Knowing Your Normal, Knowing Your Risk.
Reviewed Dr Jo Mackson, MBBS FRACGP
Published June 2026
Reading time About 30 minutes, or 3 to 5 minutes per part
Short on time? Start with the Mini Guide, then come back here when you want the full picture.
Before we begin our deep dive into breast health, a quick note on why this guide exists. Breast health is one of the rare areas in women’s health where the basics are well-known and the public messaging is clear (mammograms from a certain age, know your breasts, see your GP if anything changes). The problem isn’t that women have been dismissed about breast health. The problem is that the basics only get you so far. Once you start asking the next layer of questions, what does dense breasts on my report actually mean, do I need supplementary screening, what’s my actual risk, what about MHT, the answers stop being clear and the conversations stop being well-supported.
That gap is what this guide is for. Not to replace BreastScreen or any of the established advice, but to add the next layer of context, so that when you have those harder questions, you have somewhere to start.
And just a quick note on the medical terminology, because there is some. If you’re reading online, hover over a term and you’ll get a definition. If you’ve printed this and you’re reading it old school, hats off, and a glossary sits at the back of the guide just for you.
Knowing Your Normal: Breast Awareness.
Our SWW campaign “Feel Them On The First” is a gentle monthly reminder rather than a clinical protocol. The idea is that on the first of each month, give your breasts a feel. Notice what you notice. You’re not looking for cancer, you’re getting to know your normal. If something feels new or different, come and see us. It is not a structured exam, there is no perfect way of doing it, it is a habit of paying attention.
One thing to know: breast tissue extends well beyond the visible breast. Include the area behind the nipple, the underarm (which contains both breast tissue and the lymph nodes that drain the breast), and up toward the collarbones. Most women miss these without realising.
Follow our Instagram and we will remind you when the first of the month comes around.
Most changes you notice will turn out to be benign. Cysts, lumpiness that comes and goes with your cycle, tender breasts before a period, mild asymmetry: all common and rarely sinister. That said, certain changes warrant a conversation, and the rule of thumb is straightforward. If something is new, persistent, or different from your normal, please come and see us. Specifically:
- •A new lump or thickening that does not go away with your cycle.
- •Changes to the skin of the breast: dimpling, puckering, redness, or texture changes (some describe it as orange peel).
- •Nipple changes: a new inversion (nipple turning inward), discharge (especially blood-stained or from a single duct), or persistent crusting/scaling.
- •Persistent pain in one specific area, particularly if it does not vary with your cycle.
- •Swelling, lumps, or skin changes in the armpit.
None of these symptoms automatically mean cancer. They mean a conversation, and usually some imaging.
No one knows your normal better than you. That is what makes breast awareness work.
Understanding Your Risk.
Breast cancer is the most common cancer in Australian women. Around 1 in 7 women will develop it during their lifetime, and the risk increases with age.
The first thing most women think about when they think about breast cancer risk is family history. Family history matters. But around 90% of breast cancers happen in women with no family history at all. This is why population screening exists for everyone, why personal risk assessment matters on top of that, and why breast awareness matters at every age regardless of who in your family has or hasn’t had cancer.
| Factor | Why it matters |
|---|---|
| Age | The single biggest factor. Most breast cancers are diagnosed after the age of 50, and the older you get, the higher your risk in any given year. That said, around a third of breast cancers are diagnosed in women under 55, so being younger is not the same as being safe. |
| Having breast tissue | Anyone with breast tissue can develop breast cancer. The vast majority of cases are in cisgender women, but breast tissue is breast tissue. |
| Family history | A first-degree relative (mother, sister, daughter) with breast cancer roughly doubles your risk. Multiple first-degree relatives, or relatives diagnosed under 50, raises that further. Family history of ovarian cancer also matters because some of the same genes drive both. A single second-degree relative (grandmother, aunt) diagnosed after menopause, with no other affected family, generally does not raise your individual risk meaningfully. The combination of close relationship, young age at diagnosis, and multiple affected family members is what shifts the picture. |
| Known genetic mutations | The highest individual risk category, but only 5 to 10% of breast cancers. BRCA1 and BRCA2 carriers face lifetime risks of around 50 to 70%. Other mutations (PALB2, ATM, CHEK2 and others) carry smaller but still meaningful increases. |
| Previous breast cancer or abnormal biopsy | Having had breast cancer once, or having had a biopsy that showed certain abnormal but non-cancerous findings (most commonly atypical hyperplasia or lobular carcinoma in situ), increases the risk of a future breast cancer. |
