Published on January 28, 2025

group of smiling women with pink ribbons on their shirts.

Am I High Risk for Breast Cancer? How to Know and What to Do

Women know 40 is the recognized age to start getting a mammogram. However, when you’re at a higher risk for developing breast cancer, it’s never too early to start the conversation with your primary care provider.

“One in eight women get breast cancer,” said Charissa Etrheim, MD, Avera family medicine provider and breast expert at the High Risk Breast Clinic in Mitchell, SD. “Those at high risk have a 20% or more chance of developing breast cancer, according to the National Comprehensive Network.”

Know Your Risk

The best way to know your risk level is a mammogram if you are age 40 or older. Schedule a mammo.

Under 40 and wondering about your risk? Schedule a checkup.

But the good news? Just because you’re identified as high risk, doesn’t mean you’ll develop breast cancer.

Who do I talk with about my breast cancer risk?

When you go in for your annual checkup, tell your provider about the risk factors often associated with a higher risk of breast cancer.

These factors include:

  • A family history, whether it’s on your mom’s or dad’s side
  • If you’ve had radiation to the chest wall area; for example, radiation treatment for lung cancer
  • If you have dense breast tissue
  • If you started your period earlier than the average age of 11 or 12
  • Elevated body mass index (BMI)
  • High alcohol consumption
  • Estrogen/progesterone hormonal treatments

You may be asked to take the Tyrer-Cuzick Risk Assessment. In fact, all women who come in for a mammogram at an Avera location, starting at age 40, will take this risk assessement to determine their risk. Based off of your answers, this calculator offers an even more accurate picture of your breast cancer risk.

Just some things the assessment will cover include any previous breast biopsies, your age when you gave birth to your first child, your age of your last period, breast density and much more.

What happens after talking with my primary provider about my breast cancer risk?

Your primary care provider will help you take the next right steps, which may include the recommended course of starting a yearly mammogram at age 40. In some cases you may get referred to the High Risk Breast Clinic, with locations in both Sioux Falls and Mitchell. Here you’ll talk with a breast expert or genetic counselor.

At the High Risk Breast Clinic appointment, you and your team will:

  • Review your family medical history
  • Consider your breast cancer risk factors
  • Go over your personalized risk assessment
  • Discuss national recommendations for high-risk surveillance
  • Review breast imaging tools
  • Develop a personalized breast monitoring plan
  • Find ways you can incorporate risk reduction strategies into daily life

“You should know that your team expands across the Avera system,” said Etrheim. “You have access to a genetic team, surgeons, radiologist, clinicians, and many others who collaborate with your primary care provider to help you stay on top of your risk and breast health.”

For your convenience, Avera clinics can help accommodate virtual visits with genetic counselors and other health professionals.

Do I undergo more breast screenings? What might I expect?

“Your team will personalize your care to your needs,” said Etrheim. “The goal is to catch breast cancer in its earliest and most treatable stages.”

However, your screenings might start earlier than age 40, and happen more frequently. For example, your prevention plan might include a regular 3D mammogram once a year along with a clincal breast exam. In addition, you might have advanced imaging in the form of a breast MRI or contrast-enhanced spectral mammography (CESM).

A breast MRI offers a high resolution look at your breast tissue to discern any minute changes. During a CESM, you’re given a contrast dye that highlights potential abnormalities in your breast tissue when looked at through low- and high-energy X-rays.

Read more: The difference between mammogram and ultrasound

Can I lower my breast cancer risk?

Lifestyle choices can make a difference when it comes to health and illness even if you are considered high risk. Here are some good self-care practices that every person can weave into their everyday life:

  • Reach and maintain a weight that feels good for your height and frame
  • Get 30 to 40 minutes of moderate exercise most days of the week
  • Limit your alcohol intake
  • Stop tobacco use
  • Breastfeed a year or longer — just one of the many benefits of breastfeeding for both baby and mom is lowering breast cancer risk

“In some cases, medicine is prescribed to help reduce risk,” said Etrheim. “With medicines, there are potential side effects including hot flashes, joint pains and vaginal dryness. We would cover pros and cons of medicines based on the woman’s risk because they might not be right for everyone.”

How much does breast cancer screening cost and is it covered by insurance?

Most health insurance plans cover mammograms for women age 40 and up at 100% every one to two years. Your insurance may also cover a baseline mammogram prior to age 40, so check your coverage. Those patients deemed high risk by their doctor should work closely with their insurance provider to see how additional mammos and other tests might be covered. Advanced imaging is not always covered in the same way routine screening mammos are.

“If there is ever a cost issue, talk to your doctor to see what payment plans or programs might assist you,” said Etrheim. “We want you to feel confident that you can manage your breast health along with the help of health professionals.”