You're high-risk: Now what?

As scientists learn more about breast cancer and its causes, women face an increasingly uncomfortable decision: To what lengths should one go in the name of prevention?

Dr. Olivia Aranha, oncologist at Saint Francis Medical Center, says what makes it a difficult question is that every person is different.

The most basic decision is whether to get genetically tested. Aranha recommends testing if a patient has a family history of breast cancer or a personal history of one or more cancers before age 50.

"If I see these, I test for genetic mutation," she says. "I'm looking for BRCA1 and BRCA2 mutations. The first increases your lifetime risk [of developing breast cancer] by about 55 percent, while BRCA2 increases your risk by about 45 percent."

Aranha says other red flags include male family members with a history of breast cancer, breast and ovarian cancer in the same person, or multiple breast cancers. Ashkenazi Jews are also more likely to exhibit the mutation.

While these genetic mutations are strong indicators, Aranha says the upside is that if they are detected, preventative measures have proven extremely effective. A woman can decrease her risk by 95 to 100 percent by undergoing a bilateral mastectomy, in which the breast tissue, and often the ovaries as well, are removed.

"If they are young, I tell them having the mutation doesn't mean you have to have [a bilateral mastectomy]. It is recommended, but not mandatory," she says. "Say they're in their mid-20s; we encourage you to start a family while you're young and have the procedure later."

She says many women put off genetic testing so they aren't faced with that difficult decision, but she encourages the testing.

Even if someone finds out they're high risk, however, Aranha says there are ways they can minimize their chances of developing breast cancer.

"Physical exercise has been successful in improving quality of life and has been successful in improving prevention and overall survival," she says. "As little as three hours a week can reduce your risk."

Omega-3 fatty acids also help prevent breast cancer. Oily fish like sardines, mackerel and tuna are great natural sources of omega-3 fatty acids, but dietary supplements are also available if fish isn't appetizing. Walnuts, flaxseed and soy are also good sources.

After a bilateral mastectomy, a woman still needs physical exams to examine the chest wall and lymph nodes.

Aranha says 'sending [your breasts] to heaven' isn't an easy decision by any means, but the benefits are impressive.

"It decreases your risk," she re-emphasizes. "And most women think that's what they want to do."