High-risk breast cancer assessment: know your risk level

Being female (or assigned female at birth, also known as AFAB) is among the many risk factors for developing breast cancer. That means every woman has some level of risk — including you.

Understanding your breast cancer risk level gives you the power to take control and possibly fend off breast cancer — or catch it in the early stages when treatment is most effective.

Lisa Bash, MD, a breast radiologist with Atlantic Health System and medical director of the Breast Center at Chilton Medical Center, explains what Atlantic Health is doing to help you identify your level of risk for breast cancer and what services are available if you’re considered high-risk.

Breast cancer screenings and mammograms

Mammograms (an X-ray of the breasts) are the gold standard for breast cancer screening. Doctors at Atlantic Health who specialize in breast health recommend all women of average risk begin getting annual mammograms at age 40.

“Women with a personal or family history of breast cancer — especially a family history that includes a close relative who was diagnosed before menopause — should talk to their doctors at age 30 to determine if earlier screenings are recommended,” explains Dr. Bash. “High-risk patients may need more or earlier screenings.”

Breast cancer risk factors

Many factors determine your level of risk — some within your control and others outside it. Knowing your breast cancer risk level is the first step in managing your breast health.

Uncontrollable factors that increase your risk include:

• Being female or AFAB
• Over age 55
• Genetics, such as carrying the BRCA1 and BRCA2 gene variant
• Family history
• Previous breast cancer diagnosis
• Race and ethnicity (Caucasian women are diagnosed more often, but African American women have more aggressive forms of the disease)
• Dense breasts
• First period before age 12
• Menopause after age 55
• Benign, atypical cells
• Previous chest radiation

Some lifestyle choices may also influence your breast cancer risk, especially:

• Smoking
• Alcohol consumption
• Obesity
• Inactivity and living a sedentary lifestyle
• Using hormone replacement therapy for menopause management

Dr. Bash points out that not all risk factors carry the same weight. “Some have more impact than others and a combination of factors can also increase your risk level,” she says.

Atlantic Health’s high-risk breast cancer assessment

So how do you determine your level of risk for breast cancer?

At Atlantic Health breast centers, all patients are given a high-risk breast cancer assessment before their mammogram. Using an iPad, patients answer questions about their background, personal and family health history and certain lifestyle factors. Those answers are put into the computerized Tyrer Cuzick Model that calculates a woman’s estimated lifetime risk of developing breast cancer.

A lifetime risk of greater than 20% is considered high-risk.

Your lifetime risk and information about your breast density is added to the imaging report that is sent to your doctor to provide a complete picture about your breast health. A letter with this information is also sent to you.

I’m high-risk. Now what?

If you’ve been identified as high-risk, you may need supplemental screening such as a breast ultrasound or breast MRI.

“We strongly encourage all high-risk patients to enroll in our comprehensive High-Risk Breast Cancer Surveillance Program,” Dr. Bash says. “Once you’ve been identified as high-risk, a program coordinator will reach out by phone to answer questions and help set up your first appointment with our clinic.”

High-risk breast cancer surveillance program

The Atlantic Health high-risk breast cancer surveillance program is a comprehensive, long-term active monitoring program. You’ll receive a full breast exam and advanced testing every six to twelve months. You’ll also have access to multidisciplinary preventive care, including:

• Genetic testing and counseling
• Nutrition support
• Medical oncology assistance (for risk reduction medication)
• Surgical consultations
• Social work and mental health support
• Smoking cessation programs
• Screenings for other cancers

The high-risk breast cancer surveillance program is also a great resource for finding answers to all your questions.

“Knowledge is power,” says Dr. Bash. “Knowing your breast cancer risk level empowers you to take control of your breast health — and we’re here to help.”