Clinical implications of risk factors for breast cancer

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Abstract
Little is known about the actual causes of breast cancer, but a great deal is known about risk factors: characteristics of individual patients that increase their chances of developing breast cancer above the level of risk in the general population. The factors may be classed generally as genetic (familial history), hormonal (age at menarche and at menopause, parity, age at first birth, etc.), nutritional (possibly including social, economic, and ethnic factors), morphologic (proliferative breast disease, including cancer predictive of later risk), and breast irradiation. Because current understanding of how these risk factors relate to breast cancer causation is minimal (except for irradiation), there are few practical measures for primary prevention. However, there can and should be major use of current knowledge in arranging secondary prevention through screening and possibly even prophylactic mastectomy. The author's concern was that, at the time the National Conference on Breast Cancer was arranged, there was little consideration of breast cancer risk in the woman who lacked risk factors. Since that time, other authors have published a strong statement to the effect that breast cancer rates still are substantial and important in these women. In the current report, the author illustrates the same point for other "low-risk" groups to support the argument that by current knowledge, no adult American woman is at such low risk for breast cancer that she can safely be excluded from the educational and screening programs appropriate for her age.

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