Aetiology & risk factors of breast CA

Age

75% of women with breast CA >50 years old & 5% <40 years old
The likelihood of breast cancer rises markedly with increasing age during
the first 6 decades of life.

Female
The rate for male to develop breast cancer was 1.15 per 100,000 men
years compared to female at 42.6 per 100,000 women years.
History of neoplastic disease of the breast

Prior history of breast cancer carries an elevated risk of developing new

primary breast cancer.
Person with breast carcinoma in situ (lobular carcinoma in situ and ductal
carcinoma in situ) are at high risk to develop invasive breast carcinoma.
Person with breast tissue biopsy showing proliferative disease with and
without atypical cells has an increased risk to develop future breast
cancer. Benign breast disease with atypical hyperplasia lesion carries the
highest risk to develop breast cancer.

Family history

The risk is higher in women with breast cancer among young first degree
relatives. Sister carries more risk than mother
Carriers of BRCA1 and BRCA2 genetic mutation

Radiation exposure

Multiple exposures of therapeutic radiation to the chest for cancer at an

early age (less than 20 years old) pose a high risk of developing breast
cancer.
Contralateral breast cancer has been shown to develop after exposures of
high dose radiation used during radiotherapy for breast cancer.
Patients with Hodgkins disease receiving radiotherapy at high doses are
at high risk to develop breast cancer.
Screening using mammography has not been shown to significantly affect
the breast cancer status.

Reproductive Factors

First full-term pregnancy more than 30 years old.

Nulliparity.
Breastfeeding for duration more than 12 months is protective of breast
cancer.
Oral contraceptive use poses a mild increase of breast cancer risk
especially if it is use before the first full term pregnancy. However, the risk
is lower with low dose preparation.
Unopposed estrogen use in hysterectomised women mildly increases the
risk of breast cancer and only after longer term use (> 15 years).
Combination hormone replacement therapy has a mild risk for breast
cancer.

Age at menopause of more than 55 years old.

Age at menarche less than 12 years old.

Breast density
Higher breast density from mammography. The risk ranges from two times
in scattered fibroglandular density to four times in an extremely dense
breast.
Lifestyle

A body mass index of more than 25 has an increased risk to develop

breast cancer with higher death rate. Small waist and waist-hip ratio
(WHR) give a significant protection against breast cancer in premenopausal women.
Alcohol (especially beer) consumed more than 10 g/day especially
among postmenopausal women is a risk factor for developing invasive
breast cancer.
Moderate to vigorous exercise of more than seven hours in a week of
physical activity was inversely related to breast cancer.

http://bestpractice.bmj.com.ezproxy.lib.monash.edu.au/bestpractice/monograph/716/diagnosis/history-and-examination.html