Breast cancer risk assessed by mammography, US and MRI

When looking at those factors that increase the risk for breast cancer, we find that there are specific factors that one can modify and others that are not modifiable. Non-modifiable risk factors: 1. Female gender 2. Old age 3. Inheriting certain gene changes (such as BRCA1 and BRCA2) 4. Family or personal history of breast cancer 5. Race and ethnicity 6. Being taller 7. Having dense breasts 8. Having certain benign conditions e.g. atypical hyperplasia 9. Starting menstrual periods early or late menopause 10. Exposure to chest radiation 11. Exposure to DES (diethylstilbestrol) in utero. Modifiable risk factors: 1. Drinking alcohol 2. Being overweight/obese 3. Not being physically active 4. Being nulliparous 5. Never breastfed 6. Hormonal contraception – very rare 7. Postmenopausal hormone therapy – rare 8. Breast Implant-Associated Anaplastic Large Cell Lymphoma – very rare All these factors need to be considered when tailoring breast cancer screening programs to the patient’s specific needs. They have been incorporated into the Tyrer-Cuzick Risk Calculator, which calculates the 10- year and lifetime risk score for developing breast cancer based on the above criteria. The performance of these epidemiologically based risk models is improved by incorporating findings detected during breast imaging. The primary aim of breast cancer screening studies is to detect breast cancer early to allow early treatment and improved treatment outcomes. However, they also have the potential to identify those individuals who are at increased risk of developing breast cancer. This article describes the range of imaging features associated with breast cancer risk using digital mammography (DM), digital breast tomosynthesis (DBT or 3D mammography), breast ultrasound (breast US), and MRI.