Signs & Symptoms

• Early onset of menses and late menopause: Onset of the menstrual cycle prior to the age of 12 and menopause after 50 causes increased risk of developing breast cancer.
• Diets high in saturated fat: The types of fat are important. Monounsaturated fats such as canola oil and olive oil do not appear to increase the risk of developing breast cancer like polyunsaturated fats; corn oil and meat.
• Family history of breast cancer: Patients with a positive family history of
  breast cancer are at increased risk for developing the disease. However, 85% of women with breast cancer have a negative family history!
• Family history only includes immediate relatives, mother, sisters and
  daughters. If a family member was post-menopausal (fifty or older) when she was diagnosed with breast cancer, the lifetime risk is only increased 5%. If the family member was premenopausal, the lifetime risk is 18.6%. If thefamily member was premenopausal and had bilateral breast cancer, the lifetime risk is 50%.
• Women with a significantly positive family history of premenopausal breastcancer should begin screening mammography a decade sooner than their family member was diagnosed. BRCA-1 and BRCA-2 gene testing can identify those patients at increased risk, genetically, for developing not only breast cancer but also a variety of epithelial tumors including ovarian and colon cancer.
• At this time genetic testing is investigational. If a woman is determined to have
  these genetic markers, should we recommend bilateral mastectomy and
  oophorectomy? Further, if her insurance company knows that she has these
  genetic markers of increased risk, she may loose her insurance coverage. If a
  woman decides to proceed with genetic testing, we recommend that this test
  be paid for by the individual to keep the results confidential.
• Late or no pregnancies: Pregnancies prior to the age of twenty-six are
  somewhat protective. Nuns have a higher incidence of breast cancer.
• Moderate alcohol intake: Greater than two alcoholic beverages per day.
• Estrogen replacement therapy: Most studies indicate that taking estrogen
  longer than ten years may lead to a slight increase in risk for developing breast
  cancer. However, these studies indicate that the positive benefits of taking
  estrogen as far as reducing the risk for osteoporosis, heart disease and now
  more recently Alzheimer's and colon cancer, far outweigh the slight increase
  in risk that may be associated with estrogen replacement therapy.
• Caution should be exercised in those women with a significantly positive
  family history of breast cancer or atypical intraductal hyperplasia. Women
  with breast cancer are not currently give estrogen replacement. There are no
  scientific studies currently justifying this practice. However, until those studies
  are available, by convention, women are taken off estrogen.
• History of prior breast cancer: Patients with a prior history of breast cancer
  are at increased risk for developing breast cancer in the other breast. This risk
  is 1% per year or a lifetime risk of 10%. The reason for close clinical
  follow-up after the diagnosis of breast cancer is not only to detect recurrence
  of the disease, but also to detect breast cancer in the opposite breast.
• Female: The mere fact that being female increases the risk of developing
  breast cancer. However, for every 100 women with breast cancer, 1 male will
  develop the disease.
• Therapeutic irradiation to chest wall i.e., for Hodgkins Disease (cancer of lymph nodes): Patients who have had therapeutic irradiation to the chest are at
  increased risk for developing breast cancer approximately 10 years later and consideration should be given to earlier screening in this population.
• Moderate obesity: The relationship of breast cancer to obesity is more complex but associated with an increased risk.

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