Understanding Breast Cancer Risk

Everyone has some risk of developing breast cancer. For most women, the average lifetime risk is about 8–12%. However, some people have a higher risk—especially if they have certain family history patterns, dense breast tissue, or a genetic mutation.

Doctors use tools like the Tyrer-Cuzick model and the Gail model to estimate your personal risk. These models look at:

• Family history of breast cancer
  
  
• Personal health and reproductive history
  
  
• Breast density
  
  
• Hormone exposure over time
  
  

If your lifetime risk is 20–25% or higher, you are considered high risk and may benefit from additional screening and follow-up.

What Makes Someone High Risk?

You may be considered high risk if you:

• Have dense breast tissue (seen on a mammogram)
  
  
• Have a strong family history of breast or ovarian cancer
  
  
• Have had a breast biopsy showing certain high-risk cells
  
  
• Carry a known genetic mutation (like BRCA1, BRCA2, PALB2, etc.)
  
  
• Have a high risk score on the Gail or Tyrer-Cuzick model lifetime Risk of >20%
  
  

High-Risk Breast Cancer Screening Plan

If you are high risk, you will be followed closely in our office with:

• Visits every 6 months for a breast exam and review of your imaging
  
  
• Annual mammogram
  
  
• Annual MRI of the breast (in addition to the mammogram)
  
  

* Note: Breast ultrasound is not routinely used for high-risk screening if both mammogram and MRI are being done, even in women with dense breasts.

Medications to Lower Your Risk (Chemoprevention)

For women at increased risk (but without a genetic mutation), certain medications may help reduce the chance of developing breast cancer. These include:

• Tamoxifen or raloxifene (SERMs)
  
  
• Anastrozole or exemestane (aromatase inhibitors)
  
  

These options are based on your individual risk, age, and health history, and are typically recommended when your 5-year breast cancer risk is 1.7% or higher.

Genetic Testing and Inherited Breast Cancer Risk

About 5–10% of breast cancers are linked to inherited (genetic) mutations.

You may be offered genetic testing if you have:

• A personal or family history of breast, ovarian, or other related cancers
  
  
• A known family mutation (e.g., BRCA1 or BRCA2)
  
  

Genes That Increase Breast Cancer Risk Include:

• BRCA1, BRCA2, PALB2, TP53 (Li-Fraumeni), PTEN (Cowden), STK11 (Peutz-Jeghers), CDH1
  
  
• Other moderate-risk genes: ATM, CHEK2, NBN, NF1 and others
  
  

What Happens if You Have a Gene Mutation?

If you're found to have a pathogenic mutation, we will:

• Offer enhanced screening (e.g., annual mammogram + MRI)
  
  
• Discuss options like risk-reducing mastectomy +/- reconstruction and/or removal of ovaries
  
  
• Offer counseling for your family members, who may also be at risk
  
  

Surgical Options for Risk Reduction

• Risk-reducing mastectomy may be considered for those with BRCA1, BRCA2, PTEN, or TP53 mutations, especially if there is a strong family history.
  
  
• Preventive removal of ovaries and fallopian tubes (salpingo-oophorectomy) is recommended for BRCA1/2 carriers:
  
  
  
  • BRCA1: Consider between ages 35–40
    
    
  • BRCA2: Consider between ages 40–45
    
    
  • This surgery may also reduce breast cancer risk in premenopausal women.
    
    

Key Takeaways

• Dense breasts, family history, and genetics all play a role in your personal risk.
  
  
• If you're at high risk, you'll need closer monitoring, often with both MRI and mammogram every year.
  
  
• Genetic testing can guide screening and prevention strategies—and help your family too.
  
  
• Not every gene mutation means surgery is needed. Each case is individualized based on your full risk profile.
  
  

Lifestyle Still Matters

You can also reduce your breast cancer risk by:

• Eating a balanced, healthy diet
  
  
• Staying physically active
  
  
• Maintaining a healthy weight
  
  
• Limiting alcohol and avoiding tobacco
  
  

Make an appointment with Dr. Coste to further determine your risk of breast cancer if you have a family history of breast cancer or would like to perform genetic testing.

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