Many women are unaware of their personal risk for developing breast cancer, even though about one in eight women will be diagnosed with the disease at some point in their lives. While this statistic reflects the average risk, experts emphasize that individual risks can vary widely.
Breast cancer risk is influenced by a range of factors including health, genetics, family history, and lifestyle choices such as diet and physical activity. Risk levels are generally categorized as average (less than 15% lifetime likelihood), moderate (15% to just under 20%), or high (greater than 20%).
Dr. Alejandra Perez, who leads the Sylvester Comprehensive Cancer Center’s Breast Cancer Assessment Risk Evaluation (CARE) Clinic, said that women at moderate or high risk may need personalized screening plans and guidance on reducing their risk. “There are a lot of things you can do — from lifestyle interventions to risk-reducing surgery to medications,” Dr. Perez explains.
For those with above-average risk, changes to screening plans might include starting imaging before age 40, increasing frequency of screenings, adding ultrasounds or MRIs, or obtaining contrast-enhanced mammograms for more precise results. Risk reduction strategies can also involve regular exercise, dietary changes guided by a dietitian, reducing alcohol and tobacco use, managing body fat and muscle mass, taking certain medications like tamoxifen for several years, or considering preventive surgery.
To assess personal breast cancer risk, Dr. Perez recommends starting a conversation with a primary care or gynecologic provider at any age. “Have that conversation,” Dr. Perez says. “Just ask a simple question: ‘What is my lifetime risk of developing breast cancer?’” She notes an increased incidence among younger women and supports early assessment.
The American College of Radiology and the Society of Breast Imaging recommend all women undergo formal breast cancer risk assessment by age 25 to better understand their future risks and possible preventive measures.
Sylvester Comprehensive Cancer Center offers an online questionnaire designed to help women determine if they might benefit from further evaluation at the CARE Clinic.
Several factors increase breast cancer risk beyond being female or aging. Family history is significant; having relatives diagnosed with breast or ovarian cancer should prompt earlier screening—often starting ten years before the age at which the family member was diagnosed.
Other contributors include early onset of menstruation (before age 12), late menopause (after age 55), first pregnancy after age 30 or no pregnancies at all, lack of breastfeeding or breastfeeding less than a year, dense breasts, hormone therapy history, past biopsies or benign conditions in the breast tissue, previous chest radiation treatment for other cancers and ancestry such as Ashkenazi Jewish heritage which raises hereditary risks due to genetic mutations.
Lifestyle choices also play a role in modifying risk levels. Diets high in saturated fat and low in fruits and vegetables; lack of regular exercise; significant weight gain after menopause; alcohol consumption—linked to over 16% of cases—and smoking all contribute to higher risks.
Participants in Sylvester’s CARE Clinic receive support from health coaches who help create individualized plans for nutrition and physical activity while addressing smoking cessation and reduced alcohol intake when needed.
“We have many studies that have shown the benefits [of] maintaining your weight, exercising every day, no smoking, low alcohol intake,” Dr. Perez explained. “Those are all modifiable risk factors.”
“My message to women is: ‘Know your risk,’” Dr. Perez says. “Have that conversation with your physician. Be empowered.”
Rochelle Broder-Singer—a journalist and patient at Sylvester Cancer Center—shared her experience as both a survivor and advocate for proactive awareness about personal breast cancer risks.
