There are several risk factors for breast cancer that you cannot control and some that you can. Preventing breast cancer involves limiting the risk factors that you have control over, and taking extra precautions if you have one or more non-controllable risk factors. The main risk factors for breast cancer are:

• age
• family history of breast or ovarian cancer
• personal history of breast cancer
• genetic predisposition
• obesity
• radiation exposure
• early menarche or late menopause
• late first pregnancy
• hormone replacement therapy (HRT)
• birth control pill use
• alcohol use
• precancerous breast conditions
• dense breasts

If you limit the factors on this list that you can control, you will reduce your risk of developing breast cancer. Some other, general preventative measures you can take include:

• Take aspirin. Taking an aspirin just once a week may help protect against breast cancer, but be sure to talk to your doctor before you start.
• Limit alcohol consumption. Drinking alcohol is reliable risk factor for breast cancer, especially more than one drink per day. The type of alcohol makes no difference. Limit the amount of alcohol you drink to less than one drink a day or avoid alcohol completely.
• Maintain a healthy weight. Obesity is a clear risk factor for breast cancer, especially if you gain the weight later in life, particularly after menopause.
• Consider not using long-term hormone replacement therapy. HRT seems to increase the risk of breast cancer, especially when taken for long periods. However, HRT may actually lower your risk for heart disease, so talk to your doctor about balancing your risk.
• Stay physically active. For any age group, the American Heart Association recommends at least 30 minutes of moderate physical activity on most days. This helps prevent obesity, heart disease, and many types of cancer including breast cancer.
• Eat more fiber. Try to increase the amount of fiber you eat. Fiber may help reduce the amount of circulating estrogen in your body, which may lower cancer risk. Foods high in fiber include fresh fruits, vegetables and whole grains.
• Avoid exposure to pesticides. Some pesticides mimic the structure of estrogen, meaning they can act like the hormone if they get inside your body. Women with high levels of pesticides in their breast tissue have a greater risk of developing breast cancer.

Regular screening for breast cancer

Breast self exams

One way to increase your chances of identifying a tumor before it spreads is a monthly breast self exam. This involves feeling around your breasts and armpits for any changes from their normal structure. Breasts can normally be a little lumpy and irregular so it is important to pay attention to changes in their size, shape, or texture. It is natural for breasts to change during the menstrual cycle, pregnancy, and menopause, so not every change needs to be examined by a doctor. However, if you have an area that causes pain that lasts, or a change in the appearance or structure of the breast that seems unusual, contact your doctor and have it examined.

Benign lumps often feel different from cancerous ones. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer. However, you should not assume the worst even if you do this type of lump in your breasts. Most breast lumps aren’t cancerous; in fact, a large majority of them are nothing to worry about. Do not put off your trip to the doctor for fear of a breast cancer diagnosis.

It is important to note that breast self-exams cannot replace regular screening mammograms and clinical breast exams. Unfortunately, studies have shown that breast self-exams alone do not reduce the risk of deaths from breast cancer.

Clinical Breast Exam

During a clinical breast exam, the doctor performs the same type of exploration that you do at home in a self exam, only with more skilled hands. Many gynecologists include a clinical breast exam as part of the annual exam that women should have each year. They note the size, shape, and texture of your breasts and look for irregular coloration, dimpling, or other abnormal signs. The doctor may squeeze your nipples to check for fluid. He or she may also examine the underarm and collarbone area and check the lymph nodes near the breast to see if they are enlarged. The exam may take up to 10 minutes.

Screening Mammograms

Mammograms are breast X-rays that can often show a breast lump before it can be felt. They also can show micro-calcifications, small specks of calcium that may be due to cancer, precancerous cells, or other conditions. If an abnormal area does show up on your mammogram, you may need to have further imaging of the breast or a biopsy may need to be taken. A biopsy is required to diagnose cancer (see “How do I know if I have breast cancer”).

To find breast cancer early, The National Cancer Institute recommends that women in their 40s and older should have screening mammograms every 1 to 2 years, while women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them. Women younger than 40 who have no risk factors are very unlikely to develop breast cancer.

Mammograms can miss cancers, especially in women with dense breasts. A mammogram may also detect something that appears to be cancer, but that turns out to be something else entirely. Even with routine screening, some cancers will slip through. Certain forms of cancer are so invasive that they develop and spread before they are even visible on a mammogram.

A mammogram exposes the breast to a small dose of radiation. Radiation is itself a risk factor for breast cancer. In almost all cases, the benefits of screening outweigh the small added risk from X-ray exposure.

High risk patients

If you are at high risk for breast cancer, you may want to consider some options that go beyond lifestyle changes. Some other steps you can take, ranging from taking drugs to having your breasts removed, are described below.

Chemoprevention

Chemoprevention involves taking medications prophylactically to decrease the risk of developing breast cancer. The main drugs used for breast cancer prevention in high-risk women come from the class of drugs known as selective estrogen receptor modulators (SERMs) which includes tamoxifen and raloxifene. Taking either of these drugs daily may help reduce risk for those at high risk of developing breast cancer.

Preventive surgery

It may sound drastic, but some women opt to have surgery before any cancer is discovered. This option is not right for everyone but if a person has a high risk of developing the disease, such as someone whose mother and grandmother both had breast cancer in their 30s or 40s, it can dramatically reduce their risk of developing breast cancer. The options include:

• Prophylactic mastectomy is removal of the breast to avoid cancer. It can be a single or double mastectomy, meaning you can have one or both breasts removed. This option may be right for you if: you already had cancer in one of your breasts; you have a pre-cancerous condition such as carcinoma in situ; you have a strong family history of breast cancer; or if genetic testing determines you have one or both of the breast cancer susceptibility genes, BRCA1 and BRCA2.
• Prophylactic oophorectomy involves removal of the ovaries to prevent ovarian or breast cancer. If you are premenopausal, this surgery will make you infertile but it will also reduce the primary source of estrogen in the body that can feed a breast tumor. The surgery is not effective at preventing breast cancer in postmenopausal women.