| Dense breast tissue | Women with extremely dense breasts have a 4 to 6 times higher relative risk than women with mostly fatty breasts. Density also makes breast cancer harder to spot on a mammogram. We cover this in detail later in the guide. |
| Reproductive history | Several factors here all relate to the same underlying mechanism: more time during which breast tissue is being stimulated by oestrogen and progesterone. Early first period (before 12), late menopause (after 55), never being pregnant, and first pregnancy after 30 each add to lifetime hormonal exposure. Each one individually is a small effect, but together though they can add up. |
| Breastfeeding (when it has been part of your life) | For women in their breastfeeding years now, longer cumulative breastfeeding is associated with a small reduction in lifetime breast cancer risk (around 4% per 12 months of cumulative breastfeeding). It is a real but very small protective factor. It should not cause concern for women who could not, did not, or chose not to breastfeed, or who have not had children. |
| Lifetime hormonal exposure (hormonal contraception and MHT) | Belongs in the same biological category as reproductive history. The pill and MHT both add to lifetime hormonal exposure and both confer a small increase in risk. The numbers and the nuance matter here, so we have unpacked it in the callout below. |
Hormonal exposure appears in the risk factor list because oestrogen and progesterone stimulate breast tissue to grow and turn over each cycle. The more cycles your breast tissue goes through, and the more total hormonal stimulation over your lifetime, the more opportunities there are for a cell to copy itself imperfectly, which is what cancer is at the cellular level. Each of the factors in this group, early first periods, late menopause, never having been pregnant, the combined pill, and MHT, adds time during which the breast tissue is being stimulated by hormones.
Two things worth knowing. The absolute increase from the pill or modern MHT is small (around 4 additional cases per 1,000 women over 5 years, comparable to drinking 2 or more units of alcohol a day). And the type of MHT matters: modern body-identical MHT carries a more favourable risk profile than older synthetic formulations.
The full discussion sits in our MHT Deep Dive and Menopause Deep Dive.
| Factor | What it means |
|---|---|
| Alcohol | Alcohol increases breast cancer risk because it raises circulating oestrogen levels and damages DNA in breast cells, which together create more opportunities for the kind of cell changes that can lead to cancer over time. Studies consistently show there is no safe lower limit for breast cancer specifically. More alcohol means more risk; less alcohol means less risk. As a reference point, two standard drinks a day increases your risk by more than taking the combined pill or modern MHT. |
| Weight, particularly after menopause | We want to be careful here, because weight is a complex topic in women’s health and rarely as simple as “eat less, move more.” But the evidence on this one is clear. After menopause, adipose tissue (fat) becomes the body’s main source of oestrogen, so a higher body fat percentage means more oestrogen exposure year after year. Postmenopausal women with a BMI over 30 have around a 30% higher risk of breast cancer than postmenopausal women with a BMI in the healthy range. |
| Physical activity | The most well-evidenced protective factor on this list. Around 2.5 hours of moderate exercise per week (brisk walking, cycling, swimming) is associated with roughly a 20% reduction in breast cancer risk. |
Breast cancer is overwhelmingly diagnosed in cisgender women, but breast tissue is breast tissue, and anyone with breast tissue can develop breast cancer. This includes trans men, non-binary people assigned female at birth, and cisgender men (less than 1% of breast cancers, but real and worth knowing about). Trans men who have had top surgery still have residual breast tissue and remain at risk, though reduced. If you fall into any of these groups, the same principles of breast awareness, risk assessment, and conversation with your GP apply. Screening pathways may need to be individualised.
Risk factors do not act in isolation. They multiply. A woman with a strong family history who also drinks daily, carries excess weight after menopause, and does not exercise regularly is not adding small risks together. She is compounding them. Equally, a woman with a strong family history who keeps her alcohol low, stays active, and maintains a healthy weight is meaningfully shifting her actual lifetime risk downward, even if she cannot change the family history part. This is why personalised risk assessment, which we will get to in the next section, is more useful than reading off a single risk factor in isolation.
Most Breast Cancer Is Not Genetic.
Around 5 to 10% of breast cancers are due to identifiable inherited genetic mutations. The other 90% occur in women without identifiable mutations and often without family history. The rest of this section is about that 5 to 10%, when it matters, who it applies to, and what to do about it. But it is worth saying upfront that for the great majority of women, this is not what their breast cancer risk is about.
BRCA1 and BRCA2 are the two most commonly known genetic mutations associated with hereditary breast cancer. Carrying one of these mutations raises lifetime breast cancer risk to around 50 to 70%, depending on which mutation, alongside an increased risk of ovarian cancer.
