Are You at High-Risk for Breast Cancer?

Cassann Blake, MD – Cleveland Clinic Florida Breast Surgeon

October 11, 2017

You, or someone you know, may have already been touched by breast cancer. Risk factors include age, personal/family history, genetics, smoking, poor diet, lack of exercise, among others. Some of these risk factors are innate, but others can be controlled. Knowing your risk factors can decrease the likelihood of developing the disease, or help detect it in the earliest stages when it’s most curable.

"About 10 to 15 percent of all breast cancers are linked to a genetic predisposition that has been inherited, and, BRCA gene mutations are the most common cause," says Cassann Blake, MD, Cleveland Clinic Florida breast surgeon. Women who test positive for an abnormal BRCA gene have a much higher risk of developing breast cancer over the course of their lifetime. The average lifetime risk is about 12%, but women with the gene mutation have an increased risk of up to 80%.

If you are at high risk there are steps you can take. While you may not be able to control the risk factors you’ve inherited, you can manage the ones that are modifiable. It’s also very important to follow recommended screening guidelines. Mammography is an essential screening tool, and often your first line of defense. In addition to a standard mammogram, 3-D mammogram, breast MRI and ultrasound are other common diagnostic tools used when necessary.

According to the American Cancer Society, women should talk to their physician about breast cancer screening starting at age 40. From age 40-44 they should have the option to begin annual screening, and by age 45 they should be getting yearly mammograms. Women at higher than average risk may need to start screening earlier. You should discuss your own personal risk factors with your doctor to determine what is best for you.

There are other alternatives for women at high risk, including those who previously had breast cancer and want to decrease the chance of reoccurrence, or those who have the BRCA gene mutation. A preventive or “prophylactic” mastectomy involves the removal of one or both breasts, and has been found to reduce the risk of breast cancer in high-risk women by about 90%. But it’s important to note that approximately 10% of women who have undergone a preventive mastectomy will still develop breast cancer. The choice is very personal and should be based on your individual circumstances. Careful consideration, consulting with your breast cancer team and even seeking a second opinion, is highly recommended before making a decision.

Several innovative surgical options are now available for those women who do elect to have a prophylactic mastectomy. “New advances allow us to remove breast tissue using skin or nipple-sparing techniques,” says Dr. Blake. Sparing the skin or nipple allows for better results in the reconstruction stage of surgery, through improved shape of the reconstructed breast. And, when combined with immediate breast reconstruction, the results are greatly improved.

"Our breast cancer team includes fellowship trained breast surgeons, plastic surgeons, radiologists, genetic counselors, oncologists, a breast navigator, and other support staff. Patients benefit from the comprehensive care that our team provides," says Dr. Blake. Cleveland Clinic Florida’s breast cancer specialists collaborate to develop a personalized treatment plan. This multidisciplinary approach increases the chance for a successful outcome, and the best possible quality of life.

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