About 1 in 8 women will be diagnosed with breast cancer. For most women, a combination of factors can contribute to their level of risk, including lifestyle choices or environmental influences. Only a small percentage of women are considered to be at high risk for developing breast cancer due to family history, genetic mutation, or tissue-based findings that elevate their odds.

"It's very important for patients to know that there are things they can do to lower their risk for breast cancer," says Lauren Cornell, M.D., a breast medicine physician at the Jacoby Center for Breast Health at Mayo Clinic in Florida. "Regular cardiovascular exercise, maintaining a healthy body weight and reducing the consumption of alcohol can significantly lower a woman's risk for breast cancer."

Regular breast screenings and an individualized plan for a woman's health also can reduce the risk for breast cancer and improve survival outcomes if cancer is detected, says Dr. Cornell.

"It's important for patients to have an individualized discussion with their health care providers so that we can tailor their screening recommendations," Dr. Cornell says.

Such screening recommendations may include mammography and other imaging modalities.

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"This conversation should take into account a patient's family history of breast cancer, their reproductive history, their mammographic breast density and any previous breast biopsies ― all which may increase their future risk for breast cancer," Dr. Cornell says.

Dr. Cornell also uses a risk assessment model to determine a patient's long-term breast cancer risk.

Misconceptions about risk

Dr. Cornell says there are plenty of misconceptions about breast cancer risk. At the top of her list is a woman without a family history of breast cancer is not at risk of developing breast cancer. She points out that only about 15% of newly diagnosed patients have a family history of breast cancer. Another misconception is about the safety of mammography.

"One of the biggest myths is that screening mammography is associated with a high dose of radiation," Dr. Cornell says. "In reality, it's a very low dose of radiation. It's similar to the amount of radiation that a woman would get from her natural surroundings for about a seven-week period."

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"MBI is a relatively new tool for imaging the breast that was designed to overcome the limitations of mammography for imaging the dense breast," says Dr. Rhodes.

You see, dense breast tissue and cancer both appear white on a mammogram.

"So this tool images the breast in such a way that the tumors stand out from the background tissue and are not obscured by overlying breast density," says Dr. Rhodes.

Two large studies showed that MBI detected three to four times more cancers than mammography in women with dense tissue.

How do you know if you have dense breasts?

"Lots of women will say to me: 'Oh, I have dense breasts. I can tell by the way they feel because they're lumpy.' But that actually does not correlate with the density of the tissue. Dense tissue is defined solely by the mammographic appearance of the breast. The more white tissue on the mammogram, the denser the breast," says Dr. Rhodes.

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Dr. Robert Maxwell, a Mayo Clinic radiologist, says, with a 3D mammogram, many women can.

The technology is also called tomosynthesis, and health care providers say it offers three distinct benefits.

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“3D mammograms allow us to be more accurate in our ability to detect and diagnose cancer as compared to traditional [two-dimensional] mammograms,” says Dr. Maxwell.

Two-dimensional screening mammograms provide only two images of the breast: the top and the side.

“A 3D mammogram would obtain approximately 300 images, as compared to the [two-dimensional] mammogram, which is about four images,” says Dr. Maxwell.

And that means better cancer detection and fewer false alarms.

“3D mammograms allow the radiologist to see the breast tissue in greater detail and be able to provide a more certain diagnosis,” says Dr. Maxwell.

This is especially valuable for women with dense breasts. They have a higher cancer risk.

“It means greater peace of mind, less anxiety, more accurate diagnosis if they have cancer, more certainty that they don’t,” says Dr. Maxwell.

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Screening mammography helps diagnose breast cancer early. But who should get the test?

Dr. Ghosh says, “Currently, mammograms are the best available screening tool for women in the average risk population. Our recommendation is that women 40 and older consider yearly screening mammography.”

Women should know the risks and benefits of mammography. The big benefit is early detection of cancer. Risks include getting called back to get a closer look at tissue, which can cause anxiety. And mammograms may miss cancer in women with dense breasts, because cancer and breast tissue both appear white.

“There could be areas of that tumor hiding within the dense tissue. So, for women who have dense breasts, it is important to understand that there are additional tests. We call it supplemental screening.”

Supplemental screening tools include 3-D mammography, also called tomosynthesis, molecular breast imaging, and MRI. Supplemental tests are particularly important for women at high risk and those who test positive for the BRCA 1 or 2 genes. Dr. Ghosh says all women should talk to their health care providers about the screening that’s best for them, because screening saves lives.

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Myth or Matter-of-Fact: You can tell whether or not you have sinusitis by the color of your mucus discharge.

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A study published today in the journal BMJ says annual screening mammograms in women aged 40-59 do not reduce deaths from breast cancer any better than a physical examination or usual care.

Sandhya Pruthi, M.D., a consultant in the breast clinic at Mayo Clinic Cancer Center says one limitation of the study is that it was conducted at a time when film screen mammography was the standard. “We’re now using digital mammography which has much better detection and sensitivity in finding cancers early.” she says.

Dr. Pruthi acknowledges that routine mammography screening is a controversial issue with no current consensus among groups within the medical community, “The American Cancer Society and the American College of Obstetrics and Gynecologists recommend that we continue screening women in their 40s yearly,” Dr. Pruthi says. “The United States Preventive Services Task Force has published data recommending routine screening beginning at age 50.”

Dr. Pruthi recommends that women take an individualized approach where they talk to their doctors and weigh the risks and benefits of screening taking into account their health, family history and their personal preferences.

Mayo Clinic mammogram guidelines.

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