Commentary: The average risk of breast cancer is higher than you think

When it comes to mammography, I am not a fan of “normal.” Being told that your mammogram is normal might sound nice, but normal doesn’t tell you anything other than right now, at this exact moment, you don’t appear to have any evidence of breast cancer.

“Normal” doesn’t tell you what next year’s mammogram might look like. Or the one 10 years from now. Normal does nothing to help you decide whether you need to start making lifestyle changes or undergo genetic testing to help curb your risk of developing breast cancer over the course of your life.

Instead of being asked to settle for the “normal” amount of information we’re usually given, women should seek out the tools that will empower them to take breast health into their own hands.

Last year, Hoag Women’s Health Institute launched the Hoag Early Risk Assessment (HERA) program to provide women between the ages of 35 and 55 undergoing screening mammography with both the results of their screening mammogram and their breast cancer risk profile, based on two trusted risk-assessment models, the Gail and Tyrer-Cuzick.

Due to the success of the program, we are now developing a program for younger women who are not getting annual screening mammograms. The sooner women know their risk, the more empowered they are to make change toward prevention.

In the HERA program, women fill out a questionnaire at any one of Hoag’s six imaging centers at the time of their screening mammogram that assesses everything from body mass index to family history to lifestyle risks such as hormone use and smoking. A sophisticated computer program processes their answers and determines a woman’s unique, long-term and five year breast cancer risk.

The results are mailed along with their mammogram results to the women and their physicians. Women who have a normal mammogram but heightened risk receive a call from a high risk breast cancer nurse practitioner who shares the results as well as evidenced-based guidelines for risk reduction from the National Comprehensive Cancer Network.

HERA switches the focus of breast health from the realm of diagnosis and treatment to the much more empowering world of prevention, which is where I believe breast cancer should be focused.

So far, over 12,000 women have been screened, and 500 women were determined to have a heightened risk. Our nurse practitioner has personally reached out to the high-risk women, who reported that they appreciated being able to use the information to make educated decisions with their physicians about how to address their risk.

Of the women who completed the consultation, 94% were eligible for an annual screening MRI, 95% were advised to talk with their doctors about medication that reduces breast cancer risk, and 41% were eligible for genetic counseling. These were 35- to 55-year-old women who had no idea that they were at risk.

Women who participated in a pilot study of the program are now working to reduce their weight, increase their exercise and decrease alcohol consumption and smoking. Some have gone to genetic counseling, and all of them said they — and their physicians — understood their risk for developing breast cancer more than they had before.

Many people erroneously believe that if breast cancer doesn’t run in their family, they are automatically low or average risk. Nationwide, 1 in 8 women have a lifetime risk of developing breast cancer, with at least 75% of breast cancer cases caused by risk factors other than inherited genetic mutation.

That means that “average risk” is actually higher than you’d think, and women need to arm themselves with as much information as possible about what they can do to take control of their health.

It is my hope that breast cancer one day follows the skin cancer model, where people take action — wearing sunscreen — rather than just waiting for cancer to happen and then looking for the best program to help treat it. At Hoag, we are very good at treating breast cancer, but I hope we become equally known for helping women avoid it.

That way we can make prevention an integral part of breast health and save more lives. Prevention should be the new normal — a “normal” I could get behind.

DR. ALLYSON BROOKS is the Ginny Ueberroth executive medical director endowed chair of Hoag Women’s Health Institute and lives in Newport Beach.