ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

RISK FACTORS OF BREAST CANCER

Turan Pehlivan

Bağcılar Training and Research Hospital, Department of General Surgery, İstanbul, Türkiye

Pehlivan T. Risk Factors of Breast Cancer. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.17-30.

ABSTRACT

Risk factors in the development of breast cancer can be examined under five main categories: de- mographic characteristics, hormonal risk factors, genetic/familial factors, environmental factors, and other factors. Being female, of Caucasian race, and over the age of 50; experiencing early menarche (<12 years), late menopause (>55 years), giving birth at an older age (>35 years), not breastfeeding, and nulliparity; undergoing hormone replacement therapy; having a high socioeconomic status; al- cohol consumption; a high-fat diet; body mass index (BMI) >30 kg/m²; exposure to light at night; a personal history of invasive or in situ breast cancer; and dense breast tissue are considered minor risk factors. Major risk factors include a personal history of breast, ovarian, or peritoneal (including fallopian tube) cancer; a family history of breast, ovarian, or peritoneal (including fallopian tube) cancer; genetic predisposition (BRCA1/BRCA2, TP53, and PTEN positivity); a history of chest wall radiotherapy between the ages of 10 and 30; atypical lobular hyperplasia (ALH); atypical ductal hyper- plasia (ADH); and lobular carcinoma in situ (LCIS). Various models have been developed to identify individuals at risk. These include the Gail, Claus, BRCAPRO, Tyrer-Cuzick (IBIS), BOADICEA, and Jonker models. The most commonly used model is the Gail model, although it has some limitations. For high-risk individuals, risk-reducing strategies such as close surveillance (screening), chemopre- vention, and surgery (risk-reducing mastectomy or oophorectomy) have been defined. Recommended screening methods include breast self-examination, clinical breast examination, mammography, to- mosynthesis, ultrasonography, and MRI. There are various screening modalities regarding frequency. In Türkiye, since approximately half of breast cancer diagnoses occur in women under the age of 50, the Ministry of Health recommends starting mammographic screening at age 40 and continuing every two years between the ages of 40 and 69. However, women in high-risk groups (e.g., genetic carriers, positive family history, dense breast tissue) should begin screening at an earlier age and continue at recommended intervals using appropriate screening methods. It is argued that breast MRI should be added to the screening in individuals with a 20-25% risk of developing breast cancer. In chemopreven- tion, tamoxifen is recommended for premenopausal women, while raloxifene, aromatase inhibitors, or retinoids are recommended for postmenopausal women. In patients with confirmed genetic mutations, surgical interventions such as risk-reducing mastectomy or oophorectomy may also be considered..

Keywords: Breast cancer; Risk factors; Early diagnosis

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