Breast Cancer: Understand Your Risks

Dr. Rachel Raab is a hematologist/oncologist with Cancer Care of Western North Carolina.

Dr. Rachel Raab is a hematologist/oncologist with Cancer Care of Western North Carolina.

by Rachel Raab, MD

October is breast cancer awareness month, and I cannot think of a better time to talk with your doctor about getting a screening mammogram, starting at age 40, as well as ways you can better understand and reduce your risk of breast cancer.

As a breast medical oncologist, I’m asked by patients on a daily basis why they developed breast cancer and what they can do, in addition to recommended treatment, to reduce their risk for recurrence. Many patients are shocked by their diagnosis, as they are the first person in their family to be diagnosed with breast cancer.

Breast cancer, following nonmelanomatous skin cancer, is the most common cancer in American women. Approximately one in eight women in the United States will develop breast cancer during her lifetime.

I explain to my patients that there are many factors that contribute to development of breast cancer but that many women with risk factors never develop breast cancer. It is therefore difficult to know how different factors contribute to the development of breast cancer.

Let’s take a look at some of the risk factors for breast cancer. This is not a comprehensive list, but may help you discuss your potential risks with your doctor.

Being female and getting older: These are the two most significant risk factors for development of breast cancer. Men can develop breast cancer but it is 100 times more common in women.

Family History: Many people think that if someone in their family had breast cancer that they have an increased risk of developing breast cancer. The reality is that less than 15% of women who develop breast cancer have a family member with this disease. It is still important to let your doctor know if you have a family history of breast cancer.

Inherited genes: About 5% – 10% of breast cancer cases are hereditary. The most common inherited gene mutations are in the BRCA 1 and BRCA 2 genes, but there are other gene mutations that can increase the risk of breast cancer.

Chest radiation for another cancer such as lymphoma: The risk is highest for women who receive radiation to the chest during adolescence when the breasts are developing.

Benign, or noncancerous, breast conditions: There are many benign conditions that can affect the breast; some are associated with a much higher risk of breast cancer than others. If you have been diagnosed with a benign condition (for example, atypical hyperplasia) it is important to talk with your doctor about how this increases your risk of developing breast cancer and what, if anything, is recommended in order to decrease this risk.

Reproductive factors: Early menses, before age 12, and menopause after age 55, are thought to increase breast cancer as these result in a longer exposure time to the hormones estrogen and progesterone, which are linked to breast cancer. Not having children or having children after age 30 has also been linked to an increased risk for breast cancer.

Lifestyle associated risks: Alcohol use is associated with an increased risk for breast cancer. One alcoholic drink per day does not appear to significantly increase the risk but two to five drinks per day results in a 1.5 times greater risk; the American Cancer Society recommends no more than one alcoholic drink per day.

Obesity or being overweight after menopause increases the risk for breast cancer as fat tissue produces estrogen. Physical inactivity has been linked to an increase risk for breast cancer. The American Cancer Society recommends 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise each week. Also, a diet low in fat, low in red meat and processed meat, and high in fruits and vegetables is better for one’s overall health.

Use of hormone replacement therapy: The use of combined estrogen and progesterone has been shown to increase the risk of breast cancer. The good news is that the risk returns to normal within five years of discontinuation of hormone replacement therapy.


Dr. Rachel Raab is a hematologist/oncologist with Cancer Care of Western North Carolina with an expertise in breast cancer. She is a member of the Western Carolina Medical Society. She sees patients at both the SECU Cancer Center and Hope Women’s Cancer Center.


One comment

One comment

  1. Jenny A. Owens says:

    Dr. Raab is amazing! Everything she said here is spot on. I can’t emphasize enough the importance of screening. I was 41 years old at diagnosis, and have no family history- but every family history starts with someone. In my case it is me. As Dr. Raab wrote about in this article, I did have some benign breast conditions about 10 years prior and was told to have a mammogram yearly. The last mammogram I had at another hospital, I was told that I no longer needed yearly mammograms, and could screen every two years despite having dense breasts (which makes it harder to find cancer). I wish I had continued mine yearly, because my cancer may have been caught at an earlier stage. Thankfully, mine is still possibly curable at a stage 2b- and currently I am “no evidence of disease”. Thank you Dr. Raab for such excellent care- and thank you for always involving me in my treatment decisions. You have earned my respect. You are the best!