BRCA1 and BRCA2 are the most well-known, but there are several other genes (with names like PALB2, ATM, and CHEK2) that also carry increased breast cancer risk, generally smaller than BRCA1 and BRCA2 but still meaningful. There are also likely many more genes involved that we have not yet identified, which is one of the reasons family history can matter even when no specific mutation has been found in your family.
This is one of the most common questions we get in this space, and not only from those with family history of a known mutation. However, while it sounds like an easy and sensible thing to do, it’s unfortunately not that simple. In Australia, genetic testing for breast cancer risk is built around important genetic reasoning: the most informative test is the one done in someone who has had the cancer, rather than in a relative who hasn’t. That is what we are going to walk you through.
In Australia, genetic testing for hereditary breast cancer risk can be done through genetics departments at your local tertiary hospital, and through some private genetic clinics. We strongly recommend going through the public pathway where possible (more on the difference between the two below). Referral is usually made through your GP, and the testing is bulk-billed if you meet the criteria.
The criteria for who gets tested depend primarily on family history. As a general rule, the more relatives affected, the closer the relationship, the younger the diagnoses, and the rarer the pattern (bilateral cancer, male breast cancer, ovarian cancer) the more likely a referral is appropriate.
The first person tested in the family is whichever relative has actually had the cancer. The reason: if a mutation is found in someone who has had cancer, you have confirmed that this mutation is the cause of cancer in this family. After that, any other family member can be tested for that exact mutation, with a clear answer: positive means confirmed elevated risk, negative means the same risk as the general population. Without that first step, a test result in a healthy person is harder to interpret either way.
Genetic testing is never a private medical decision. A positive result for you is also information about your biological family. Every one of your first-degree relatives (parents, siblings, children) has a 50% chance of carrying the same mutation, which means your result has implications for them whether or not they wanted to know.
The implications can also extend beyond breast cancer itself. Some genes that increase breast cancer risk also raise the risk of other cancers (pancreatic, prostate, ovarian) in the wider family. A few genes carry additional implications for reproductive planning. The genetic counselling process is built to surface all of this, which is one of the reasons we recommend going through it carefully rather than going direct to consumer.
So what if you don’t have a strong family history but want to be tested anyway? You can. Private genetic testing is available in Australia for women who don’t meet the public criteria, with costs typically in the range of several hundred dollars depending on the panel. If this is the right path for you, we prefer to have testing through a breast physician/surgeon rather than direct-to-consumer testing. This is because pre-test and post-test counselling in genetic testing is extremely important.
Two things to think about before going down that road. First, the same interpretation problem applies, actually even more so when there is no known cancer mutation to look for. A negative result does not rule out a hereditary risk, because the test only looks for specific known genes, so a negative tells you that you don’t carry one of the common ones, not that you have no genetic risk. This is important so you don’t get false reassurance. A positive result does not mean you are going to get breast cancer, but it allows for informed choice about risk, screening, and preventative treatment (Tamoxifen or mastectomy). Second, there is a chance of a Variant of Uncertain Significance, where the lab finds a change in one of the tested genes but cannot say whether it actually increases your risk. A VUS is not a yes and not a no, and it can be more anxiety-producing than not knowing.
If you are weighing this up, please come and have the conversation with us first. The right pathway for you might be private testing through a breast physician, or it might be a referral into the public system after a closer look at your family history, or it might be a different kind of risk assessment entirely (we cover that in the next section). Either way, going in with eyes open is what matters.
So What Is My Actual Risk?
Whether you do or don’t have a family history, or even a proven genetic risk, how else can we assess our risk? This is where personalised risk assessment is important.
Personalised risk assessment uses your individual factors (age, family history, reproductive history, breast density if known, and lifestyle) to give you a percentage estimate of your breast cancer risk, both over the next 10 years and over your lifetime. This tells you where you sit with your specific risk, against the commonly quoted 1 in 7 average risk.
The tools we use most often are iPrevent (an Australian tool developed by Cancer Australia and Peter MacCallum Cancer Centre), Tyrer-Cuzick (also called IBIS), and CANRISK. They are not all the same: each uses slightly different inputs and works best in slightly different populations, and we choose between them based on your individual situation.
We recommend every SWW patient do an iPrevent assessment. It takes around 20 minutes, it is free, and you can do it from home (link in our patient resources). The output gives you two things at once: your actual personalised risk, and a clear picture of how the modifiable factors (alcohol, weight, exercise) shift that risk for you specifically.
Once you know your personal risk, we use it to guide your individual screening plan: how often you need imaging, whether supplementary screening makes sense, and what other interventions might be worth discussing for your risk level (medication like Tamoxifen, increased surveillance, or in higher-risk situations, risk-reducing mastectomy). A personal risk assessment is not just a result. It is the foundation on which a personalised plan for risk reduction, optimised screening, and early detection is built.
