The majority of women with breast cancer do not have a family history of breast cancer. For this reason annual mammography is recommended starting at age 40 in average risk women. Breast self exam is recommended starting at age 20. There has been much discussion on the recommendations of the United States Preventive Services Task Force with annual mammography starting at age 50 and no benefit of breast self exam after age 40. If this recommendation is followed many breast cancers would present at a later stage when the tumor becomes palpable and patients would have a worse prognosis. Many organizations including the American Cancer Society, American Society of Breast Surgeons, and the American College of Radiology disagree with the findings and recommended screening mammogram begin at age 40. Although cancers can grow at different rates and have different levels of aggressiveness if found small the outcome is always better.

There is a formula to determine each individual patient’s lifetime risk of developing breast cancer. This is called the GAIL model. This formula takes into account the patient’s age as most breast cancers develop in women over 50. Other factors include the age of menarche (when the patient starts her menstrual cycle) and the age a patient had her first baby or if she has not had children. This also takes into account the number of breast biopsies the patient has had and if any of these biopsies showed atypia. Finally a calculation in the GAIL model is if the patient has been exposed to estrogen. There is now recommendation to place patients on a medication to lower this risk if they reach a certain threshold in the GAIL model. One other factor that is not contained in the GAIL model that does increase a patient’s risk of breast cancer is obesity. This link is thought to be secondary to the estrogen released by fat cells.

Finally there is the inherited form of breast cancer inherited through the genes BRCA 1 and BRCA 2. Although this only accounts for around 7% of all breast cancers this is associated with bilateral breast cancer as well as being associated with other cancers including ovarian cancer. Only certain patients qualify for this test. After a careful personal and family history we will assess whether this is a good test for the patient to have. If testing is deemed in the best interest of the patient we will go over the benefits of testing and proceed. This may change the surgical therapy as well as pharmaceutical therapy for the patient.