It is estimated that one in eight women will receive a diagnosis of breast cancer during her lifetime. Given this prevalence, understanding personal risk factors—especially how family history plays a role—is essential for proactive breast health. While family history is a significant consideration, most diagnoses occur in women with no known history. In fact, over three out of four women with breast cancer have no family history of the disease. However, determining if breast cancer is part of your genetic makeup involves looking closely at your family background and understanding both inherited and lifestyle risk factors. Being aware of your risk profile and committing to annual screening mammograms are vital steps in maintaining your breast health.
Does Breast Cancer Run in Families?
While the majority of women diagnosed with breast cancer do not have a family history, the risk increases substantially if you have close relatives who have had the disease. Having a family history of breast cancer means the disease can potentially run in the family, though not all cases are hereditary.
The degree of increased risk correlates directly with how closely related the affected family member is:
- If you have one first-degree relative (such as a mother, sister, or daughter) diagnosed with breast cancer, your personal risk nearly doubles.
- If you have two first-degree relatives diagnosed, your risk increases nearly threefold.
- If you have a second-degree relative (such as an aunt or grandmother) diagnosed with breast cancer, your risk is also increased.
It is important to note that breast cancer diagnosed in younger women is more often hereditary than in older women. For women who are considered higher risk due to family history, screening may need to begin earlier than the recommended age of 40.
How is Breast Cancer Inherited?
Breast cancers that run in families are typically caused by certain gene mutations, most commonly mutations to the BRCA genes. BRCA stands for breast cancer genes 1 and 2. Normally, everyone inherits two copies of these genes, one from each parent. The proteins created by healthy BRCA genes are tumor suppressors, which help restore damaged DNA.
When these genes contain harmful variants or mutations, they can lead to abnormal cell growth, which in turn significantly increases the risk of cancer. When cells lack normal BRCA1 or BRCA2 proteins, they can grow out of control and become cancerous. It is estimated that up to 10% of breast cancer cases are hereditary, caused by an inherited genetic mutation, most often BRCA1 or BRCA2.
Who Carries the Breast Cancer Gene?
If you have a parent who carries a mutation in either the BRCA1 or BRCA2 genes, you have a 50% chance of inheriting that mutation. Women who carry a BRCA1 or BRCA2 gene mutation face a significantly higher lifetime risk of developing breast cancer, with up to a 70% chance of developing the disease by age 80.
Genetic testing, often preceded by consultation with a genetic counselor, is recommended for people who are at higher risk for developing breast or ovarian cancer. This includes individuals who:
- Have a relative with a harmful variant of BRCA1 or BRCA2.
- Have a family history of breast or ovarian cancer.
- Are of Ashkenazi Jewish descent (a risk factor for younger women).
A positive result from a BRCA test means a harmful variant was detected, indicating a higher risk for developing cancer and the possibility of passing the variant to children. Even with a positive result, remember that genetic testing research is ongoing, and regular well visits and annual screenings empower women to take an active role in their health.
Causes of Breast Cancer
Asking, “Is breast cancer genetic?” is an important question, but genetics is only one piece of the puzzle. The two biggest risk factors for developing breast cancer are being a woman and aging. Most breast cancers occur in women aged 55 and older.
Risk factors for breast cancer can be categorized as those you cannot control and lifestyle factors you can modify.
Risk Factors You Cannot Control
- Age: Risk increases as you get older.
- Breast density: Dense breast tissue is an independent risk factor for developing breast cancer. Approximately 50% of the female population falls into the dense breast category. Dense tissue appears white on a mammogram, similar to cancerous areas, making detection more difficult.
- Menopause and menstruation: Women who go through menopause later (especially after age 55) or who had their first period at a younger age (especially before age 12) have a slightly higher risk.
- Personal history: If you have had breast cancer, the risk is higher for developing cancer in the other breast or in a different area of the same breast.
- Radiation: Having had radiation therapy to the chest for another type of cancer, especially as a teen or young adult, can increase the likelihood of breast cancer developing later.
