Many women worry about breast cancer, especially those around the age of 40 and above.

You may already know some of the breast cancer risk factors, such as being female itself exposes you to a higher risk due to possessing a higher volume of breast tissue.

However, there are lesser-known risks too. It helps you to understand them and reduce your risk.

Here are five such lesser-known risks of breast cancer and what you can do:

1. Dense breast tissue

Dense breast tissue is more prone to breast cancer.^[1] Yet many women don’t know what dense breast tissue is and how it may trigger breast cancer. Your breasts may not feel different if they are dense. Also, breast density is not related to firmness or size. You can only tell if someone has dense breast tissue on a mammogram.[2] Breasts are known as dense if you have more fibrous and glandular tissue than fatty tissue as seen on a mammogram.

With the older technology mammograms, dense breasts pose another risk by making it harder for doctors to detect cancer hiding behind dense tissue in some cases. But now the latest 3D mammography machines are designed to provide higher-quality images from multiple angles and improve breast cancer detection in dense breast tissue.^[3]

What you can do: Check if you have dense breasts- by undergoing a 3D mammogram. Talk to your doctor about your breast density.

If you are already screening yourself every year as a healthy routine for early detection of breast cancer, your mammography report may already have your breast density mentioned. There are four categories of breast density ranging from almost all fatty tissue to very dense tissue with very little fat. Your radiologist will explain your category with the help of your mammogram report.

2. Having your first child at a later age

Women who have their first child at age 35 or later carry about three times the breast cancer risk compared to women who have their first child around the age 18. Having more children does not significantly reduce the risk if the first birth occurs at a later age.[4]

What you can do: While you can’t change your reproductive history, please discuss your risk factors with your doctor and follow the recommended screening guidelines diligently.

3. Certain non-cancerous breast conditions

Certain non-cancerous breast conditions sometimes can mean a higher risk of breast cancer. One of these is LCIS (lobular carcinoma in situ), where abnormal cells in the breast lobules (milk-producing glands) exist. It’s not cancer itself, but it does mean a higher chance of getting breast cancer later. Another condition like this is atypical hyperplasia i.e., breast cells look abnormal and grow too much. Doctors usually find these conditions during a biopsy, which is a test to check for breast issues.

What you can do: If you have been diagnosed with any of these conditions, make regular screening with a 3D mammography a priority irrespective of your age, stay vigilant about any changes in your breasts, and report any new lumps, pain, or changes in breast shape or size to your doctor immediately.

4. Early age periods

Women who started menstruating before age 12 have a 30% higher risk of breast cancer compared to those who started at age 15 or later.^[5]

What you can do: If you are concerned about breast cancer risk due to your early menstruation history, please prioritize regular 3D mammography, maintain a healthy lifestyle, and discuss your concerns with a doctor. Medications or genetic counselling also may be recommended based on your individual risk factors. Taking proactive steps to manage your breast health empowers you to take charge of your well-being and inspire positive changes in your and your loved one’s lives.

5. Your belly fat. Not just obesity

What we already know is that obesity is strongly linked to increased breast cancer risk due to factors like increased estrogen levels from fat tissue, inflammation, insulin resistance, and high cholesterol.^[6]

However, women with normal weight but central obesity (high waist circumference) consistently have a higher risk of breast cancer, especially in their postmenopausal phase.^[7]

What you can do: Monitor your weight and always try to stay below 24 BMI. Even if you are a normal-weight person, keep track of your waist measurement and aim to maintain it below 88 cm. Follow a healthy diet, exercise regularly, and have health check-ups, including cholesterol levels, blood sugar, and other routine tests your health condition may need, along with mammography for routine breast cancer screening.

In conclusion

Understanding these lesser-known risks of breast cancer can empower you to stay breast-healthy. Here are some general tips for your action:

• Never miss your annual mammogram: Annual mammograms are vital. They can detect breast cancer early when it is most treatable. Don’t rely on breast self-exams or other modalities. Make it a priority to schedule your screening every year even if you are feeling perfectly healthy.
• Select the right mammography centre: You may have many options at your place to get a mammogram done. For example, a diagnostic lab, a hospital, or a dedicated breast clinic. How to select one among all available choices? Here are three easy steps to help you navigate well in choosing the right mammography centre.
• Overcome your mammography anxiety if you have any: If you feel anxious before a mammography session, you are not alone. Your stress could be due to either it being your first mammogram, your fear of discovering cancer, some myths harboured in your mind, or your past uncomfortable experience. Whatever your reason, it’s important to remember that mammograms save lives, and here are seven tips to help you relax before your next mammogram.
• Stay informed. Stay healthy: Your family needs you forever. Your health is as important to them as it is to you. Keep up with the latest research and reliable information on mammography and breast health. Follow healthy routines and medical advice to protect yourself and your loved ones.
• Take timely actions: The best protection against breast cancer is early detection. Hence, if you are eligible for breast screening either by age (40 years and above) or due to high-risk factors such as family history (in which case even if you are younger than 40 years), subscribe today to an annual screening mammography plan at a center near you and never miss your test – A simple ritual that can save your life!

1. Boyd NF, Guo H, Martin LJ, et al. Mammographic Density and the Risk and Detection of Breast Cancer. New England Journal of Medicine. 2007;356(3):227-236. doi:10.1056/nejmoa062790
2. https://www.webmd.com/breast-cancer/news/20180626/study-confirms-denser-breasts-are-more-prone-to-cancer accessed on 9 April 2022.
3. https://www.mayoclinic.org/tests-procedures/3d-mammogram/about/pac-20438708 accessed on 9 April 2022
4. MacMahon B, Cole P, Lin TM, et al. Age at first birth and breast cancer risk. Bull World Health Organ. 1970;43(2):209-221.
5. Brinton LA, Schairer C, Hoover RN, Fraumeni JF. Menstrual Factors and Risk of Breast Cancer. Cancer Investigation. 1988;6(3):245-254. doi: https://doi.org/10.3109/07357908809080645 
6. Engin A. Obesity-associated Breast Cancer: Analysis of risk factors. Obesity and Lipotoxicity. 2017;960:571-606. Doi: https://doi.org/10.1007/978-3-319-48382-5_25
7. Park YM, White AJ, Nichols HB, O’Brien KM, Weinberg CR, Sandler DP. The association between metabolic health, obesity phenotype and the risk of breast cancer. International Journal of Cancer. 2017;140(12):2657-2666. doi: https://doi.org/10.1002/ijc.30684