Breast Cancer Awareness Month: what women should know about their risk

• Identifying personal risk factors empowers women to protect their health and ensure the most appropriate screening plan, says a Cleveland Clinic specialist.

A significant risk factor for many types of cancer, including breast cancer, is obesity. In general, women are advised to follow general guidelines for good health, which include exercising regularly and following a healthy eating plan.

Cleveland, 18 October 2023: It is important for women to familiarise themselves with breast cancer risk factors so they can ask their doctor about appropriate screening methods and frequency, and know whether they or their relatives could benefit from genetic counselling or risk-reducing medication, says an expert from the global health system Cleveland Clinic.

“Breast cancer screening guidelines have changed over the years, and advice also varies between different healthcare bodies. If women know their risk factors, they can make sure they are screened appropriately and also take simple steps to reduce their risk wherever possible,” says Holly J. Pederson, director of Medical Breast Services at Cleveland Clinic’s Breast Center.

Dr. Pederson notes that even if a woman feels “lumpy” on a physical exam, she may not have mammographic density. Only by having a mammogram will a woman know the density of her breasts. She recommends that average-risk women have a baseline mammogram, preferably before age 40, and discuss their density and other medical risk factors.

“High breast density can obscure mammographic findings, and extreme density is also an independent risk factor for breast cancer. Increased breast density, together with other factors that raise risk, may lead to a recommendation for annual screening breast MRI or consideration of risk-reducing medication,” she adds.

All women (whether high or low risk) should have an annual mammogram, says Dr. Pederson. “Annual screening is important for everyone, as science cannot yet identify low-risk people who could be less vigilant. What’s more, around 75% of breast cancers diagnosed occur in women with no identifiable risk factors.”

She adds: “Screening mammography saves lives, and only mammograms can detect microcalcifications, which can be the earliest sign that breast cancer is developing. It should be noted that women should not worry about radiation from regular mammograms, as the exposure is negligible.”

For patients who have dense breast tissue or have been identified as being at higher risk of breast cancer, supplementary screening options are available, although not all are usually covered by health insurance. The doctor gives the example of FAST MRI, a shorter version of a standard breast MRI, which is an option for women with dense breasts who want early detection despite the possibility of some false positive results.

Explaining the effectiveness of supplementary screening options, Pederson says research estimates that for every 1,000 women who have a conventional 2D mammogram, around 5 breast cancers will be detected. The supplementary yield per 1,000 women screened is estimated at 1.2 to 3 additional breast cancers with 3D mammograms, 15.1 to 27.4 additional breast cancers with FAST MRI, and 13.1 to 15.5 additional breast cancers with contrast-enhanced mammography. A 2023 study of whole-breast ultrasound reported finding only 1.1 additional breast cancers per 1,000 women screened.

In addition to breast density, there are many other non-modifiable risk factors for breast cancer. These include women’s medical history, for example having had mantle radiation for Hodgkin lymphoma as a child or a previous cancer diagnosis, as well as their family medical history. She therefore advises women to talk to their doctor to see whether there are any red flags indicating that they should be referred for genetic testing. She notes that these red flags are not limited to breast cancer but could also include other cancers, such as ovarian, pancreatic, metastatic prostate or diffuse gastric cancer, and that ancestry is important in assessing risk.

“Genetic testing can inform the best treatments for newly diagnosed cancer patients, and can also identify people who may benefit from annual full-sequence MRI, risk-reducing medication and even risk-reducing surgery for those at the highest levels of risk,” says the specialist.

There are also several modifiable risk factors that women can address to reduce their risk of developing breast cancer, adds Dr. Pederson. “A significant risk factor for many types of cancer, including breast cancer, is obesity, so it is important to try to maintain a healthy weight. Alcohol has also been associated with a higher risk of breast cancer. In general, we recommend that women follow general guidelines for good health, which include exercising regularly and following a healthy eating plan such as the Mediterranean diet,” she says.

“Breast Cancer Awareness Month is an ideal opportunity to remind women to be aware of risk factors and, where possible, mitigate them, but also to encourage appropriate screening, as we want to detect breast cancer at its earliest and therefore most treatable stage,” she concludes.

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About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical centre that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based on the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States.  

U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 72,500 employees worldwide are more than 5,050 salaried physicians and researchers, and 17,800 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties.  Cleveland Clinic is a 6,500-bed health system that includes a 173-acre main campus near downtown Cleveland, 21 hospitals, more than 220 outpatient facilities, and locations in northeast Ohio; southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England.

In 2021, there were 10.2 million outpatient visits, 304,000 hospital admissions and observations, and 259,000 surgeries across Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries.  

Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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