Women with close relatives who have been diagnosed with breast cancer have a higher risk of developing the disease. If you’ve had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5 times higher than average. If your brother or father have been diagnosed with breast cancer, your risk is higher.
In some cases, a strong family history of breast cancer is linked to having an abnormal gene associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 gene. In other cases, an abnormal CHEK2 gene may play a role in developing breast cancer.
To find out more about your risk of developing breast cancer, depending on your family history and other associated risk factor, consultation with genetic counselors is recommended. Here at Hunterdon, our Family Risk Assessment Program offers consultation and genetic testing, to determine risk.
There are lifestyle choices you can make to keep your risk of developing breast cancer as low as it can be:
- Maintaining a healthy weight
- Exercising regularly
- Limiting alcohol
- Eating nutritious foods
- Never smoking (or quitting if you already smoke)
Along with these lifestyle choices, there are other risk-reduction options for women with a strong family history of breast cancer.
Hormonal Therapy Medicines
Four hormonal therapy medicines have been shown to reduce the risk of developing hormone-receptor-positive breast cancer in women at high risk. The SERMs (selective estrogen receptor modulators) Tamoxifen and Evista (chemical name: raloxifene) and the aromatase inhibitors Aromasin (chemical name: exemestane) and Arimidex (chemical name: anastrozole) are the four medicines used in this way.
- Tamoxifen has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in both postmenopausal and pre-menopausal women at high risk. Certain medicines may interfere with Tamoxifen’s protective effects. Visit the Tamoxifen page to learn more.
- Evista has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in postmenopausal women. Visit the Evista page to learn more.
- Aromasin has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in postmenopausal women at high risk. Aromasin isn’t approved by the FDA for this use, but doctors may consider it a good alternative to Tamoxifen or Evista. In 2013, the American Society of Clinical Oncology (ASCO) released new guidelines on using hormonal therapy medicines to reduce breast cancer risk in high-risk women. These guidelines recommend that doctors talk to high-risk postmenopausal women about using Aromasin to reduce risk. ASCO is a national organization of oncologists and other cancer care providers. ASCO guidelines give doctors recommendations for treatments that are supported by much credible research and experience. Visit the Aromasin page for more information.
- Arimidex has been shown to reduce the risk of first-time, hormone-receptor-positive breast cancer in postmenopausal women at high risk. Like Aromasin, Arimidex isn’t approved by the FDA for this use, but doctors may consider it a good alternative to Tamoxifen, Evista, or Aromasin. Visit the Arimidex page for more information.
Together, you and your doctor can decide if medicine to lower your risk is a good option for you.
More Frequent Screening
If you are at high risk because of a strong family history of breast cancer, you and your doctor will develop a screening plan tailored to your unique situation. Recommended screening guidelines include:
- A monthly self-breast examination
- A yearly/biannual breast examination by a healthcare professional
- A mammogram every year starting at 40 years old (or younger if family history of breast cancer at a young age)
- Breast MRI (magnetic resonance imaging) on an annual basis
Removing one or both healthy breasts and ovaries — called prophylactic surgery (“prophylactic” means “protective”) — are very aggressive, irreversible risk-reduction options that some women choose. Prophylactic breast surgery may be able to reduce a woman’s risk of developing breast cancer by as much as 97%. The surgery removes nearly all of the breast tissue, so there are very few breast cells left behind that could develop into cancer.
Women with an abnormal BRCA1 or BRCA2 gene may reduce their risk of breast cancer by about 50% by having prophylactic ovary removal (oophorectomy) before menopause. Removing the ovaries lowers the risk of breast cancer because the ovaries are the main source of estrogen in a pre-menopausal woman’s body. Removing the ovaries doesn’t reduce the risk of breast cancer in postmenopausal women because fat and muscle tissue are the main producers of estrogen in these women. Prophylactic removal of both ovaries and fallopian tubes reduces the risk of ovarian cancer in women at any age, before or after menopause.
Of course, each woman’s situation is unique. Talk to your doctor about your personal level of risk and how best to manage it. It is important to remember that no procedure — not even removing both healthy breasts and ovaries at a young age — totally eliminates the risk of cancer. There is still a small risk that cancer can develop in the areas where the breasts used to be. Close follow-up is necessary, even after prophylactic surgery.
Prophylactic surgery decisions require a great deal of thought, patience, and discussion with your doctors, genetic counselor, and family over time — together with a tremendous amount of courage. Take the time you need to consider these options and make decisions that feel comfortable to you.