What “High Risk” Means And What You Can Do

How do doctors estimate risk, what raises it, and what you can do today.

Image Courtesy of Peter Lindbergh via Vogue

Disclaimer: This article is for informational purposes only and does not replace medical advice. Always consult your GP or a specialist for your personal risk assessment and screening recommendations.

One in eight women will develop breast cancer in her lifetime. A statement many have heard, but few have really paused to consider. The risk of breast cancer among young adult women is increasing every year. According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer in women worldwide, and also in Belgium. But what does this number mean for us personally?

Not every woman has the same risk. Everything depends on age, genetics, lifestyle, and hormonal factors. That’s why there is growing attention to personalized risk assessment: exploring which tools are available to understand better your situation and what actions you can take.

Am I at risk?

To understand if you are at risk of breast cancer, imagine this: a 50-year-old woman is told that she has a 2% chance of developing breast cancer in the next five years. What does this mean in practice? How do you distinguish between “lifetime risk” and “relative risk”? Simply put, risk is not a prediction (“this will happen”), but an estimate (“this could happen”).

Lifetime risk refers to the chance, expressed over your entire life, of developing breast cancer. In the U.S., this is about 13%, or 1 in 8 women. Relative or absolute risk is “your chance is 2% over the next five years.” This translates to: “you have 1.5 times the risk of the average woman.”

It’s important to understand that these tools provide estimates without certainty. In short, a higher estimated risk does not mean you will definitely develop breast cancer, but it may indicate that you should pay extra attention to your risk factors.

Which factors are essential for me?

Factors can be divided into two categories: those you cannot change and those you can influence. It’s essential to know both, because the changeable factors give you opportunities to act.

Unchangeable factors

Your age is the most substantial risk factor: the older you get, the higher the risk. Sex also plays a role: breast cancer occurs much more frequently in women. Your family history or genetics can increase risk. Variants in genes such as BRCA1 and BRCA2 can significantly increase risk. Both genes help repair damaged DNA in your cells — think of them as a “DNA repair squad.” If either mutates, repair may not occur properly, and cells accumulate errors faster, which can lead to cancer. These mutations often occur at younger ages. Some studies suggest that the risk for BRCA1 mutation carriers can be as high as 72%.

Your personal medical history also matters: previous breast problems or chest radiation at a young age can influence risk.

Changeable factors

Do you drink alcohol daily or in the evenings? It’s best to remove this habit from your lifestyle. Excessive alcohol consumption slightly but measurably increases risk. As the ads say: drink in moderation. Regular exercise and healthy nutrition already put you on the right track. Being overweight causes fat tissue to produce estrogen. For women in menopause undergoing hormone therapy (HRT), consult your doctor to adjust dosage and consider a short-term plan instead of a long-term trajectory.

In short, there are things you can actively work on, and that’s good news.

Please, doctor, save my life and educate me

Doctors use models or calculators to map personal risks — not to cause panic but to determine whether extra action or attention is useful. A widely used tool is the Breast Cancer Risk Assessment Tool (BCRAT), or Gail model. This calculator estimates the chance that a woman will develop breast cancer in the next five years and over her lifetime. It is not a diagnosis but a risk indicator.

A woman fills in information such as age, age at first menstruation, number of breast biopsies, and family history (mothers, sisters, daughters with breast cancer). The calculator then estimates risk. Note that the Gail model does not account for BRCA1 or BRCA2 mutations. Women with hereditary risk factors need a different genetic test or tool.

The Tyrer-Cuzick model (IBIS) is another tool, similar to the Gail model, but more focused on hereditary factors. It considers family history and genetic factors extensively when estimating risk.

What can you do?

Very simple:

• Collect your family and personal medical history (who in your family had breast cancer, at what age, what type)

• Discuss with your doctor which model is most appropriate for you

• If your risk appears reasonably high, discuss whether referral to genetic counseling, MRI screening, or preventive medication is appropriate

What you can do today

Enough theory — what can you do concretely? Here are actions Generation Z to X can take:

• Limit excessive alcohol: each daily drink counts, so try to reduce intake

• Exercise regularly: aim for 150 minutes of moderate-intensity activity per week or 75 minutes of vigorous activity

• Monitor your weight — especially after menopause — and focus on healthy nutrition and physical activity

• Discuss with your doctor whether postmenopausal hormone therapy is suitable for you — and understand the benefits and risks

• Breastfeeding is not only beneficial for your baby, but it may also reduce your breast cancer risk

• Be proactive — know your family history, talk with your doctor, and be aware of your risk instead of hoping “it will be fine”

Screening: when to start, what to expect

Screening is intended to detect breast cancer early. Early detection generally leads to better treatment options. In the U.S., mammography is often recommended from about age 40 for women with average risk, and earlier or more frequently for high-risk women.

In Belgium, a population-based breast cancer screening program invites women aged 50–69 every two years for a free mammogram. This program is organized by the Centrum voor Kankeropsporing in Flanders, BruPrev in Brussels, and the Centre Communautaire de Référence pour le Dépistage des Cancers in Wallonia.

Women under 50 may get a mammogram if symptoms appear, as a doctor prescribes.

What to expect from a mammogram: A mammogram is an X-ray of the breast, sometimes supplemented with an ultrasound or an MRI if needed. Screening is recommended for women at average risk every 1–2 years after a certain age. Screening before symptoms can detect tumors while they are still small, significantly improving five-year survival. Guidelines may change, so discuss with your doctor the best timing.

Next steps

You now have a better understanding of what your breast cancer risk actually means, the factors involved, how doctors assess it, and most importantly, what you can do. Gather your family history, and plan a discussion with your GP or breast/oncology specialist if you feel extra attention is needed. The earlier you act, the more precise your picture knowledge is power. Don’t forget the psychological side; learning that your risk is higher can be stressful. You don’t have to face it alone.

Stay alert, stay active, and keep talking. Don’t let risks paralyze you — let them motivate you.