Breast Cancer Prevention

There is no guaranteed way to prevent breast cancer. Some risk factors, such as age, genetics, and family history, cannot be changed. However, there are steps you can take that may lower your risk of developing breast cancerUnderstanding your individual risk can also help you and your healthcare team decide whether you may benefit from additional screening, genetic testing, medications, or other risk-reducing strategies.

Know your breast cancer risk

Anyone can develop breast cancer, but certain factors can increase your risk. Some of the most important include:

• Age. Breast cancer risk increases as you get older.

• Family history. Having a parent, sibling, or child with breast cancer can increase your risk, particularly if they were diagnosed at a younger age.

• Inherited genetic changes. Harmful variants in genes such as BRCA1, BRCA2, PALB2, TP53, CHEK2, and ATM can increase breast cancer risk.

• Personal history of breast cancer. People who have previously had breast cancer have an increased risk of developing another breast cancer.

• Certain breast conditions. Some noncancerous breast conditions, particularly atypical hyperplasia and lobular carcinoma in situ (LCIS), are associated with a higher risk.

• Dense breasts. Having dense breast tissue can increase breast cancer risk and can also make cancer more difficult to detect on a mammogram.

• Hormonal and reproductive factors. Longer lifetime exposure to estrogen, such as beginning menstruation at a younger age or experiencing menopause later, can modestly increase risk.

• Previous radiation therapy. Radiation to the chest at a young age, such as treatment for Hodgkin lymphoma, can significantly increase future breast cancer risk.

Having one or more risk factors does not mean that you will develop breast cancer. Some people diagnosed with breast cancer have few known risk factors.

Lifestyle choices that may lower your risk

Certain healthy habits are associated with a lower risk of breast cancer.

• Limit alcohol. Alcohol increases breast cancer risk. The more alcohol a person drinks, the greater the risk. If you drink alcohol, limiting how much you drink can help reduce your risk.

• Stay physically active. Regular physical activity is associated with a lower risk of breast cancer. Aim to incorporate movement into your routine through activities you enjoy, such as walking, cycling, swimming, strength training, or other forms of exercise.

• Maintain a healthy weight. Being overweight or having obesity after menopause is associated with an increased risk of breast cancer. Maintaining a healthy weight through balanced nutrition and regular physical activity may help lower risk.

• Avoid smoking. Smoking is linked to many cancers and may increase breast cancer risk, particularly with long-term or heavy tobacco exposure. If you smoke, quitting can improve your overall health and reduce your risk of several cancers.

• Breastfeed, if possible. Breastfeeding is associated with a modest reduction in breast cancer risk, particularly when breastfeeding continues for a longer period of time.

Talk with your doctor about hormone therapy

Some types of menopausal hormone therapy, particularly treatments containing both estrogen and progestin, can increase breast cancer risk when used for several years. If you are considering hormone therapy for menopause symptoms, talk with your healthcare provider about your individual risks and benefits, as well as the lowest effective dose and appropriate length of treatment.

Genetic counseling and testing

Genetic counseling may be recommended if your personal or family history suggests that you could have an inherited cancer predisposition. This may include a history of:

• Breast cancer at a young age

• Multiple relatives with breast cancer

• Ovarian, pancreatic, or prostate cancer in the family

• Male breast cancer

• Multiple cancers in the same person

• A known cancer-associated genetic variant in the family

Genetic testing can identify inherited changes in genes such as BRCA1 and BRCA2 and other genes associated with increased breast cancer risk. Knowing that you carry one of these genetic changes can help you and your healthcare team develop a personalized plan for screening and prevention.

Medications to reduce breast cancer risk

Some people at increased risk of breast cancer may benefit from medications that lower the chance of developing hormone receptor-positive breast cancer. Depending on your age, menopausal status, and individual risk, these medications may include:

• Tamoxifen

• Raloxifene

• Certain aromatase inhibitors

These medications can have side effects and are not appropriate for everyone. Your healthcare provider can help you weigh their potential benefits and risks.

Risk-reducing surgery

People with a very high risk of breast cancer, particularly those with certain inherited genetic variants such as BRCA1 or BRCA2, may consider preventive surgery. A risk-reducing mastectomy removes most breast tissue before cancer develops and can substantially reduce breast cancer risk. Some people with inherited genetic syndromes may also consider removal of the ovaries and fallopian tubes. This is primarily performed to reduce ovarian and fallopian tube cancer risk and may affect breast cancer risk in some situations. These are highly personal decisions that should be made with specialists experienced in hereditary cancer risk.

What you can do

You cannot control every breast cancer risk factor. Instead, focus on the factors you can influence and make sure you understand your individual risk. Talk with your healthcare provider about your family history, breast density, previous biopsies, genetic risk, and other factors that may affect your chances of developing breast cancer. For people at increased risk, prevention may also include earlier or more intensive screening, genetic counseling, medications, or risk-reducing surgery. The goal is not only to reduce your risk when possible, but also to make sure that if breast cancer does develop, it has the best possible chance of being found early.