“Breast cancer doesn’t run in my family.”
That is good news.
But no family history of breast cancer does not mean no risk. Family history is useful. It is only one piece of a larger picture.
So if breast cancer does not run in your family, what else should you know?
Let’s talk about that.
Quick Answer: Can You Get Breast Cancer Without a Family History?
Yes. Most women diagnosed with breast cancer do not have a close family history of the disease.
Your breast cancer risk is influenced by a combination of factors. Those include age, breast density, your own breast history, certain inherited genetic changes, reproductive history, previous radiation exposure, alcohol use, body weight after menopause, physical activity, and some forms of hormone therapy.
Having one or more risk factors does not mean you will develop breast cancer. Having few known risk factors does not guarantee that you will not.
Understanding your own risk is more useful than simply asking whether breast cancer runs in your family.
Family History Is Only One Part of the Picture
If your mother, sister, or daughter has had breast cancer, your own risk may be higher. The details are important. A diagnosis at a younger age can carry different implications than a diagnosis late in life. Several affected relatives can be more significant than one.
Family history can also get too much attention in the other direction.
A woman may think:
“My mother never had it. Neither did my grandmother. I’m probably fine.”
That conclusion skips over the other factors that affect breast cancer risk.
The American Cancer Society notes that most women who get breast cancer do not have a family history of the disease. Having a first-degree relative with breast cancer nearly doubles risk. Two first-degree relatives raise it further. A father or brother with breast cancer also raises risk.
Family history is useful information. It is not a guarantee in either direction.
Age Is One of the Biggest Risk Factors
Sometimes the most important risk factor is also the easiest to overlook.
Age.
Breast cancer risk rises as women get older. According to the CDC, most breast cancers are diagnosed after age 50. The National Cancer Institute identifies increasing age, after female biological sex, as the most important breast cancer risk factor.
You cannot change your age.
Age does change the conversation about screening, mammograms, and the rest of a woman’s history. That is one reason women who have never had breast cancer in the family should still take screening seriously. We covered how the major guidelines differ in When Should You Get a Mammogram?.
Dense Breasts Belong in the Conversation
Many women first learn they have dense breasts when they read a mammogram report.
Dense breast tissue is common. The National Cancer Institute and the CDC both note that nearly half of women age 40 and older who have mammograms are found to have dense breasts.
Dense breasts come up for two separate reasons.
First, dense tissue can make breast cancer more difficult to see on a mammogram because dense tissue and some cancers both appear white.
Second, breast density itself is associated with increased breast cancer risk.
That does not mean a woman with dense breasts has cancer. It does not automatically mean she needs an MRI or ultrasound.
It means breast density belongs in the larger discussion about her personal risk. We recently discussed this in Dense Breasts After a Mammogram: What Should You Ask Next?.
If your mammogram says your breasts are heterogeneously dense or extremely dense, do not panic over the terminology. Ask what it means when combined with your age, family history, and other risk factors.
Your Own Breast History Can Change the Picture
What has happened in your own breasts may be just as important as what happened in your mother’s or sister’s.
A previous breast cancer increases the risk of developing another breast cancer. Certain noncancerous breast conditions can also increase risk.
Atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ can change a woman’s risk calculation even though they are not the same thing as invasive breast cancer. The CDC includes prior radiation to the chest and certain high-risk breast findings among the factors that raise risk.
That is why the words on an old biopsy report may still be useful years later.
If you have had a breast biopsy in the past, it helps to know what it actually showed rather than simply remembering, “It was benign.”
Benign is good news. Some benign findings still carry more risk than others.
What About BRCA?
BRCA1 and BRCA2 get plenty of attention, and for good reason. Certain harmful inherited changes in these genes can substantially increase breast and ovarian cancer risk.
BRCA is not the whole genetics story.
Other inherited gene changes, including variants in genes such as PALB2, CHEK2, ATM, and others listed by the National Cancer Institute, may also increase breast cancer risk.
At the same time, most breast cancers are not explained by one of these inherited mutations. About 5% to 10% of breast cancers are thought to be hereditary, according to the American Cancer Society.
That is another reason “no breast cancer in my family” cannot settle the question.
Genetic testing can be extremely useful for the right person. It is not something every woman automatically needs.
Begin with a careful family and personal history. That helps determine whether genetic counseling or testing deserves consideration.
Your Father’s Side Counts
This is easy to miss.
People often talk about breast cancer history as though it belongs to the women on their mother’s side of the family.
Genetic risk does not work that way. You inherit genes from both parents.
Breast or ovarian cancer on your father’s side of the family can be every bit as relevant as cancer on your mother’s side. Male breast cancer in the family is also important information. The CDC specifically includes breast cancer among relatives on either parent’s side when discussing family history.
The paternal side can also be harder to track. There may be fewer women in that branch of the family, or you simply may not know as much about their medical histories.
When someone asks about your family history, think beyond your mother. Think about both sides.
Some Risk Factors Can Be Changed
You cannot change your age, your genes, or the family you were born into.
Other risk factors are at least partly modifiable.
The American Cancer Society and the CDC both associate alcohol use with increased breast cancer risk, and risk rises as alcohol intake increases. Being overweight or having obesity after menopause is also associated with greater risk. Physical inactivity is another factor.
Some forms of menopausal hormone therapy, particularly combined estrogen and progestin therapy, can also raise breast cancer risk with use over time.
This is not a reason to turn breast cancer prevention into a guilt exercise.
Risk does not work that neatly.
Someone can exercise, maintain a healthy weight, never drink alcohol, and still develop breast cancer. Another person may have several risk factors and never develop it.
The useful question is not, “What did I do wrong?”
It is, “What can I reasonably do with the information I have?”
