There are several breast cancers, differing according to their location

and extent. The three most frequently encountered forms are:

Carcinomas in situ: the cancer cells remain in the ducts (ductal cancer
in situ) and the lobules (lobular cancer in situ), and have not been
disseminated into the surrounding tissues. Ductal cancer in situ is the
most common form of breast cancer in situ, according to the INCa;
Infiltrating carcinomas: here, the cancer cells have invaded the tissues
surrounding the ducts and lobules. If this type of cancer is not treated
in time, it leads to the formation of metastases in the axillary lymph
nodes and the rest of the body;
Inflammatory carcinomas: they are located on the surface, at the skin
level.
There are also rarer forms of breast cancer, such as mucinous
carcinoma, tubular carcinoma, tubular or papillary carcinoma.
• The origin of breast cancer is multifactorial and one of the current
findings is that the risk of breast cancer increases from year to year.
The unfavorable evolution of hormonal and reproductive factors over
generations partly explains this result. But this also suggests that
emerging risk factors not yet clearly established must also be involved
(INCa, 2019).
• Proven risk factors
Proven risk factors are those for which there is sufficient data to

Individual risk factors

 Age
As with most cancers, age is a risk factor for breast cancer: the older a
woman gets, the more her risk increases. It usually affects women
after menopause. The risk is highest around 65-74 years and the
median age at diagnosis is 63 years (INCa, 2019).
 Genetic
Family history of breast cancer represents an important risk factor.
The increased risk associated with family history may be due to
hereditary genetic factors but also linked to sharing the same lifestyle
and environmental factors.
Around 10% of breast cancers occur in the context of genetic
predisposition or a family history of breast cancer (Loibl, 2021). The 2
most frequently found genes are the BRCA1 (BReast CAncer 1) and
BRCA2 (BReast CAncer 2) genes which play an important role in DNA
repair and whose transmission is autosomal dominant.
 Breast diseases
Patients with atypical hyperplasia have a 3 to 5 times higher risk of
developing breast cancer.
Having dense breasts is also associated with a higher risk of breast
cancer. Having high breast density is not a disease in itself, it means
that the breast contains little fatty tissue compared to fibrous and
glandular tissue. Compared to women with very fatty breasts, the risk
of cancer could be 3 to 5 times higher in women with dense or very
dense breasts .
 Exposure to natural hormones throughout life
The duration of exposure to natural hormones is defined by the
period between menarche and menopause. The risk of breast cancer
is linked to this duration, and increases with the number of menstrual
cycles over a lifetime. Early puberty and late menopause, increasing
this duration, are risk factors.

According to a study, the risk of developing breast cancer in a woman

who had her period before the age of 11 would be 1.19 times higher
compared to menarche at 13 years old. Conversely, early menopause
is protective, the risk would be approximately 0.7 times lower in the
event of menopause between 40 and 44 years of age compared to
women who postmenopause between 50 and 54 years of age.
Different factors are also associated with pregnancy. By allowing
breast cells to mature, the first pregnancy carried to term would have
a protective role against breast cancer. According to a study of around
100,000 French women, the risk of breast cancer is linked to the age
the woman has at her first full-term pregnancy: after age 22, this risk
increases by around 4% per year. for pre-menopausal breast cancer
and 2% per year for post-menopausal breast cancer.
Regarding pregnancies that are not carried to term (spontaneous or
induced abortion), they do not increase a woman's risk of developing
breast cancer .
If breastfeeding is beneficial for the baby, it is also beneficial for the
mother. Thus, breastfeeding and, moreover, prolonged breastfeeding,
reduces the mother's risk of breast cancer by approximately 4% per
12-month period of breastfeeding (CGHFBC, 2002). In France, in 2015,
3% of breast cancers were attributable to a duration of breastfeeding
of less than 6 months
 Diethylstilbestrol (DES, Distilbene®)
Diethylstilbestrol is a powerful synthetic estrogen, prescribed in
France between 1948 and 1977 to pregnant women to reduce the
risk of miscarriage. However, this drug has been shown to be toxic
and carcinogenic (IARC, 2012).

Indeed, there is an established causal link between the treatment of

pregnant women with DES (“Mother DES – first generation”) and the
risk of breast cancer, increased by approximately 30% compared to
untreated women (Titus-Ernstoff , 2001).
Furthermore, recent results suggest that not only do girls exposed to
DES in utero (“DES Girls – second generation”) have an increased risk
of developing breast cancer, but that this risk may also extend to their
daughters and little girls.
 Alcohol consumption
Compared to a woman who does not consume alcohol, a woman who
drinks one glass of alcohol per day would increase her risk of
developing breast cancer by approximately 10%, this risk would

double for someone who consumes two glasses of alcohol. alcohol

per day, would triple for someone who consumes three, and so on
(Sun, 2020).
Note that the risks associated with alcohol are generally calculated
based on an average consumption of 10 g/day, which is equivalent to
a “standard” drink. However, no dose has been identified as being
safe. In addition, no type of alcohol is considered more or less risky
than another (IARC, 2012).
 Overweight, obesity
The tall height of women also appears to be associated with an
increased risk of breast cancer, but it is not the height itself that
is to blame. In reality, it is the factors that lead to high growth
(reflected by the height reached in adulthood) that are
responsible for an increased risk of breast cancer.
 Smoking

Numerous studies have looked at the link between breast

cancer and smoking. But unlike other tobacco-related cancers,
the associations observed are
weaker and less consistent for
breast cancer. Thus, in 2012, the
IARC concluded that there was
limited evidence in favor of a
causal link between active
smoking and breast cancer
(IARC, 2012).
A more recent study found a 1.08 to 1.13 times increased risk
of breast cancer among women who smoke tobacco and
therefore concluded that there was consistent evidence of a
moderate increase in risk (Macacu , 2015).
Although it is rare, it represents about 1% of all breast cancers.
About 1 in 1,000 men will develop breast cancer during their
lifetime. Most breast cancers in men are infiltrating ductal
carcinomas.

Risk factors are similar in men and women (Giordano, 2018;

INCa):
 Age
The older a man gets, the more his risk increases with a
median age at diagnosis of 67 years.

 Genetics
family history of breast cancer (both in men and women)
represents an important risk factor. Around 4 to 16% of breast
cancers in men are due to a genetic predisposition: mutation of
the BRCA2 gene (BReast CAncer 2). Klinefelter syndrome, which
is a rare genetic disease, lowers the level of male hormones
and increases that of estrogen (female hormone), thus
promoting the development of breast cancer.

 Exposure to natural hormones over the course of life:

men who naturally have high enough estrogen levels have up
to a 2.5 times higher risk of developing breast cancer compared
to those with low levels ( Brinton, 2015). Gynecomastia,
obesity, liver cirrhosis and certain testicular abnormalities
(cryptorchidism, orchiectomy) also seem to increase the risk of
breast cancer in men by increasing the blood level of estrogen.

 Alcohol consumption
as in women, in addition to being a risk factor for many
diseases, alcohol appears to be a risk factor for breast cancer in
men.
 Ionizing radiation

the risk of breast cancer is increased, whether in men who

survived an atomic bombing or in those who received
radiotherapy to the chest.

Mortality after breast cancer diagnosis is higher in men than in

women, even taking into account the later age of onset of
breast cancer in men. This suggests that other factors
(biological, therapeutic, lifestyle-related) must be identified to
eliminate this disparity.