High-Risk Evaluation and Treatment

What Puts You at High Risk for Breast Cancer?

While the cause of breast cancer is still unknown it is known that some factors can increase your risk of developing the disease. While some of these factors may be out of your control, others can be altered by making simple lifestyle choices. Known breast cancer risk factors include the following.

Being Female: Being a woman or a person assigned female at birth is the most significant risk factor for developing breast cancer. A woman’s average risk of breast cancer is 8-12% for the entire lifetime.

Age: Your risk of breast cancer increases as you age. About 2 out of every 3 invasive breast cancers are found in women 55 years or older. Breast cancer can occur in females of any age.

Family History: Those with close relatives who have been diagnosed with breast cancer have a higher risk of developing the disease. Mother, sister, daughter/ Father, brother, son are first-degree relatives.

Personal History: If you have been diagnosed with breast cancer, you may be more likely to develop a new cancer. This risk is about 0.25%/year following the diagnosis. Over the 10 years following diagnosis, this adds up to about 2.5%.

Genetics: It has been found that 5-10% of breast cancers are believed to be hereditary and linked to a specific gene. This means the person has inherited a change in a gene that causes cancer. Individuals with the BRCA 1 or BRCA 2 genes and other genes will be at higher risk.

Race/Ethnicity: Caucasian women have a slightly her risk of developing breast cancer compared to Hispanic, Black, and Asian women. However, Black women have a higher risk of developing more aggressive and advanced-stage breast cancer at a younger age.

Radiation: If you have had radiation to your chest or face to address another cancer before the age of 30, you have a higher risk of developing breast cancer.

Breast Changes: You may have a higher risk of breast cancer if you have been diagnosed with certain benign breast conditions like atypia.

Being Overweight: Women who are overweight or obese have a higher risk of breast cancer, especially after menopause. This translates to a 20-60% increase in risk of breast cancer.

Menstrual History: If you had your first period before you turned 12, you may have a higher risk of breast cancer later in life. Having a baby at an age >35 or not having children at all also contributes to increased risk. A later menopause also increases the risk.

Lifestyle: Drinking alcoholic beverages, lack of exercise, and smoking are all linked to a higher risk of breast cancer. Overall, choosing the healthiest lifestyle options available can empower you to ensure that your personal breast cancer risk is as low as possible.

Environmental Exposures: Certain environmental exposures may increase your risk of breast cancer. These may include chemical exposure to agents such as benzenes, pesticides, formaldehyde, nuclear plant work, and well water contaminated with chemicals.

Treatment Option for High-Risk Individuals

Antihormonal therapy (Chemoprevention)

Medications such as Tamoxifen and aromatase inhibitors like Letrozole (Femara) have been shown in long-term clinical research to reduce the risk of breast cancer. This type of therapy is traditionally called chemoprevention but does not involve chemoprevention. It can be called anti-hormonal therapy because both types of medication change the way estrogen is used or created in the body. They must be taken for 5 years for the full effect of a 45-60% reduction in lifetime risk for breast cancer. The benefit is thought to last for 20 years after stopping the medication. More recent studies show that lower doses of Tamoxifen in some patients may be equally effective with fewer side effects and complications.

Prophylactic or Risk Reducing Surgery

Risk Reducing mastectomy is very effective at minimizing the risk of breast cancer. It reduces the risk by about 95% for the remainder of the patient’s life. The risk for breast cancer will never be zero, it can still occur in the skin, lymph nodes, or elsewhere in the body even after extensive surgery.

While patients of low to moderate risk may choose this approach, it is only recommended for patients with high-risk gene mutations such as BRCA 1,2, TP53, and a few other mutations. In this highest-risk category, there is an improvement in survival for patients who choose mastectomy. For low to medium-risk patients, the benefits are less clear. At Tucson Breast Health Specialists, we will carefully review the risks and benefits of such a procedure with you.

Contralateral Prophylactic Mastectomy

This procedure is performed to remove the healthy breast (the other side or contralateral) in a woman who currently has or has had breast cancer in one breast. It may be recommended if you have a high-risk gene mutation such as BRCA or have a high risk of developing breast cancer from other factors. It is not routinely recommended for patients who do not have a genetic mutation or other very strong risk factors as the benefits are usually similar to the risks of surgery.

Bilateral Prophylactic Mastectomy

This procedure involves removing both breasts in women who do not currently have breast cancer to lower their chances of getting breast cancer. This can be done with skin-sparing or nipple-sparing techniques. Patients may also choose non-skin-sparing mastectomy or flat aesthetic closure.

Prophylactic Oophorectomy

Individuals with the BRCA1 or BRCA2 gene mutations have a higher risk of developing breast cancer and ovarian cancer. Many doctors recommend that these women have surgery to remove their ovaries -called bilateral salpingectomy and oophorectomy (BSO) once they are finished growing their families. The exact timing depends on both the patient’s and their relatives’ history. This procedure greatly reduces the risk of ovarian cancer; however, it will cause a pre-menopausal female to go into menopause. It is important to discuss your options with your healthcare team regarding this type of surgery.

Contact Us Today

If you are concerned regarding your breast cancer risk, do not hesitate to reach out to Tucson Breast Health Specialists in Tucson, AZ today. We will be happy to thoroughly discuss all of your options with you.

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“The level of care is excellent.”

Dr. Ley is an excellent doctor who cares about her patients. She takes the time to explain everything and provides all options. The level of care is excellent.

Dr. Ley helped me through the first round of BC in 2017 with kindness, compassion and expertise! I had absolutely no reservations when trusting her for a 2021 and now for the 3rd time I can’t imagine going through this without her. She is a lion when it comes to fighting for you, calls you personally even though she has to be the busiest Dr. and mother I know. She’s considerate of your needs, fears and concerns and never lets you go it alone. Can’t say enough good!

When diagnosed with Breast Cancer my daughter, which is a surgical nurse, started searching for a breast surgeon for me. Within a short period of time, she called stating “Mom, Dr Ley is the surgeon for you”! I have not been disappointed & have had nothing but positive experiences with Dr. Ley & her staff. They truly care.

I have no words to express my gratitude for Dr. Ley! I was diagnosed Feb. 2020 and Dr. Ley besides being the best in her field and doing an amazing job on my double mastectomy she was even able to save my nipples. She is also a remarkable human being, patient, kind very clear in explaining everything and making you feel heard and safe in her hands. I 100% recommend her and her very helpful, kind and amazing team! If you have recently been diagnosed this is the team you want to have your back!

Dr. Ley is extremely good at explaining your breast cancer, treatment options, and everything she is going to do. She is a masterful surgeon and uses plastic techniques to close incisions, leaving minimal scarring. In addition, she is warm, pleasant, and a lovely person. I am so happy that I found her based on a friend’s recommendation. I can’t say enough about her and the practice’s excellent care.