One in eight women in the United States will develop breast cancer over their lifetime, according to the National Cancer Institute. To put that into perspective, if you know more than eight women, chances are you probably know someone who has had breast cancer or will be diagnosed in the future.

If you’re trying to understand your risk, you may have so many questions for your doctor that you don’t even know where to start when making a list to narrow it down.

We spoke with Radha Iyengar, M.D., a breast surgeon on the medical staff at Texas Health Allen and at Texas Health Breast Specialists, a Texas Health Physicians Group practice, to get her insight on the top questions to ask to help you assemble that list.

“If you’re trying to understand your risk, it’s natural to have a lot of questions, and we do our best to answer every and any question you may have, or provide answers to questions you didn’t even know to ask,” Iyengar explains. “But if you’re looking for a good place to start, whether you have breast cancer or not, below are the top questions I receive, and are some of the most important to ask.”

What is the best screening test for breast cancer?

For decades, mammograms and clinical breast exams have been suggested as helpful tools for prevention, but it’s natural to wonder if there are newer or different prevention tools out there.

“The best screening test for breast cancer continues to be mammograms combined with a clinical breast exam,” Iyengar says. “Women at average risk in the U.S. should start getting mammograms at age 40 and annually after that.”

Clinical breast exams, which is an exam by your doctor, should happen during an annual physical exam, such as your Well Woman exam. While the American Cancer Society no longer advocates for regular clinical breast exams or breast self-exams as part of a routine breast cancer screening schedule, Iyengar adds that this does not make a case for these exams never being done.

“In some situations, such as for women at a higher-than-average risk for developing breast cancer, your doctor may still offer clinical breast exams, along with providing counseling about risk and early detection,” she explains. “Additionally, some women may still opt for regular self-exams for peace of mind and to keep track of how their breasts look and feel so they can identify changes as soon as possible.”

What is the difference between a screening and diagnostic mammogram?

You may think there’s only one type of mammogram, the kind you might have been getting every year for a while now. So if your doctor suggests you also have a diagnostic mammogram performed, you may be wondering what the difference is.

“A screening mammogram is done when a woman has no breast issues or complaints and is performed as part of her annual preventive exams. This is to find cancers that are too small to feel on a clinical breast exam,” Iyengar explains. “A diagnostic mammogram is done to assess a new issue or complaint in the breast. The radiologist will read the study right away and add ultrasound evaluation if needed.”

The American Cancer Society recommends that women ages 40 to 44 consider starting annual screening mammograms, while women ages 45 to 54 should get mammograms once per year. If you are younger than 40 with a family history of breast cancer or a higher-than-average risk of developing breast cancer, Iyengar says your doctor will likely suggest starting yearly mammograms a bit earlier.

Can you lower your risk of developing breast cancer?

While there is no guaranteed way to completely prevent breast cancer, Iyengar says there are things you can do to lower your risk.

• Try limiting or avoid alcohol use – Alcohol increases the risk of developing breast cancer. Even drinking small amounts has been linked with an increased risk. If you drink, try to have no more than 1 alcoholic drink a day. A drink is considered as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (hard liquor).
• Exercise regularly – Studies have shown that moderate to vigorous physical activity is linked with lower breast cancer risk. The American Cancer Society recommends that adults get at least 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity activity each week (or a combination of these).
• Maintain a normal body weight – Both increased body weight and weight gain as an adult are linked with a higher risk of breast cancer after menopause.
• Avoid hormone replacement therapy after menopause – Using hormone therapy after menopause can increase your risk of breast cancer. To avoid this, talk to your health care provider about non-hormonal options to treat menopausal symptoms.

How do I know if my family history puts me at risk for developing breast cancer?

Family history can be an important topic to discuss with your physician when determining your risk of developing breast cancer. But determining what you need to disclose and how far back you need to go in your family tree can be tough. Iyengar says important family history to disclose includes:

• Breast cancer in 2 or more 1st and/or 2nd-degree relatives, especially if diagnosed at a young age
• Anyone in your family diagnosed with male breast cancer
• Breast and ovarian cancer on the same side of the family, such as multiple people on your maternal or paternal side
• A 1st or 2nd-degree relative with breast cancer diagnosed on both sides of the family (maternal and paternal)
• Breast cancer combined with Ashkenazi Jewish ancestry

Your doctor may also ask how old your relative(s) were when they were diagnosed (specific age or best guess), what stage they were diagnosed at and if they are still living.

I’ve been told I have dense breast tissue but what is it and how does it affect my risk factor?

“Dense breast tissue is normal breast tissue that is denser and therefore appears white on a mammogram,” Iyengar says. “Because of this, dense breast tissue decreases the sensitivity of mammograms, making them harder to interpret or detect issues that may warrant more testing. It is also an independent risk factor for developing breast cancer.”

Having dense breasts can affect you in two ways:

• Increases the chance that breast cancer may go undetected by a mammogram, since dense breast tissue can mask a potential cancer.
• Increases your risk of breast cancer, though doctors aren't entirely certain why.

As stated above, it’s recommended that women of average risk consider regular mammograms at age 40, but women at a higher risk may need to start earlier. Women with dense breasts, but no other risk factors for breast cancer, are considered to have a higher risk of breast cancer than average, so screening is recommended earlier.

If you’ve been told you have dense breasts, Iyengar adds that mammograms are still effective screening tools despite concerns about detecting cancer in dense breasts.

Can a breast biopsy cause cancer cells to spread?

If you’ve received a mammogram, and diagnostic mammogram, and it’s been recommended by your physician to have a biopsy performed, you may be worried about the likelihood of potential cancer cells spreading due to the procedure. However, Iyengar notes that breast biopsies are safe and have not been shown to cause cancer cells to spread.

The Takeaway

If you or a loved one are diagnosed with breast cancer or are concerned about your risk, keeping up with your regular screenings and consulting with a trusted physician for individual risk factors and additional measures you can take can go a long way for early detection and lowering your risks. While this list is not exhaustive, it can provide a good jumping-off point to get the conversation started between you and your physician. And remember, there is no question too small or silly, or too many questions you can ask regarding your health.

Click here to schedule your mammogram at a Texas Health breast center near you.