Breast Cancer Risk Management

First, let’s calculate your individual risk

Breast Cancer is the most common non-skin cancer in Australian women, with 1 in 7 women at risk of developing the disease by the age of 85.  So I work with women to assess their individual risk so they can make plans for long-term breast cancer risk reduction. 

To accurately quantify risk, I gather information around personal history, personal lifestyle factors, family history and genomic testing results.  In addition, I gather information around breast density and specific genomic testing results.   

If breast cancer risk is something you would like to discuss with me, get in touch via my Contact page.

Breast density and breast cancer risk

Women with dense breasts can have an increased risk of developing breast cancer. Breast density can be graded on a specialised mammogram, using a computer-based calculation and then reported as BIRADS A,B,C or D.  The BIRADS grade C may increase cancer risk by 3 times and BIRADS D by 6 times. Women in these risk groups should be counselled about additional breast imaging modalities, such as ultrasound or MRI to make plans for long-term breast cancer risk reduction.

Breast cancer risk groups

Depending on what risk group you have been told you come under, your risk of breast cancer will differ from another woman’s. Most women (95% of the population) will be found to be at average risk, while 1% of the population will be at high risk (more on this group later). For the Moderate Risk group (4% of the population), discussions around supplementary screening, genomic testing and risk reducing medication come into play. Genomic testing has become much more accessible with Medicare funding for patients at 10% risk of being found to have an inherited mutation.  I recommend my patients undergo testing with the BraOVO panel for ATM, BRCA1, BRCA2, CHEK2, CDH1, PALB2, PTEN, STK11, TP53 mutations. 

Risk-reducing medication requires a very careful discussion.  Pre-menopausal women can be prescribed a drug called Tamoxifen, although those with a history of clotting should avoid this drug and be monitored for endometrial hyperplasia.  Post-menopausal patients can consider an aromatase inhibitor and will also be closely monitored.  This practice is not common in Australia but there are local guidelines from the Clinical Oncological Society of Australia.  

Most women (95% of the population) will be found to be at average risk of developing breast cancer.  Going forward, the most important steps for breast cancer risk reduction are regular breast imaging, breast self-examination and risk factor modification.  

Risk reducing surgery

For women at High Risk (1% of all women), we need to talk about risk reducing surgery and whether it is right for you.  Prophylactic surgery can be combined with immediate reconstruction however, this is a major decision and requires clear communication around absolute risk and benefit, tailored for each woman and their circumstance.  I recommend reading around breast reconstruction, to understand the options available, particularly using your own tissue (autologous flaps) or implant based reconstruction.  You can find out more about this on my breast reconstruction page.