High Risk for Breast Cancer

When it is functioning normally, BRCA is a gene that makes proteins to help repair damage to DNA and stop tumor growth. Mutations in BRCA1 and BRCA2 gene are inherited in families and can lead to an increased risk of certain cancers, including breast, ovarian, prostate, and pancreatic cancer, among others.

The gene can be inherited from either a person’s mother or their father. There are certain “red flags” in families that might make us worry about a BRCA mutation, including history of multiple different cancers, male breast cancer, ovarian cancer, or cancers diagnosed at a young age.

If indicated, testing for a BRCA mutation typically consists of a blood test. Results can be very important in determining the most appropriate cancer screening and methods to reduce cancer risk.

Yes. The more we learn, the more we discover that there are many other mutations that increase the risk for breast cancer. These include genes like PALB2, CHEK2, P53, and others. The risk from each of these mutations is variable.

A physician or genetic counselor can use information about your family history to determine whether testing for these other mutations would be indicated.

The majority of breast cancers have no symptoms and are detected during screening with mammogram or other breast imaging studies.

However, some warning signs include:

• A new lump in the breast or in the armpit
• Dimpling or thickening of the breast skin
• New redness on the skin
• New pulling in of the nipple
• Nipple discharge
• Change in shape or contour of the breast
• New and persistent breast pain.

If you have any symptoms that might worry you, please contact your doctor.

There are many different ways to image the breast, including 2D or 3D mammogram, breast ultrasound, and breast MRI. The “best” way to image the breast depends on your individual breasts and your risk factors for breast cancer.

For most women, a mammogram once a year is the best way to screen for breast cancer. For some women with dense breast tissue, a 3D mammogram or ultrasound may enhance screening. Many factors may indicate that a women is at an increased risk of developing breast cancer.

Some of these factors include having undergone previous breast biopsies, family history of cancer, or having a known genetic mutation. For these women identified as “high risk”, additional imaging with a breast MRI may be the best option.

Don’t be afraid to ask your doctor or breast radiologist about these choices and what’s best for you if you have any questions. In the breast cancer prevention program, we discuss each of these options to come up with the right plan for each individual.

It’s also important to remember that recommendations may vary over time as new technology is available and more information is gathered about the best screening methods.

Currently, we do not recommend breast self-exams as a screening tool for breast cancer. However, it is important to be familiar with the way your breasts look and feel so you can be aware of any changes.

Yes! There are many things about your risk of breast cancer, such as your family history, that you cannot change. However, there are also many risk factors that you can change.

We know from good scientific evidence that a healthy lifestyle can significantly reduce the risk of breast cancer. This includes:

• Maintaining a healthy body weight (or BMI)
• Being physically active
• Regularly exercising
• Eating a healthy diet
• Limiting alcohol intake

Breastfeeding and limiting exposure to hormone replacement therapy can also lower your risk. In addition, there are certain prescription medications, such as Tamoxifen, that can lower risk of breast cancer in women who are at high risk.