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/ Providers FAQs / How does breast density compare to other risk factors for developing invasive breast cancer?

How does breast density compare to other risk factors for developing invasive breast cancer?

The charts below detail relative risk and prevalence [1-15].

Relative Risk: The top chart shows approximate relative risk of developing breast cancer by age 80 for a woman with a given risk factor compared to a woman without that risk factor: 1) disease-causing BRCA1 or -2 mutation [1-3]; 2) prior ductal carcinoma in situ [4-6]; 3) prior atypical ductal hyperplasia [7-9]; 4) mother or sister diagnosed with breast cancer by age 50 [10]; 5) combined estrogen and progesterone therapy after menopause [11]; 6) heterogeneously dense breast tissue (relative to a woman with fatty breasts) [12]; or 7) extremely dense breast tissue (relative to a woman with fatty breasts) [12].

1Average relative risk for BRCA1 or -2 mutations is about 10, varying widely from about 3-17 depending on study design and population studied [1-3].

2The 15-year risk of developing invasive breast cancer among women with untreated DCIS (i.e. found on retrospective review of surgical biopsy specimens years later) is about 10 times greater than the risk in the general population [4, 5]. The risk 3 years or more after DCIS diagnosis in women who receive standard treatment is nearly 3 times greater than the risk in the general population [6].

3 At any given age, risk associated with having a mother or sister diagnosed with breast cancer tends to be higher the younger the relative was at diagnosis, particularly for women under 50. For example, Data from nearly 160,000 women showed that in women under 40, relative risk was nearly 6 times greater if the relative was diagnosed before age 40, and nearly 3 times greater if the relative was diagnosed between age 40-50, than women without a family history in a first degree relative. In contrast, women 60 and older with a family history in a first degree relative have about a 40% increased risk regardless of the relative’s age at diagnosis [13].


Prevalence: 
The lower chart shows estimated prevalence of each risk factor in American women aged 40-74, except for hormone replacement therapy which applies only to postmenopausal women. Dense breast tissue is quite common, seen in 43% of all women aged 40-74.

bar chart for prevalence

References Cited

1. Kuchenbaecker KB, Hopper JL, Barnes DR, Pet al. Risks of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. JAMA 2017; 317(23):2402-2416

2. Kurian AW, Hughes E, Handorf EA, et al. Breast and Ovarian Cancer Penetrance Estimates Derived From Germline Multiple-Gene Sequencing Results in Women. JCO Precis Oncol. 2017; 1:1-12

3. Hu C, Hart SN, Gnanaolivu R, et al. A Population-Based Study of Genes Previously Implicated in Breast Cancer. N Engl J Med. 2021; 384(5):440-451

4. Page DL, Dupont WD, Rogers LW, Landenberger M. lntraductal carcinoma of the breast: follow-up after biopsy only. Cancer1982; 49: 75 1-758

5. Betsill WL Jr, Rosen PP, Lieberman PH, Robbins GF. Intraductal carcinoma: Long-term follow-up after treatment by biopsy alone. JAMA1978; 239:1863-1867

6. Mannu GS, Wang Z, Broggio J, et al. Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study. BMJ 2020;369:m1570

7. Worsham MJ, Abrams J, Raju U, et al. Breast cancer incidence in a cohort of women with benign breast disease from a multiethnic, primary health care population. Breast J. 2007; 13:115–21

8. Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005; 353:229–37

9. Hartmann LC, Radisky DC, Frost MH, et al. Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res (Phila) 2014; 7:211–7

10. Colditz GA, Kaphingst KA, Hankinson SE, Rosner B. Family history and risk of breast cancer: nurses’ health study. Breast Cancer Res Treat. 2012;133(3):1097-1104. doi:10.1007/s10549-012-1985-9

11. Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R. Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk [published correction appears in JAMA 2000 Nov 22-29;284(20):2597]. JAMA. 2000;283(4):485-491

12. Cummings SR, Tice JA, Bauer S, et al. Prevention of breast cancer in postmenopausal women: Approaches to estimating and reducing risk. J Natl Cancer Inst2009; 101:384-398

13. Collaborative Group on Hormonal Factors in Breast Cancer. Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. Lancet. 2001; 358(9291):1389-1399

14. Couch FJ, DeShano ML, Blackwood MA, et al. BRCA1 mutations in women attending clinics that evaluate the risk of breast cancer. N Engl J Med1997; 336:1409-1415

15. Sprague BL, Gangnon RE, Burt V, et al. Prevalence of mammographically dense breasts in the United States. J Natl Cancer Inst2014; 106

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