An SJRA breast imaging specialist helps you understand your breast cancer risk


We hear the phrase a lot: risk factor. It can sound scary, but what does it really mean to have a risk factor – or multiple – when it comes to breast cancer? Is it a guarantee you’ll be diagnosed with the disease? Does being risk-factor free mean you’ll be breast cancer-free your whole life? If you only eat vegetables and never have a sip of alcohol, does that lower the chance of having breast cancer?

These are questions that may enter all our minds, but playing guessing games when it comes to personal health is not recommended, so we caught up with South Jersey Radiology’s Breast Imaging Radiologist Dr. Nikki Ariaratnam to understand breast cancer risk factors and what they mean for your future health.

Dr. Nikki Ariaratnam worked with state legislators to ensure a law passed mandating insurance companies cover additional breast screening, when needed

What is a risk factor?

First things first, we’re all going to close out of WebMD and have an expert answer this significant question: “What we mean by risk factors are things that elevate your risk above the baseline risk of having breast cancer for an average person,” says Dr. Ariaratnam.

Breast cancer is a random mutation though, she says. So, while risk factors can point to a higher chance of getting the disease, it doesn’t mean you’ll definitely get it. On the flip side, having zero risk factors for breast cancer doesn’t mean you’re guaranteed to be cancer-free.

And not every risk factor is controllable. For example, your family history.

“That’s one of the risk factors that can have the most impact,” she says, “specifically if you have a family member who is a first degree relative – a mother, sister or daughter – who was diagnosed with breast cancer.”

But it’s important to find out when they were diagnosed. If the diagnosis happened pre-menopause, you should start getting your annual mammogram screenings 10 years before the age when they were diagnosed. Dr. Ariaratnam also recommends undergoing genetic testing in these cases.

Your age will also have an effect on your risk of breast cancer, with likelihood increasing the most throughout your 40s. 1 in 6 (12.5%) of breast cancers occur in women aged 40 to 49.

The third risk factor is how long you’ve been having periods, says Dr. Ariaratnam. “If you had your first period before age 12 or if your menopause happened after age 55, you’re at a slightly more elevated risk of breast cancer,” she says.

So what can you control?

There are a number of breast cancer risk factors you can control – for the most part – including managing your weight and limiting alcohol intake.

In addition, your choices surrounding pregnancy and breastfeeding play a role. (And remember, this doesn’t mean that if you get pregnant you definitely won’t get breast cancer or that if you don’t get pregnant, you’re guaranteed to get the disease.)

“When patients are pregnant and breastfeeding, you’re disrupting the surges of estrogen and progesterone,” says Dr. Ariaratnam. “So we tell patients when they’re considering breastfeeding, that the breasts are finally doing what they always wanted to do. Let them do it if they can.”

Another hormone-related risk factor is undergoing hormone replacement therapy during menopause. “The shortest amount of time you can be on those extra hormones, the better for your breast health,” she says. “Because while it does make you feel like a pre-menopausal woman, it’s also stimulating your breast tissue and can make the tissue more dense. So it’s something we need in our toolkit to deal with menopause, but it shouldn’t be a long-term solution.”


“When you choose a Comprehensive Breast Imaging Center, you’re not just guaranteeing that the equipment is good and the technologists are good, but then also the radiologists who are reading your studies are at the top of their game.”


What should you do with all this information?

Yeah, it’s a lot of information. But it’s all important when it comes to sustaining your breast health. Luckily, Dr. Ariaratnam has an easy-to-follow timeline for you.

It starts in your 20s. You’ll want to make sure you know your family history, and that your family/primary care doctor and your OB/GYN also know that family history.

In your 30s, if you get pregnant, you’ll want to breastfeed, if possible (this applies to getting pregnant at any age). You’ll also want to keep an eye on how your breasts change during these two life stages and be sure to tell your doctor if you feel any lumps during a breast self-exam.

In your 40s, mammogram screenings start and continue every year, until you and your doctor decide you can stop.

Before your first screening, says Dr. Ariaratnam, make sure you’re going to a Comprehensive Breast Imaging Center – a special accreditation from the American College of Radiology – like South Jersey Radiology. South Jersey Radiology has state-of-the-art equipment, and its technologists receive additional training consistently to make sure screenings are conducted correctly

“When you choose a Comprehensive Breast Imaging Center, you’re not just guaranteeing that the equipment is good and the technologists are good, but then also the radiologists who are reading your studies are at the top of their game,” Dr. Ariaratnam says.

Once you start your screenings, you’ll be told how dense your breasts are, as part of the screening’s findings.

“If your breasts are categorized as dense or extremely dense,” Dr. Ariaratnam says, “you should get additional evaluation of your breast cancer risk, using the Tyrer-Cuzick Breast Cancer Risk Assessment Tool.”

The tool can be found online, and anyone can enter their risk factors as well as other personal information – including their breast density. Then you’re given a risk percentage. If it’s above 20% overall lifetime risk, says Dr. Ariaratnam, you can add a breast MRI to your annual mammogram screenings.

“I helped lobby for the legislation that mandates the additional MRI screening to be covered in the state of New Jersey,” she says. “And if you’re in the 15% to 20% range, or if you don’t like getting MRIs, you can also do breast ultrasound – just another way of looking for the dense breast tissue and checking to make sure there’s nothing being masked on the mammogram.”

But the main takeaway, Dr. Ariaratnam says, is that early detection saves lives. “If everyone got annual mammogram screenings starting at age 40, there would be up to a 40% reduction in breast cancer deaths,” she adds. “When breast cancer is found early, we find smaller instances and then it is highly treatable. It can be managed without any significant risk leading to better outcomes.”