A Risk Factor Is Not a Prediction
A risk factor changes probability. It does not predict your future.
Having dense breasts does not mean you will develop breast cancer.
Having a mother with breast cancer does not mean you will develop it.
Having no known family history does not mean you will not.
Even formal breast cancer risk calculators provide estimates, not guarantees. The National Cancer Institute’s Breast Cancer Risk Assessment Tool notes that even when a woman’s risk can be estimated, the model cannot say precisely which woman will develop breast cancer. Some women who never develop the disease have higher risk estimates than some women who do.
That does not make risk assessment useless. It makes it a tool.
What Is a Breast Cancer Risk Assessment?
A breast cancer risk assessment looks at more than one factor at a time.
Depending on the individual and the risk model being used, the discussion may include:
- Age
- Family history
- Personal history of breast cancer
- Previous breast biopsies and what they showed
- Breast density
- Reproductive history
- Genetic factors
- Previous radiation exposure
- Other medical and lifestyle information
Risk assessment tools can then help estimate a woman’s probability of developing breast cancer over a defined period of time or over her lifetime.
That information can help guide a more useful discussion about screening.
For some women, routine mammography may be appropriate.
For others, the combination of risk factors may justify earlier screening, more frequent screening, genetic evaluation, or consideration of additional imaging.
A risk number is not meant to frighten anyone. It is meant to help make a better screening plan.
Who Should Ask About a Breast Cancer Risk Assessment?
You do not have to wait until something is wrong.
A risk assessment may be particularly worth discussing if:
- Breast or ovarian cancer occurs in your family
- A relative developed breast cancer at a young age
- You have breast or ovarian cancer on your father’s side of the family
- A man in your family has had breast cancer
- You have dense breasts
- You have had previous breast biopsies
- You have had an atypical or high-risk breast finding
- You received significant radiation to the chest when you were young
- You are unsure whether your current screening plan fits your risk
You can also ask simply because you do not know your risk and want to understand it better.
That is a legitimate reason.
What If You Have No Obvious Risk Factors?
Keep screening.
A woman does not need a strong family history, a known genetic mutation, or an obvious warning sign to develop breast cancer.
Most women who develop breast cancer do not have a family history.
Do not let the absence of a dramatic risk factor become a reason to skip mammograms or ignore a new breast change.
If you notice a new lump, nipple discharge, skin dimpling, persistent swelling, a nipple that has suddenly turned inward, or another breast change, call your physician rather than waiting for your next screening. We covered those signs more fully in When a Breast Change Should Be Checked.
Screening and risk assessment are useful. Paying attention to your own body still belongs in the plan. More general questions about diagnosis and follow-up are also covered in our Breast Cancer FAQs.
Breast Cancer Risk Assessment in Bend and Central Oregon
Dr. Andy Higgins, M.D., evaluates breast cancer risk in Bend along with breast lumps, abnormal mammograms, ultrasound, breast biopsy, breast cancer consultation, and second opinions.
For women in Bend and throughout Central Oregon, a risk assessment can help put the pieces together.
Maybe breast cancer does run in your family.
Maybe it does not.
Maybe your mammogram says you have dense breasts. Maybe you had a biopsy years ago and are not sure whether the result affects your current risk. Maybe you simply want to know whether the standard screening recommendations make sense for you.
Those are good questions.
You do not need to diagnose your own risk before you ask them.
Frequently Asked Questions About Breast Cancer Risk
Can I get breast cancer if no one in my family has had it?
Yes. Most women diagnosed with breast cancer do not have a family history of the disease. Family history can increase risk, but age, breast density, personal breast history, genetics, and other factors also contribute.
How much does family history increase breast cancer risk?
It depends on who was affected, how many relatives had breast cancer, and how young they were when diagnosed. Having a first-degree relative such as a mother, sister, or daughter with breast cancer increases risk, and multiple affected close relatives can raise it further.
Does breast cancer on my father’s side matter?
Yes. Inherited breast cancer risk can come through either parent. Breast or ovarian cancer on your father’s side should be included when discussing family history with your physician.
Do dense breasts increase breast cancer risk?
Yes. Dense breasts are associated with a higher risk of breast cancer, and dense tissue can also make cancer harder to see on a mammogram. Density is one risk factor and should be considered along with your other history.
Does having a breast biopsy increase my risk?
The biopsy itself does not necessarily increase risk, but what the biopsy showed may. Certain findings, such as atypical hyperplasia or lobular carcinoma in situ, are associated with increased breast cancer risk.
Should everyone get BRCA genetic testing?
No. Genetic testing can be very useful for people whose personal or family history suggests inherited cancer risk, but it is not automatically necessary for everyone. A risk assessment can help determine whether genetic counseling or testing should be considered.
Can a doctor tell me exactly whether I will get breast cancer?
No. Risk assessments estimate probability. They cannot predict with certainty whether one individual will or will not develop breast cancer.
“It Doesn’t Run in My Family” Is Good News. It Is Not the Whole Answer.
Family history is one piece of breast-health information.
If breast cancer has not affected your mother, sisters, daughters, grandmothers, or aunts, that is certainly something to be grateful for.
Just do not let that one fact stand in for the rest of your breast health.
Know when you are due for a mammogram. Know whether you have dense breasts. Keep track of previous breast biopsies and findings. Learn what happened on both sides of your family. And if you are uncertain about your personal risk, ask.
You do not need to be frightened of breast cancer to take breast health seriously.
You just need good information and a plan.
Call Dr. Andy Higgins’ office at (541) 749-7000 if you have questions about breast cancer risk, an abnormal mammogram, a breast lump, a second opinion, or other breast-care concerns.
We are here for you.
Dr. Andy Higgins, M.D., and Team