What you can do

Death rates from breast cancer have been dropping, especially among younger women.

Breast cancer often has no symptoms in its early stages. If you notice any of the following signs, you should see your doctor.

• A lump or thickening in or near the breast or underarm. Nipple tenderness.
• A nipple turned inward (inverted) into the breast.
• A clear or bloody fluid discharge from your nipple.
• A change in breast size or contours.
• Any flattening or indentation of the skin over your breast.
• Red or irritated skin over the breast.
• Pitting of the skin over your breast, similar to an orange peel.

• A clinical breast exam by a doctor: You may need these exams yearly or more often, depending on your personal level of risk.
• Mammograms: All women should get a mammogram every year beginning at age 40. Mammograms are X-ray pictures of the breast. Yearly mammograms reduce the risk of death from breast cancer by 25 to 35 percent in women more than 50 years old. If you have a higher risk of developing breast cancer, your doctor may consider that you start this and other breast cancer screening before age 40.
• Breast self-exam: The organization breastcancer.org offers helpful tips on how and when to perform a self-exam. Breast self-exams cannot replace regular screening mammograms or clinical breast exams by your doctor. Research has shown that statistically, breast self-exams alone don't reduce the number of deaths from breast cancer or increase the number of cancers detected. But in any one woman they can result in the detection of a problem.
• MRI: Magnetic resonance imaging uses a powerful magnet to make detailed pictures of breast tissue. Research has shown that MRI scans are better than mammograms at finding invasive cancers early in high-risk women, especially in younger women who have dense breast tissue. The American Cancer Society recommends yearly MRI screening for women with a lifetime breast cancer risk of 20 percent or higher. If your Navigenics results place you in this risk category, talk with your doctor about whether an MRI is appropriate for you. The ACS also recommends annual MRI screening for women who received chest radiation between ages 10 and 30 and women with a strong family history of breast and ovarian cancers. MRI is not recommended for routine screening because it has a high rate of false-positive results — finding problems where none exist. The quality of the MRI scan and interpretation can also be an issue.
• Ultrasound: An ultrasound device sends out waves that bounce off tissues, and a computer uses the echoes to create a picture. Ultrasound can be used in a woman of any age to evaluate a breast thickening or lump. This technique isn't used for routine screening because it has a high rate of false-positive results.

Anti-estrogen drug therapy. Medications for preventing breast cancer affect the hormone estrogen, which influences the growth and development of many breast tumors. (These tumors are called estrogen-receptor positive.) Because of significant side effects, these drugs are used only after careful consideration in individuals at very high risk, usually because of a significant family history or because they carry one of the rare BRCA gene mutations, which Navigenics does not test for.

• Tamoxifen. Tamoxifen is approved by the Food and Drug Administration for breast cancer prevention. Tamoxifen blocks the receptor in estrogen-receptor-positive breast cancer cells, preventing them from growing. Research has shown that tamoxifen results in a relative risk reduction of about one-third for non-invasive breast cancer and about one-half for invasive breast cancer in women at high risk of developing breast cancer. It has short-term side effects, but also long-term risks: uterine cancer, blood clots in the legs or lungs and stroke. Because of these risks, women taking tamoxifen should be monitored by their doctors for any sign of serious side effects.
• Raloxifene. Raloxifene is approved for prevention and treatment of postmenopausal osteoporosis but is also used to prevent breast cancer. Like tamoxifen, raloxifene blocks the effect of estrogen on breast tissue. Research has shown that raloxifene is as effective as tamoxifen in preventing estrogen-receptor-positive breast cancer in postmenopausal women at high risk for developing breast cancer. Although raloxifene reduces the risk of invasive breast cancer, it does not have the same protective effect against non-invasive cancer. Raloxifene has a lower risk of certain side effects such as uterine cancer and blood clots in the legs or lungs, compared to tamoxifen.

Prophylactic oophorectomy. This measure is only considered for women at very high risk of breast cancer because of a significant family history or because they carry one of the rare BRCA gene mutations, which Navigenics does not test for. This surgical procedure removes the ovaries and fallopian tubes. It lowers the amount of estrogen available to stimulate estrogen-receptor-positive breast cancer. However, removing your ovaries means you will experience early menopause, exposing you to a different set of risks, including osteoporosis and menopausal symptoms.

Prophylactic mastectomy. This measure is only considered for women at very high risk of breast cancer because of a significant family history or because they carry one of the rare BRCA gene mutations, which Navigenics does not test for. This surgical procedure removes nearly all of the breast tissue, so there are very few breast cells left behind that could develop into a cancer. If you take this step, there is no guarantee that you will not develop breast cancer.

