There are many known risk factors for breast cancer that cannot be easily modified such as increasing age, family history of breast cancer, high breast tissue density (the greater the density, the greater the risk – women with the greatest density have a 4 to 6-fold increased risk of breast cancer), the age at which women begin menstruating, and the age at which women begin menopause. Other risk factors for breast cancer that can be modified more readily include obesity after menopause, alcohol consumption, the use of certain hormone replacement therapies, and the lack of physical activity.
The recent use of oral contraceptives slightly increases the risk of breast cancer, which increased risk is returned to normal 10 years after stopping the use of oral contraceptives. The recent use of hormone replacement therapies with combined estrogen and progestin increases the risk of breast cancer but the increased risk returns to normal within 5 years after the therapy is stopped. On the bright side: breast cancer risk is reduced by breastfeeding (the longer length of time of breastfeeding, the greater the reduction in risk of breast cancer).
The most important risk factor is being a female. The second most important risk factor is aging. About 1 in 8 women in the U.S. will develop breast cancer during their lifetime (up from 1 in 11 during the 1970s, probably due in part to longer life expectancy and other factors).
Women who have a family history of breast cancer, especially with a close relative such as a mother, sister, or daughter who had breast cancer, are at a greater risk for developing breast cancer (the risk is even greater if more than one of such close relatives had breast cancer and/or if the breast cancer was diagnosed at an early age in the close relative (about 5% to 10% of breast cancers are the result of gene mutations that are inherited in certain susceptible genes designated as BRCA1 and BRCA2 – these gene mutations are present in much less than 1% of the general population). Women who have mutations in BRCA1 have an estimated 57% risk for developing breast cancer by age 70 and women who have mutations in BRCA2 have an estimated 49% risk for developing breast cancer by 70, but these mutations account for only about 50% of breast cancers that run in families). The U.S. Preventive Task Force recommends that only women with a strong family history of BRCA mutations (only about 2% of women in the U.S.) be considered for genetic testing for the mutations.
Some commonly held beliefs regarding increased risk for breast cancer that have been generally refuted as of the present time include that environmental pollutants have added to the risk of breast cancer, that women who have had breast implants are at a higher risk of breast cancer, and that women who have had an abortion are at a higher risk of developing breast cancer.
Women who were diagnosed with breast cancer before the age of 40 have an almost 3-fold increased risk of developing a subsequent cancer and a 4.5-fold increased risk of developing a subsequent breast cancer. Breast cancer is one of the most common cancers in women who had a childhood cancer. High-dose radiation therapy to the chest increases the risk of breast cancer beginning about 8 years after the radiation treatment and remains higher for more than 25 years.
The National Cancer Institute provides on its website a risk assessment tool for estimating the risk of developing breast cancer (www.cancer.gov/bcrisktool/ ).
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