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Risk Assessment and Patient Counseling

What is a risk factor? A risk factor is a variable that is associated with an increased risk of disease (RR = Relative Risk). Established risk factors for breast cancer include:

  • Female gender: this is the most common risk factor; 99% of breast cancers occur in women
  • Increasing age: a nearly linear increase in incidence exists between age 40-80 years
  • Genetics: 5-10% of breast cancers are hereditary
    • Gene mutations such as BRCA 1 and 2 are most common
    • Rare genetic syndromes also increase risk such as Cowden’s, Li Fraumeni etc
  • Previous chest wall radiation between age 10-30 years (RR=5.2x)
  • Lobular carcinoma in situ (RR=16x)
  • Personal history of invasive breast cancer: (RR=6.8x)
  • Proliferative lesions with atypia (RR=5.3x)
  • 1st degree relative with breast cancer (mother, sister or daughter)
  • (RR=3.3 premenopausal/1.8 post menopausal)
  • Breast Density: Heterogeneously dense (RR=1.2x) or Extremely dense (RR=2.1x)
  • Race: Caucasians are slightly more likely to develop breast cancer than African-American women, but African-American women are more likely to die of breast cancer
  • Benign proliferative lesions (RR=1.9)
  • Early menarche (before age 12) or late menopause (after age 55) – longer lifetime exposure to hormones (RR=1.3x)
  • Lifestyle-related risk factors include: Combined hormone replacement therapy, >1 alcoholic drink/day, overweight or obese, physical inactivity (RR~1.2x)

All patients being screened for breast cancer should be aware of their own personal risks for the disease. This is especially important in women with dense breasts, since an increased overall risk factor may inform the decision making to proceed with supplemental screening. Singletary SE. Rating the risk factors for breast cancer, Annals of Surgery 2003 Vol. 237, No. 4, 474–482

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