From OHC, Specialists in the Treatment of Adult Cancers and Blood Disorders

October 14, 2022

Outside of some types of skin cancers, breast cancer is the most common cancer affecting American women. Specifically, one in eight women will be diagnosed with breast cancer at some point in her lifetime. In recognition of Breast Cancer Awareness Month, we sat down with OHC’s fellowship-trained team of breast surgical oncologists, Nicole M. Melchior, DO, FACS, and Abigail M. Tremelling, MD, FACS, to ask questions about breast cancer risk and understanding prevention strategies.

What are the risk factors for developing breast cancer?

Dr. Melchior: Some of the risk factors for developing breast cancer include:

  • Starting menstrual cycles at a younger age
  • Going through menopause at an older age
  • Never having given birth or giving birth at an older age (after age 30)
  • A family history of breast cancer
  • Inheriting certain cancer genes
  • Taking certain hormone replacement therapy
  • Taking some birth control methods that use hormones
  • Having dense breast tissue
  • Being overweight
  • Lack of exercise
  • Drinking alcohol
  • Smoking
  • Age (most women are diagnosed after age 50)
  • Having certain breast diseases, like atypical hyperplasia or lobular carcinoma in situ
  • A history of radiation to the chest

What does it mean to be at high risk for breast cancer?

Dr. Tremelling: If a woman’s lifetime risk of developing breast cancer is 20 percent or higher, then she is considered to be a high-risk patient. A high-risk evaluation might be recommended for you if you have multiple family members with breast cancer or relatives who were diagnosed with breast cancer at age 45 or younger. A family history of any ovarian, pancreatic, metastatic prostate, or male breast cancer might also increase your risk. Women with dense breast tissue (as characterized by mammography) have a higher risk of breast cancer than women with less dense breast tissue, and this risk increases with increasing breast density. Known genetic mutations or being of Ashkenazi Jewish ancestry might also predispose you to breast cancer.

What is the best way to detect breast cancer?

Dr. Melchior: Mammograms are the best tools physicians have for detecting breast cancer as early as possible. Based on the National Comprehensive Cancer Network (NCCN), American College of Radiology (ACR), and Society of Breast Imaging (SBI) breast cancer screening guidelines for women at average risk, women should have annual mammograms beginning at age 40. If you think you may be at higher-than-average risk, you should speak with a family doctor, gynecologist, or breast surgical oncologist about having a formal risk evaluation. If you do meet high-risk criteria, then you may be advised to start breast cancer screening before age 40.

There is a lot of information about breast cancer risk assessment models. What is the best one?

Dr. Tremelling: Currently, there is no standardized approach to assessing an individual for breast cancer risk. For most women, a variety of factors come into play when determining risk level, and these include personal and family health history, lifestyle choices, and environmental factors. The goal of risk assessment models is primarily to classify women for general counseling and possible recommendations for genetic testing, preventative approaches, and additional screening. At OHC, we utilize risk assessment models that incorporate a women’s individualized history to estimate her risk of breast cancer.

Good risk assessment is critical for the early identification of high-risk patients and tailored approaches to screening.

What does my risk level mean?

Dr. Melchior: If your lifetime risk of breast cancer is less than 20%, then you should continue with annual screening mammograms. We might consider supplemental screening with breast MRI for certain women, based on their individual risk factors. If a woman meets high-risk criteria, we will also discuss preventative approaches and surveillance. Recommendations can be different for each patient but might include starting screening at an earlier age, getting screened more frequently, or getting screened with both mammograms and MRI.

If I am at high risk for breast cancer, what preventative proactive strategies can I use to minimize my risk for the disease?

Dr. Tremelling: Again, this will depend on the individual, but all women should:

  • Conduct monthly breast self-exams and stay up to date with your mammograms
  • Stay physically active
  • Maintain a healthy weight
  • Refrain from smoking and tobacco products
  • Reduce alcohol consumption
  • Follow a heart-healthy diet
  • Limit the length of time you take post-menopausal hormones because some of these therapies increase breast cancer risk

High-risk women should receive care from a breast specialist to discuss a personalized screening plan and whether genetic counseling, prophylactic (preventative) surgery, and/or medications are recommended. Surgery may include a bilateral mastectomy (the removal of both breasts) or the removal of the ovaries. Risk-reducing surgeries are typically reserved for those with a breast cancer gene mutation. While surgery greatly reduces the risk of breast cancer, it does not guarantee that a woman will never develop the disease. Preventative medications, like anti-estrogen drugs, may also be an option for some women.

Should I have genetic testing?

Dr. Melchior: About 10 percent of breast cancers are considered hereditary, or the result of a genetic mutation/change that was passed down. If you have a family history of multiple family members with breast cancer, family members with breast cancer at a young age (45 or younger), or family members with ovarian, pancreatic, metastatic prostate, or male breast cancer then your doctor may recommend genetic testing. Choosing to have genetic testing is an individual decision. Some people prefer to know. Armed with the results, you can work with your healthcare team to formulate a plan of action including cancer screening recommendations and lifestyle changes as preventative measures.

OHC offers a Genetic Risk Evaluation and Testing Program (GREAT) that provides counseling and testing for those who may be at risk for a hereditary cancer syndrome. Our team of cancer genetic specialists helps high-risk individuals make informed decisions, and you do not have to be an OHC patient to see an OHC cancer genetic specialist.

OHC’s breast surgical oncologists are board certified and have completed additional fellowship training in breast cancer care. Because breast cancer treatment is complex, they collaborate with a multidisciplinary team of experts from specialized fields within oncology to develop personalized treatment plans based on every patient’s individual diagnosis. OHC’s breast surgical oncologists are up to date on the latest guidelines for breast cancer treatment as well as high-risk screening and breast cancer prevention, giving patients access to the full spectrum of breast care.

For more information on breast cancer risk and advanced breast cancer therapies, or to request an appointment with one of OHC’s breast surgical oncologists, call 1-888-649-4800 or visit

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