October 9, 2026
When breast cancer runs in your family, it is natural to wonder whether it means your genetics have destined you to develop the disease, too. But inherited genetic mutations are only one piece of a much larger picture when it comes to understanding your breast cancer risk.
In fact, less than 10% of breast cancers are considered hereditary, according to the CDC. While certain genetic mutations can significantly increase risk, factors ranging from age and family history to breast density and previous radiation exposure can also contribute to a woman’s individual risk. This is why knowing the full potential of your individual risk is so important.
Ezinne Ihenachor, MD, a breast imaging radiologist affiliated with Memorial Hermann, says women should begin conversations about breast cancer risk with their primary care provider early, ideally by age 25. Understanding where you fall on the risk spectrum can help determine whether you need genetic testing, when you should begin breast cancer screening and what type of screening may be appropriate for you.
Breast Cancer Risk Is About More Than Genetics
Breast cancer risk is complex. While researchers have identified numerous factors associated with the disease, Dr. Ihenachor says that “age and being female are two of the strongest risk factors for breast cancer, but they are not the only ones.” There are other factors that can contribute to a person’s overall risk, including family history, breast density, a personal history of breast cancer or certain high-risk breast lesions, inherited genetic mutations and a history of radiation to the chest. Race and ancestry can also provide important context when assessing breast cancer risk.
However, looking at any one of these factors in isolation does not necessarily provide an accurate picture of your likelihood of developing breast cancer. The range of differences reinforces why you should discuss your background, family history and other risk factors with your primary care provider. “Every woman should have a breast cancer risk assessment by the age of 25,” Dr. Ihenachor says. “This is especially important for Black women and those of Ashkenazi Jewish descent.”
According to the CDC, non-Hispanic Black women had the highest breast cancer incidence rates among women younger than 45 during most years studied from 2001 to 2022. Additionally, the National Cancer Institute says that about 2% of people of Ashkenazi Jewish descent, or approximately 1 in 50, carry a harmful change in the “BReast Cancer” gene (referred to as BRCA1 or BRCA2). By comparison, these mutations occur in approximately 1 in 400 people in the general population.
A key tool that many health care providers use is the Tyrer-Cuzick Risk Assessment Calculator, which considers multiple pieces of information to estimate a woman’s risk of developing breast cancer. The results can help physicians identify women who may benefit from additional evaluation or earlier screening.
The important point is not to wait until you reach the age for routine mammograms, typically age 40, to begin thinking about breast cancer. Knowing your risk earlier gives you and your physician more time to develop a screening plan tailored to you.
When Should You Consider Genetic Testing?
A breast cancer risk assessment done in your mid-20s can also help determine whether genetic counseling or testing may be appropriate. Certain inherited genetic mutations can significantly increase the likelihood of a woman developing breast cancer. Two of the best-known mutations are in the BRCA1 and BRCA2 genes.
Normally, these genes help protect against cancer. However, when you inherit a harmful mutation in one of them, that protection does not function as intended and instead increases the risk of certain cancers, including breast cancer. And your father’s family history matters just as much as your mother’s when discussing hereditary breast cancer risk with your physician. “You can inherit a BRCA mutation from either your mom or your dad,” Dr. Ihenachor says. means
Not everyone needs genetic testing, but it’s worth talking with your physician about your personal and family history, along with the results of your risk assessment, to determine whether testing is recommended for you.
An Increased Risk Can Change When Screening Begins
For women at average risk, annual mammograms should start at age 40. But women with an elevated risk may need to start much earlier. This is one of the most important reasons to understand your individual risk profile in your mid-20s.
If you have a genetics-based risk or a calculated lifetime risk of at least 20%, your screening may begin at ages 25 to 30 with annual MRI, with the addition of annual mammography at a variable starting age between 25 and 40, depending on your specific risk factors. The screening itself may also look different if you are at higher risk, where a physician may recommend additional imaging or a more intensive screening schedule. But Dr. Ihenachor has a word of caution: Knowing your risk does not tell you whether you will develop breast cancer. Instead, it gives you information that can help you and your physician determine when and how closely you should be screened.
What Can You Do to Lower Your Breast Cancer Risk?
Many of the factors that contribute to breast cancer risk cannot be changed. There are, however, a few lifestyle factors you can address to decrease your risk. Dr. Ihenachor notes three in particular:
- Exercise regularly. Staying physically active is one of the lifestyle behaviors associated with a lower risk of breast cancer.
- Maintain a healthy weight. Keeping your weight within a healthy range is important, especially after menopause when increased body fat is associated with higher breast cancer risk.
- Limit alcohol. Reducing alcohol consumption is another step you can take to lower your risk.
These habits are important, but they cannot eliminate the possibility of developing breast cancer. This is why prevention is only part of the conversation. Knowing your risk and following the appropriate screening recommendations is vital.
Knowledge Is Power
It can be unsettling to learn that many breast cancer risk factors are outside of your control. But there is something you can do: understand your individual risk and act on that information.
To gain that knowledge, start the conversation with your health care provider by age 25. Share your family history, complete a breast cancer risk assessment and ask whether genetic counseling or testing may be appropriate for you. Once you know your risk category, follow the screening recommendations your physician provides.
Understanding your risk will not tell you with certainty whether you will develop breast cancer. But it can help make sure that should cancer develop, you have the best opportunity to find it early and begin treatment promptly.
“Knowledge is power,” Dr. Ihenachor says. “Knowing the risk category you fall into, acting on that information and following screening recommendations can save your life.”
