have genetic testing. The goal of speaking to a counselor is to gain information so that you can be empowered and supported to make the best healthcare choices for you. If you decided to pursue genetic testing, a followup appointment will be schedule to review results and recommendations based on the results.
Knowing your risk factors will help your radiologist make recommendations for the best breast cancer screening program for you. If you are at high risk you may qualify for risk-reducing medications or surgeries to decrease your chance of receiving a breast cancer diagnosis. If you are diagnosed with breast cancer, knowing if you have a genetic mutation that raises your risk may be an important consideration in guiding your treatment plan. When a gene mutation is found, others in your family may as have the mutation as well and that information could help them be proactive in their health choices as well.
While breast cancer and genetic risk assessment is complex, your care team at GRACE will be your trusted partner to navigate your individual breast cancer risk.
