Lowering Your Risk
You can lower your risk of breast cancer by changing those risk factors that can be changed. (See the section “What are the risk factors for breast cancer?“)
Both increased body weight and weight gain as an adult are linked with a higher risk of breast cancer after menopause. Alcohol also increases risk of breast cancer. Even low levels of alcohol intake have been linked with an increase in risk.
Many studies have shown that moderate to vigorous physical activity is linked with lower breast cancer risk.
A diet that is rich in vegetables, fruit, poultry, fish, and low-fat dairy products has also been linked with a lower risk of breast cancer in some studies. But it is not clear if specific vegetables, fruits, or other foods can lower risk. Most studies have not found that lowering fat intake has much of an effect on breast cancer risk.
At this time, the best advice about diet and activity to possibly reduce the risk of breast cancer is to:
- Get regular, intentional physical activity.
- Reduce your lifetime weight gain by limiting your calories and getting regular physical activity.
- Avoid or limit your alcohol intake.
For more information, see our document American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.
Women who choose to breastfeed for at least several months may also get an added benefit of reducing their breast cancer risk.
Not using hormone therapy after menopause can help you avoid raising your risk.
It’s not clear at this time if environmental chemicals that have estrogen-like properties (like those found in some plastic bottles or certain cosmetics and personal care products) increase breast cancer risk. If there is an increased risk, it is likely to be very small. Still, women who are concerned may choose to avoid products that contain these substances when possible.
Finding Breast Cancer Early
Other than lifestyle changes, the most important action a woman can take is to follow the American Cancer Society’s guidelines for early detection. Early detection will not prevent breast cancer, but it can help find it when the likelihood of successful treatment is greatest.
For Women Who Are or May Be at Increased Risk
If you are a woman at increased risk for breast cancer (for example, because you have a strong family history of breast cancer, a known genetic mutation of a BRCA gene, or you have had DCIS, LCIS, or biopsies that have shown pre-cancerous changes), there may be some things you can do to reduce your chances of developing breast cancer. Before deciding which, if any, of these may be right for you, talk with your doctor to understand your risk and how much any of these approaches might lower this risk.
Genetic Testing for BRCA Gene Mutations
Many women may have relatives with breast cancer, but in most cases this is not the result of BRCA gene mutations. Genetic testing for these mutations can be expensive and the results are often not clear cut. Testing can have a wide range of consequences that need to be considered. It should only be done when there is a reasonable suspicion that a mutation may be present.
Different expert groups have different recommendations about who should be considered for genetic testing.
For example, the U.S. Preventive Services Task Force (USPSTF) has guidelines aimed at women without a history of cancer. The USPSTF recommends that women with an increased risk of having a BRCA mutation based on a family history of breast, ovarian, fallopian tube, and/or primary peritoneal cancer should be referred to a genetics professional about testing. The genetics professional can evaluate that risk further, discuss the pros and cons of testing if the woman is at high risk (this is called genetic counseling), and arrange for the test if the patient wished to proceed. It is important to realize that BRCA mutations are rare, and only a small fraction of women who have a family history of breast cancer should be referred for genetic counseling and testing.
Other medical groups offer guidelines that include women with cancer. For example, the National Comprehensive Cancer Network guidelines advise referring women 60 and under who have triple-negative breast cancer for genetic counseling and testing.
If you are considering genetic testing, it is strongly recommended that you talk first to a genetic counselor, nurse, or doctor qualified to explain and interpret the results of these tests. It is very important to understand what genetic testing can and can’t tell you, and to carefully weigh the benefits and risks of testing before these tests are done. Testing is expensive and may not be covered by some health insurance plans.
Most large cancer centers employ a genetic counselor who will assess your risk of carrying a mutated BRCA gene, explain the risks and benefits of testing, and check with your insurance company to see if they will cover the test.
Breast Cancer Chemoprevention
Chemoprevention is the use of drugs to reduce the risk of cancer. The drugs tamoxifen and raloxifene are approved by the US Food and Drug Administration to lower breast cancer risk. These drugs block the action of estrogen in breast tissue. Raloxifene is only used in women who have gone through menopause, while tamoxifen can be used in women even if they haven’t gone through menopause. Experts recommend that these drugs only be used to lower breast cancer risk in women who are at increased risk of the disease.
Other drugs are being studied to see if they can lower the risk of breast cancer.
For more information on the possible benefits and risks of chemopreventive drugs see our document Medicines to Reduce Breast Cancer Risk.
Preventive Surgery for Women with Very High Breast Cancer Risk
For the few women who have a very high risk for breast cancer, surgery to remove the breasts or ovaries may be an option.
Preventive (prophylactic) mastectomies: Removing both breasts before cancer is diagnosed can greatly reduce the risk of breast cancer (by up to 97%). Some women diagnosed with cancer in one breast choose to have the other, healthy breast removed as well to prevent a second breast cancer. Breast removal does not completely prevent breast cancer because even a very careful surgeon will leave behind at least a few breast cells. The cells can go on to become cancerous. Some of the reasons for considering this type of surgery may include:
- Mutated BRCA genes found by genetic testing
- Strong family history (breast cancer in several close relatives)
- Lobular carcinoma in situ (LCIS) seen on biopsy
- Previous cancer in one breast (especially in someone with a strong family history)
This type of surgery has been shown to be helpful in studies of large groups of women with certain conditions, but there is no way to know ahead of time if this surgery will benefit any one woman. Some women with BRCA mutations will develop breast cancer early in life, and have a very high risk of getting a second breast cancer. A prophylactic mastectomy before the cancer occurs might add many years to their lives. But while most women with BRCA mutations develop breast cancer, some don’t. These women would not benefit from the surgery, but they would still have to deal with its aftereffects.
Second opinions are strongly recommended before any woman decides to have this surgery. The American Cancer Society Board of Directors has stated that “only very strong clinical and/or pathologic indications warrant doing this type of preventive operation.” Nonetheless, after careful consideration, this might be the right choice for some women.
Prophylactic oophorectomy (ovary removal): Women with a BRCA mutation may reduce their risk of breast cancer by 50% or more by having their ovaries surgically removed before menopause. This is likely because the surgery removes the main sources of estrogen in the body (the ovaries).
It is important that women with a BRCA mutation recognize they also have a high risk of developing ovarian cancer. Most doctors recommend that women with BRCA mutations have their ovaries surgically removed once they finish having children to lower this risk.