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  • br controlled trial previously investigated a long term dietary inter


    controlled trial previously investigated a long-term dietary inter-vention on breast cancer incidence.7 Results supported a Mediter-ranean diet supplemented with extra-virgin BYL-719 olive oil for primary prevention of breast cancer. Likewise, physical inactivity has been thought to raise the risk of getting breast cancer,6 and increased physical activity may lower breast cancer risk.8
    Nonmodifiable Risk Factors
    A nonmodifiable risk factor for breast cancer is female sex. The American College of Obstetricians and Gynecologists (ACOG) re-ported that 99% of breast cancer occurs in women. Another risk factor of getting breast cancer is age.1,3,9
    Family History
    Women with a family history of breast cancer, ovarian cancer, prostate cancer, pancreatic cancer, and inherited mutations in BRCA1 and BRCA2 gene carriers are at higher risk of breast cancer.1 Additionally, women with BRCA1 and BRCA2 genes have inherited mutations. Those who are carriers account for up to 30% of inher-itable breast cancer.10
    Reproductive Risk Factors
    Nulliparity, early menarche, late menopause, long menstruation history, never conceiving, not breastfeeding, conceiving late at age 30, recent use of oral contraceptives, and use of menopausal hor-mone therapy (eg, BYL-719 and progestin) raise the risk of breast cancer.3 A prospective, longitudinal cohort study of BRCA1 and BRCA2 mutation carriers was conducted between 1995 and 2017 with women from 80 participating centers in 17 countries.11 The results suggested that after oophorectomy, the use of estrogen therapy did not increase the risk of breast cancer among women who were carriers of the BRCA1 mutation.11
    2 M.J. Cadet / The Journal for Nurse Practitioners xxx (xxxx) xxx
    Breast Disorders and Breast Density
    Having a history of breast disorders was thought to increase the risk of breast cancer including atypical ductal hyperplasia, lobular carcinoma in situ, and atypical lobular hyperplasia.3 Women with high-density breast tissue are more likely to get breast cancer.1 Dense breast notification laws have been enacted in many states in the US to notify women of their risk of developing breast cancer. Failure to inform them about their risk or diagnosis is a potential source for malpractice.12 The state of Connecticut mandates in-surance companies cover additional testing for women with dense breasts diagnosed by mammography screening.12 It is believed consumers additional tests such as ultrasounds and magnetic resonance im-aging (MRI) may benefit these women to diagnose breast cancer.12
    Prediction Models
    Breast Cancer Risk Assessment Tool
    NPs need to consider a validated risk assessment tool to collect risk factors and health history. A well-known risk assessment tool, the Breast Cancer Risk Assessment Tool, is used to guide screening surveillance, genetic testing, and risk reduction. It assesses the risk of developing invasive breast cancer over the next 5 years and can be used with women up to age 90.13
    The Breast Cancer Risk Assessment Tool has been validated to assess breast cancer risk among Hispanic, black, white, Asian, and Pacific Islander women in the US. However, there are some limi-tations for its use. It cannot accurately estimate breast cancer risk among women with breast cancereproducing mutations in BRCA1 (a women suppressor gene) or BRCA2 or women with a previous breast cancer history, invasive breast cancer, or breast cancer in situ (ductal carcinoma in situ or lobular carcinoma in situ).13
    Other common validated tools are the Gail Model,14 a nonge-netic risk assessment model, and genetic risk models including the BRCAPRO,15 Claus,16 and Tyrer-Cuzick17 models. All of these screening tools have limitations. For example, the Gail Model may underestimate risk in Hispanic women born outside the US and black women with previous biopsies.14 Other breast risk assess-ment tools can be retrieved from about.html.