Understanding Risk: The First Step in Breast Cancer Prevention

Rebecca Kaltman, MD is a board-certified hematologist oncologist. She serves as the Medical Director of the Inova Saville Cancer Screening and Prevention Center.

If there was just one thing I could say to a woman who asked me what she should do to prevent breast cancer, it would be simple: Know your risk.

Knowing your risk for breast cancer can affect the screening plan, lifestyle modifications and risk reduction strategies including medications a physician recommends for you. More importantly, it can increase the chance we detect breast cancer early, which leads to improved outcomes.

Breast cancer is the most common form of cancer in the United States, with nearly 300,000 new cases expected in 2022. The basics of breast cancer screening are relatively well-known: Annual mammograms are recommended for most women starting at age 40.

But there is significantly more one can do to understand their breast cancer risk. The main way we assess risk is through tools — many of which are available free online — that look at things like your family history, environmental exposure and hormone exposure.

The next step in risk assessment is to consider if there is any cancer risk that has been passed down through your family – your hereditary risk. We used to think of assessing hereditary breast cancer risk by asking, “Do you have any relatives who had BREAST cancer?” We now ask questions like, “What kinds of cancers run in your family?” You might have men or women in your family who have had colon cancer, pancreatic cancer or melanoma, and that can be a factor in assessing your hereditary risk.

When we examine a patient’s family history, we take a more in-depth, three-generation look at their family, looking at all types of cancer. If there is a suggestion of a hereditary link, cancer genetic counseling and testing is recommended to further clarify that risk.

Another way women can better understand their breast cancer risk is by knowing their breast density. Women with dense breasts have a higher risk of developing breast cancer for two reasons: breast density makes cancers harder to spot with a mammogram, and studies have shown that women with dense breasts are up to twice as likely to develop breast cancer as women with average-density breasts.

For that reason, 38 states and the District of Columbia have passed laws mandating that breast density information be included on a mammogram report. And there is a push to add more states to the list, as well. Why does knowing your breast density matter? If you know your breast density, you can discuss it with your health care provider because there may be additional types of breast imaging, such as ultrasound or MRI, that can provide a better image of your breasts.

What We Can Do When We Understand Risk

The reason women should know their risk is not simply to get assessed and then get afraid.

Instead, knowing your risks means your physician can implement changes in your screening plans so that we can do a better job at early detection. These changes include additional imaging, as mentioned above. There are also medications that can be prescribed that can reduce risk by half, bringing those with elevated risk closer to the risk of the general population. For those at highest risk of developing breast cancer, those with genetic mutations such as BRCA1 or BRCA2, risk reducing surgery may be discussed as an option.

It’s especially important for Black women to know their risk. While breast cancer occurs more frequently in White women, the breast cancers that develop in Black women tend to develop at younger ages and are more aggressive often leading to poorer outcomes.

One step in overcoming the disparities seen in breast cancer care is raising breast cancer awareness in the Black community. The Saville Center is committed to addressing these disparities and is working with community leaders and local health clinics to identify and overcome barriers to breast cancer screening and to help facilitate genetic testing and breast cancer risk assessment.

With the creation of Inova Saville Cancer Screening and Prevention Center, we have an incredible opportunity to expand our outreach and help educate more women about breast cancer and the importance of knowing your risk. That knowledge can be empowering and can ultimately save lives.