It’s not fair! There’s no family history.

By Debbie Kerr

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As a child, you might have uttered, “It’s not fair.” For flair, you may have even stomped a foot or stuck out your tongue.  There could have been tears from you… and your parents, depending on how long the tantrum lasted. As a teen, “It’s not fair” could have been accompanied by a door slam or colourful language. As an adult, “It’s not fair,” might be something you think rather than say; however, if the emotions are strong, like with a cancer diagnosis, you might yell, “It’s not fair.” You might even yell, “It’s not fair; there’s no family history.”  

But do you really need a family history to get breast cancer? Not according to the American Cancer Society’s website that states, “It’s important to note that most women who get breast cancer do not have a family history of the disease.” It is an important risk, but it's not the only risk. 

If that’s the case, why did you get cancer? It’s hard to tell. According to The Society of Breast Imaging website, “Seventy-five percent of women diagnosed with breast cancer have no special identifiable risk factors: screening only women with risk factors will miss the vast majority of women who will develop breast cancer.” 

Fortunately, there are some risk factors that are known. Some of them are beyond your control, but some of them you can control enough to minimize the risks. 

Risks outside your control
The following conditions (in no particular order) increase your risk of developing breast cancer, but there is little to nothing that you can do to decrease these risks:

• Being a woman – Men get breast cancer, but most breast cancers are found in women.
• Your current age – The older you are, the higher your risk.
• Dense breasts – Having dense breasts is a major risk factor; however, very few people talk about it and some doctors don’t appreciate how critical it is to know this information. While only a mammogram can determine breast density, that density also makes it harder to detect breast cancer without additional tests like an ultrasound or MRI. Unfortunately, this critical piece of information is not always included in your breast cancer results, which means that you won’t know if you are at a higher risk.
• Personal history of breast cancer – If you had breast cancer, your risk of developing cancer again is higher. Women whose cancer was hormone driven may have the option of being able to take certain medications to minimize this risk.
• Genetics – There are certain gene mutations (for example, BRCA1 or BRCA2) that, if passed from mother to child, increase the risk of developing breast cancer. BRCA gene mutations are more common in women who have an Ashkenazi Jewish history. Some women have their breasts surgically removed to decrease their risk.
• Atypical hyperplasia – This is a non-cancerous condition where there is a higher than normal number of abnormal cells in the breast tissue. 
• Race/Ethnicity – The frequency of diagnosis and type of breast cancer varies by race and ethnicity.
• Reproductive history – If you were under age 12 when you started your period, over 55 when you went into menopause, didn’t have a child or had your first full-term pregnancy after age 30, you are at a higher risk of developing breast cancer.
• Radiation therapy to the chest, neck or armpit prior to age 30.
• Family history – The relationship between you and the person who has/had breast cancer determines how much the relationship impacts your risk of developing breast cancer. Only about 10 to 15% of breast cancers have a direct association to a family history. That’s not to say this is not an important risk, but it is not the only risk. 

Risks you can minimize
While you can’t lower your breast cancer risks in some areas, here are a few actions you can take to help reduce your risk:

• Maintain a healthy weight. For example, even after menopause, extra weight (fat tissue) will produce estrogen.  The more fat tissue there is, the greater the amount of estrogen produced.
• Exercise.
• Eat a healthy diet.
• Reduce alcohol consumption or eliminate it entirely.
• Stop smoking.
• Reduce your exposure to chemicals that you can find in food (for example, grilled or processed meat), pesticides, sunscreens, plastics, and cosmetics.
• Get enough sleep and sleep in a darkened room. The latter is of special concern for women who sleep during the day because they work at night and women who live in an area where there is a lot of light, even at night (like near a street light). 
• Reduce or eliminate the use of the pill or hormone replacement therapy (HRT) for long periods of time.

​No guarantees
Know the signs - Even if you do everything you can to minimize your risk of developing breast cancer, it’s still possible for you to get it. If this happens, it’s critical that you know the early signs of breast cancer, so that your breast cancer can be detected early. 

​One step in awareness is knowing that, in addition to a lump, there are many other signs of breast cancer. The “Know Your Lemons” campaign is one example of an easy-to-understand approach to relaying information about breast cancer.   

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​Get early and regular testing – Based on studies, age 40 is the best time to start having regular mammograms. My first mammogram was at age 49 when I noticed something unusual about my breast (not a lump). I was not scheduled to have my first mammogram until I was 50. During testing, I also discovered that I had dense breasts, so it took an ultrasound, biopsy, MRI, and an MRI biopsy to get a clear and complete picture of the type and extent of my cancer. 

Remember, family history is only part of the story.
Understand your risks and, where you can, minimize your risks.

Some Resources

• American Breast Cancer
• Canadian Cancer Society
• Society of Breast Imaging
• Know Your Lemons
• Dense Breasts Canada

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