Knowing your breast cancer risk can help guide your planning and treatment choices

Having a higher-than-average risk of breast cancer can cause some anxiety. You might always wonder if this time the screening is going to come back positive.

But how do you know if you are at high risk in the first place? Sometimes, the answer may be clear because multiple generations of people in your family have had the same cancer. In other instances, determining your risk may not be so straightforward.

Enter Samantha Woehrle, APRN, an advance practice nurse in the M Health Fairview Cancer Risk Management Program, which supports people with an increased risk for cancer. We asked Woehrle for her guidance on risk assessments, cancer screenings, and self-monitoring.

Accurately accessing breast cancer risk

Breast cancer assessment tools are widely available online. Some are validated by the National Comprehensive Cancer Network (NCCN) to predict lifetime or five-year risk of some cancers. You might also come across online assessments that aren’t validated or may not be quite right for you. Your healthcare provider can recommend the one that’s best for you.

Even validated assessments have limitations. Some models might underestimate the risk for people of color, people who have had a previous breast biopsy, or people born outside of the United States. Further, they cannot accurately estimate breast cancer risk for people who carry genetic mutations, such as a BRCA genetic mutation.

Healthcare providers have the training to know which of the different assessments to use for each patient – which is one reason why Woehrle recommends completing the assessment with your healthcare provider.

“The risk estimate that you get is only as good as the information you put in,” she said. “Your provider can make sure that they’re putting in the most accurate information and that they’re using the right model for your situation.”

Then the provider is there to have a conversation with you about what the results mean and next steps.

Making decisions about genetic testing

If you have a family history of cancer, you can also ask your primary care provider whether genetic testing may be an option for you. Your provider will determine if you might benefit from meeting with a genetic counselor. A genetic counselor will review your personal medical history and family history and discuss genetic testing options. If genetic testing is right for you, it’s an easy blood or saliva test that you can even do from home under direction from your care team.

Several gene mutations affect breast cancer risk. It can be helpful to know if you carry one because they might increase the risk of cancer developing in other organs, meaning you may benefit from additional annual screenings. Knowing if you carry a gene mutation can help you inform cancer risks for family members since gene mutations can also be passed onto children.

“Not everyone who has a genetic mutation gets the disease,” Woehrle said. “But it’s important to know because we’re learning more and more about these genes.”

That's why Woehrle recommends involving your provider to help evaluate the results and develop a plan.

Breast cancer screening

For people at higher risk for developing breast cancer who are enrolled in our cancer risk management program, we may recommend an annual mammogram and additional imaging with an annual breast MRI. For people of average risk, annual mammograms are usually recommended after age 40.

A fear for many healthcare providers is that if someone takes an online assessment and their risk comes back low, they might skip or delay recommended cancer screenings, like mammograms.

“Low risk doesn’t mean no risk,” Woehrle said.

In fact, most cancers are sporadic, meaning there was no family history or identified genetic mutation to help explain why a cancer develops. The risk assessments are better used to guide decisions about more frequent screening, genetic testing, or risk reduction strategies. Not less. 

Get to know your body

Finally, Woehrle recommends being aware of your own body. Know what your breasts normally look and feel like. Be aware of any new lumps, bumps, nipple discharge, nipple inversion, and any changes in the texture of the skin, and reach out to your provider with any concerns.

“I tell my patients that I want them to be familiar with their own breast tissue because if there's a change, they may be the first person to notice it,” Woehrle said.

If you notice a change, schedule an appointment with your primary care provider or with Woehrle, if you’re in the risk management program.