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Better understanding your risk of breast cancer

All women are at some risk of developing breast cancer. But some women are at a higher risk than others. Understanding your level of risk can help you make informed decisions about breast cancer screeningScreening:
the search for diseases such as breast cancer in people without symptoms. Mammography is an important tool for breast cancer screening and earlier detection.
.

Risk categories can help inform women and their health care providers about options for breast cancer screening and risk reduction. The most commonly used risk categories are average risk and high risk.  A third, less commonly used, category is that of intermediate risk. Only 1-2% of women are at high risk for developing breast cancer in their lifetime. Most women – approximately 80% - are at average risk for developing the disease.

Within each risk category, a woman’s risk of breast cancer depends on her age and other risk factorsRisk factor:
Anything that increases a person’s chance of developing a disease, such as cancer.
. A risk factor is something that increases a person’s chance of developing a disease. Established breast cancer risk factors are backed up by a body of research that is confirmed by different sources and studies.

Average risk of breast cancer

The majority of Canadian women (approximately 80%) are at average risk of developing breast cancer in their lifetime. Average risk means that over their lifetime they have a 1 in 9 chance, or 11% risk, of developing breast cancer.

Women at average risk have the key risk factors for breast cancer (gender and aging) but none of the risk factors listed for intermediate or high risk of breast cancer.

High risk of breast cancer

A small number of Canadian women (approximately 1-2%) are at high risk of developing breast cancer in their lifetime. High risk means that over their lifetime they have at least a 1 in 4 chance, or 25% risk, of developing breast cancer. In the case of rare geneticGenetic:
related to or caused by the genes.
mutationsMutation:
Any change in the DNA sequence of a cell. Mutations can be harmful, beneficial, or have no effect. Certain mutations may lead to cancer or other diseases.
(e.g., in BRCA1BRCA1:
A gene which, when damaged (mutated), places a person at greater risk of developing breast and/or ovarian cancer, compared someone who does not have the mutation.
, BRCA2BRCA2:
A gene which, when damaged (mutated), places a person at greater risk of developing breast and/or ovarian cancer, compared someone who does not have the mutation.
or other genes), the risk of developing breast cancer can be as high as 85%.

Although the definition of high risk can vary somewhat, the following list of criteria are generally included in most definitions of women who are at high risk of developing breast cancer. 

Women at high risk include those with one or a combination of the following risk factors:

Some provinces and territories include screening for women at high risk of breast cancer in their screening programs. Others have developed guidelines for health care providers to follow in referring their high risk patients for breast cancer screening.

Women who are at high risk of developing breast cancer are advised to consider breast cancer screening at an earlier age than women at average risk. The age at which high risk women are recommended to start screening varies by province and territory, but may begin as early as age 25.  Screening for women at high risk of developing breast cancer includes digital mammographyDigital mammography:
a low-dose X-ray similar to screen-film mammography, equipped with a digital receptor and a computer instead of film.
and MRIMagnetic Resonance Imaging (MRI):
an imaging technique that uses powerful magnetic fields and radio waves to create detailed, 3-dimensional images of the organs and tissues in the body, such as the breast.
, if available. Women at high risk may also be offered genetic counselling and testing to determine if they carry a genetic mutation that increases their breast cancer risk.

For more information about breast cancer screening and high risk women see our section on high risk.

Intermediate risk of breast cancer

Some women are at intermediate risk of developing breast cancer in their lifetime. Intermediate risk means that they have a 15-25% risk (or up to a 1 in 4 chance) of developing breast cancer in their lifetime.

Women are considered intermediate risk if they have clinically diagnosed high breast densityDense breasts (breast density):
Dense breasts have less fat and more glandular and connective tissue. A woman’s breast density depends on her age and genetic factors. Breast density is a risk factor for breast cancer. Having “dense breasts” is a clinical diagnosis that can only be assessed by mammography.
and one of the following risk factors:

If you think you may be at intermediate risk, speak to a health care provider about your options for breast cancer screening. Your health care provider may wish to discussion your family history and personal medical history to better understand your risk for developing breast cancer.

Make an informed decision about what is right for you.

For all women, Canadian Breast Cancer Foundation encourages you to learn about your breast health, breast cancer risk, ways to reduce your risk, and about the benefits and limitations of breast cancer screening. If you are in your 40’s, nearing them, or a woman 50+ and not currently being screened for breast cancer, we encourage you to consider speaking to a health care provider to help you make an informed decision about what is right for you and to learn about the breast cancer screening options available in your province or territory.

If you think you may be at intermediate or high risk of developing breast cancer, a health care provider can do an initial assessment of your risk based on your family and medical history, and consider referring you for genetic counselling for further assessment – or to a high risk screening program or clinic.  


Sources:

Canadian Breast Cancer Foundation. (2010). Earlier Detection and Diagnosis of Breast Cancer: A Report from It’s About Time! A Consensus Conference. Toronto, ON: Canadian Breast Cancer Foundation. 

Canadian Breast Cancer Foundation. (2010).  Earlier Detection and Diagnosis of Breast Cancer. Recommendations and Scientific Review from It’s About Time! A Consensus Conference. Toronto, ON: Canadian Breast Cancer Foundation.

Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2014, Toronto, ON: Canadian Cancer Society, 2014.