Beyond the Mammogram: Do You Know Your Breast Cancer Risk?

Every October, we talk about mammograms. And yes, mammograms matter.

But there’s another conversation I want women to be having: Do you actually know your personal risk for breast cancer?

I ask because breast cancer risk is not one-size-fits-all. And it is definitely not as simple as, “No one in my family has had breast cancer, so I’m probably fine.”

Family history matters, but it is only one piece of the picture.

Your age, breast density, personal breast history, reproductive history, genetics, certain previous medical treatments and other health and lifestyle factors can all contribute to your overall risk.

Your mammogram tells us more than “normal” or “abnormal.”

One thing I especially want women to understand is breast density.

If you've had a mammogram, your report should tell you whether your breasts are considered dense. Dense breast tissue is incredibly common, but it matters for two reasons: it can increase your risk of developing breast cancer, and it can make cancer more difficult to see on a mammogram.

That doesn't mean mammography isn't important. It absolutely is. But depending on your overall risk, we may want to have a conversation about whether your current screening plan is enough.

“My mammogram was normal. Am I good?”

A normal mammogram is reassuring, but I don't want it to be the end of the conversation.

For some women, routine mammography is exactly the appropriate screening plan. For women at higher risk, additional screening, such as breast MRI, may be recommended.

The key is knowing which group you fall into.

That's where an individualized breast cancer risk assessment can be helpful. We can look at the bigger picture rather than relying on any one factor to tell us your risk.

And yes, we should talk about hormones.

I know this question comes up frequently, especially among my menopausal patients.

The relationship between menopausal hormone therapy and breast cancer is nuanced. The type of hormone therapy, how it is used, your personal medical history and your underlying breast cancer risk all matter.

This is exactly why I don't believe women should make decisions about their menopause care based on a scary headline or a blanket statement that hormones are either “good” or “bad.”

We should be talking about your risks, your symptoms and your options.

What I want you to ask at your next visit

Instead of only asking, “Am I due for a mammogram?” consider asking:

• Do I have dense breasts?

• What is my individual breast cancer risk?

• Does my family history suggest that genetic counseling or testing could be appropriate?

• Is a mammogram enough for me, or should we discuss additional screening?

• Has anything changed in my health or family history that changes my risk?

These are conversations worth having before there is a problem.

Breast Cancer Awareness Month is a good reminder to schedule the mammogram you've been putting off. But I hope we can take awareness one step further.

Know your breasts. Know your history. And know your risk.

Because screening is important. Personalized screening is even better.

Dr. Laurie Birkholz