According to ACOG guidelines, which breast cancer risk factors should be periodically assessed in women?

Updated: Feb 04, 2021
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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ACOG recommends that health care providers periodically assess patients' breast cancer risk by reviewing the history (level B). Breast cancer risk factors include the following:

  • Family history of breast cancer, ovarian cancer, or other hereditary breast and ovatrians syndrome-associated cancer (eg, prostate cancer, pancreatic cancer)
  • Known deleterious gene mutation
  • Prior breast biopsy with atypical hyperplasia (lobular or ductal) or lobular carcinoma in situ
  • Early menarche
  • Late menopause
  • Nulliparity
  • Prolonged interval between menarche and first pregnancy
  • Menopausal hormone therapy with estrogen and progestin (decreased risk with progestin alone)
  • Not breastfeeding
  • Increasing age
  • Certain ethnicities (eg, higher likelihood of  BRCA mutation in Ashkenazi Jewish women)
  • Higher body mass index
  • Alcohol consumption
  • Smoking
  • Dense breasts on mammography
  • Prior exposure to high-dose therapeutic chest irradiation at age 10-30 years

Women whose initial history indicates a potentially increased risk of breast cancer should have further risk assessment (level B), using the Gail model or another of the validated assessment tools available online, such as the BRCAPRO, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, International Breast Cancer Intervention Studies (IBIS, also known as Tyrer–Cuzick), or the Claus model.

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