Early detection. Regardless of risk, every woman should practice early detection measures. Careful monitoring may not prevent breast cancer, but it increases the chance that cancer will be caught early, while it is non-invasive and most treatable. Talk to your doctor about developing a specialized program for early detection that meets your individual needs and gives you peace of mind.

Avoid long-term HRT. Using postmenopausal hormone replacement therapy for several years, particularly estrogen and progesterone combined, increases your breast cancer risk and the likelihood that cancer won't be caught until it's more advanced. Your risk climbs steadily each year you continue to use it. If you stop using HRT, it seems to take about five years for your risk to drop back to normal. Use of estrogen alone does not appear to increase risk of breast cancer, although study results have been mixed. If you're approaching menopause, talk to your doctor about options for managing your symptoms, including short-term hormone therapy.

Don't smoke. Smoking is linked to an increased risk of breast cancer. Smoking can also increase complications from breast cancer treatment.

Work out. Get 30 minutes of aerobic exercise three to five times a week. Some studies have shown that brisk walking, swimming, running or biking can help prevent cancer and its recurrence. (Check with your doctor before beginning a strenuous exercise program.) Other research suggests that exercise boosts the immune system, limits weight gain from chemotherapy and eases treatment side effects.

Maintain a healthy weight. Research has shown that significant weight gain between age 18 and menopause increases your risk of breast cancer. Overweight women also have an increased risk of developing breast cancer after menopause.

Eat a healthy diet. Researchers disagree on whether certain vegetables, fruits or supplements reduce risk for breast cancer. However, a healthy diet can help you lose weight or maintain normal weight, which can lower breast cancer risk. Here are the most important changes to make:

• Add more fruits, vegetables, beans and high-fiber grains. Substitute monounsaturated fats such as olive oil for saturated fats and animal fats. Avoid trans fats.
• Do not replace high-fat foods with simple carbohydrates such as white bread, rice and potatoes.
• Aim for a varied diet instead of eating the same foods every day.

Eat your omega-3's. Consider incorporating omega-3 fatty acids into your diet. Two servings a week of fatty fish, such as salmon, trout, herring, sardines, tuna and mackerel, are a good source of these fats, which may suppress the growth of tumor cells. (You will need to be aware of the mercury content of some of these fish, especially if you are pregnant or might get pregnant. Check our chart for help selecting fish high in omega-3s but low in mercury.) If you don't eat much fish, ask your doctor whether you should take a dietary fish oil supplement of about 1,000 or 1,200 mg. The supplements may cause excessive bleeding in some people.

Ask about the risks of birth control pills. Overall, risk of breast cancer for users of birth control pills is small and appears to be confined to the short term. Risk levels return to normal within five to 10 years after discontinuing use. Because this is an area of ongoing study, talk with your doctor about the latest information on birth control pills and breast cancer.

Breast-feed your baby if possible. Some studies suggest that breast-feeding may slightly lower breast cancer risk, especially if it is continued for 18 to 24 months.

Avoid alcohol. Avoid alcohol if you are at heightened risk for breast cancer. One drink a day raises your risk by 10 percent, one recent study found. Three or more drinks a day raise it by 30 percent. It doesn't matter what kind of alcohol — wine, beer or hard liquor.

Consider aromatase inhibitors. If you are at high risk of breast cancer due to many factors, discuss aromatase inhibitors with your physician as an option. These drugs block an enzyme, aromatase, which is critical for estrogen production in women who have experienced menopause. They currently are used in women who have already had breast cancer, and clinical trials are under way to test whether aromatase inhibitors lower other women's risk of breast cancer. The approved drugs include Arimidex (anastrazole), Femara (letrozole), and Aromasin (exemestane). Aromatase inhibitors are not without side effects and may contribute to bone fractures and osteoporosis.

• Has anyone in your family had breast cancer? How old were they when they were diagnosed?
• Have you found any unusual lumps during breast self-exams? Do you have nipple discharge, bleeding or breast pain?
• Are you are taking any hormones or medications that can cause breast tenderness or increase your risk of cancer? (Make a list of all the medications you are taking, as well as herbs or vitamins.)

• Conduct a baseline breast examination.
• Depending on your age, risk and findings, send you for a mammogram or other screening test.
• Change or adjust medications if they may be contributing to symptoms or cancer risk.
• Refer you to a breast specialist if your history or findings are complex.
• Schedule you for regular mammograms.
• If your risk is extremely high, based on family history or other factors, refer you to specialists for further evaluation.