- Race: Diagnostic rates of breast cancer are higher in Caucasian and Black women, but lower in Asian, Hispanic, and Native American women.
Lifestyle Factors That Play a Role
- Obesity: Being overweight or obese, particularly after menopause, increases risk.
- Physical activity: Exercising regularly, especially after menopause, can lower your risk.
- Diet: Eating a healthy diet can help lower your risk.
- Alcohol consumption: Some studies suggest drinking alcohol can increase risk; limiting intake may help lower risk.
- Hormone use: Taking combined hormone therapy to relieve menopausal symptoms can raise breast cancer risk.
- Childbearing: Women who do not become pregnant or who have their first child after age 30 have a slightly higher risk.
- Breastfeeding: Studies suggest women who do not breastfeed may be at a slightly higher risk.
What to Do if You Have a Family History of Breast Cancer?
If you have a family history of breast cancer or other risk factors, maintaining your best breast health requires a personalized surveillance strategy.
Genetic Testing and Counseling
If you have risk factors, genetic testing may be recommended to get a more accurate picture of your personal risk. If you test positive for a BRCA mutation, you will work with your provider and genetic counselor to develop a breast cancer surveillance strategy.
Early and Annual Screening
While women at average risk should begin annual screening mammograms at age 40, if you have known risk factors like a strong family history, you should talk to your provider about starting earlier. Expert guidelines suggest starting screening 10 years before the age of diagnosis of your first-degree relative. For instance, if your mother had cancer at 42, you would need to start screening at 32.
Supplemental Imaging
For those considered high risk, supplemental screening options are often added to annual 3D mammography. These may include:
- Breast MRI (Magnetic Resonance Imaging): This advanced technology can detect some cancers that may not be visible on a mammogram. It is often used for additional surveillance, typically in between annual screening mammograms at six months. Abbreviated Breast MRI (ABMRI) is a shorter version offered primarily for women with an average or lower overall risk of breast cancer and for women with dense breasts.
- Screening Breast Ultrasound (SBU) or Automated Breast Ultrasound (ABUS): This screening technology uses sound waves to view breast tissue and provides additional information, especially for women with dense breasts or other risk factors. When ABUS is used in conjunction with mammography, it can help improve breast cancer detection rates.
The Importance of Early Detection
The most critical step in managing risk and ensuring positive outcomes is prioritizing early detection. Even without known risk factors, you are not immune to breast cancer, so annual screening is essential.
Annual Screening Mammograms
Expert guidelines recommend women aged 40 and older at average risk get a screening mammogram every year. Annual 3D mammography (digital breast tomosynthesis) is the standard of care for all patients at Charlotte Radiology.
Annual 3D mammography is clinically proven to detect breast cancer early. Screening mammograms can detect breast cancer up to three years before a lump can be felt. When breast cancer is detected at the earliest stages (Stage 0 or Stage 1) and confined to the breast, women typically require less invasive treatment and have a significantly higher chance of survival, with nearly a 100% five-year survival rate.
Annual screening allows providers to compare images year over year, making it easier to detect subtle changes. Mammography is also the only way to measure breast density, which also changes over time.
Being “Breast Aware”
Routine monthly breast self-exams and clinical exams during your annual wellness visit can help you become more “breast aware” and familiar with the look and feel of your breasts. You should perform a physical and visual breast self-exam at the same time each month, typically three to five days after your period begins, when breasts are less tender.
Be vigilant and consult with your provider if you observe any concerning changes, such as:
- A new lump in the breast or armpit
- Breast swelling or thickening
- Dimpling or irritation in the breast skin
- Nipple pain, pulling in at the nipple, or discharge that is not breast milk
Take Action for Your Health
Regardless of your personal risk profile or family history of breast cancer, making informed choices on prevention and early detection is an important part of taking care of your health. We believe the key to finding and fighting breast cancer is early detection.
If you are a woman aged 40 and older, or if you have risk factors that suggest an earlier start date, talk to your provider about developing a breast health screening plan that is right for you. Find your reason for scheduling your annual screening mammogram today.
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