Population statistics tell you what “women” are at risk of. Personalised risk assessment tells you what YOU are.
Screening: What It Catches, What It Misses.
BreastScreen Australia is the national breast cancer screening program. Its goal is to find breast cancers early enough that treatment is more effective and outcomes are better, which for breast cancer makes a measurable difference (stage 1 cancers are close to 100% survivable; later stages much less so). The program offers a free (bulk-billed) 2D mammogram every two years to women aged 40 to 74.
A small but important detail in how the program is structured: women aged 50 to 74 are actively invited, meaning BreastScreen will send you a reminder when you are due. Women aged 40 to 49 are eligible to be screened (it is free, you can self-refer), but you are not actively invited, so the responsibility for booking sits with you. This is part of why women in their 40s are screened less consistently than women over 50, even though many of them would benefit from it.
Our position is to recommend routine mammographic screening from age 40, with earlier screening for women whose individual risk profile suggests it. The reasons: breast cancer in women in their 40s, while not common, is sadly not rare. The evidence supports that earlier screening reduces mortality in this age group, and the trade-offs (covered in detail below) are reasonable for most women. Women with a strong family history, known genetic mutations, or other significantly elevated risk should usually start earlier than 40, often after specialist input.
Below age 40, routine screening mammography is generally not recommended for average-risk women. The natural question is: surely more screening is better? Why not just screen everyone, all the time? To answer this you will have to bear with us, while we take a small detour back to Stats 101 (and we apologise for any flashbacks to year 11 maths). Screening tests have a measure called positive predictive value, which is the chance that a positive result actually means cancer (versus a false alarm). When you screen a population where the underlying rate of disease is low (women in their 30s), most of the abnormal findings on a mammogram will turn out to be something benign, but they still trigger biopsies, follow-up imaging, and significant anxiety. The same test in an older woman, or a woman with elevated baseline risk, is more likely to find real cancer because the underlying rate is higher. So it is not that mammograms become better as you age, it is that screening becomes more useful as the chance of actually having cancer rises. Below 40, in average-risk women, the benefit-to-harm ratio doesn’t justify routine screening.
A mammogram is a low-dose X-ray of the breast tissue. Each breast is compressed between two plates and imaged from two angles. The compression spreads the tissue out for a clearer image and reduces the X-ray dose required. Yes, it is uncomfortable. Most women describe it as a few seconds of pressure rather than pain, and the discomfort ends as quickly as it starts.
There are two types of mammogram: 2D (digital mammography) and 3D (also called tomosynthesis). 2D produces a single flat image of each angle. 3D takes multiple thin-slice images and reconstructs the breast in layers, which makes it easier to see through overlapping tissue and to find cancers that a 2D image might miss. The trade-off: 3D involves a slightly higher radiation dose and is not yet routinely available through BreastScreen Australia, although it is widely available in private radiology clinics. Where the choice is yours, 3D is generally the better test, particularly in women with denser breast tissue.
Mammography is the foundation of breast cancer screening because it is the only screening test that has been studied in large randomised trials and shown to reduce breast cancer deaths (not just diagnoses, deaths).
Mammograms are designed to find three things in particular: masses (which appear as dense areas), distortions in the normal architecture of the breast, and calcifications (small calcium deposits, some patterns of which can indicate early cancer). Most findings on a mammogram are not cancer. Cysts, benign lumps, and harmless calcifications are common and account for the majority of “abnormal” findings.
Many findings on a mammogram fall into a grey zone, neither clearly cancer nor clearly benign. The radiologist’s job is to flag anything in that uncertain space for closer examination, because the only way to definitively call something benign is often to look at it more closely.
If a screening mammogram finds something that needs a closer look, you will be recalled. The next step is usually a diagnostic mammogram (which is more detailed than a screening mammogram, with extra views), often combined with ultrasound. If the diagnostic imaging confirms something looks suspicious for cancer, a biopsy follows.
The recall rate (the proportion of women called back for further investigation after a screening mammogram) sits at around 10% in BreastScreen Australia. A great majority of recalls turn out to be nothing. Estimates vary, but roughly 90 to 95% of women recalled after a screening mammogram do not have breast cancer.
We mention this not to dismiss the experience. A recall is anxiety-inducing in a way that is hard to describe to anyone who has not been through it. The wait between the recall letter and the diagnostic appointment is one of the most stressful experiences in routine women’s healthcare. Knowing in advance that recalls are common, and that a great majority resolve without a cancer diagnosis, doesn’t make the wait painless. But it can take some of the catastrophising out of the experience while you wait.
An interval cancer is a breast cancer diagnosed between scheduled screening rounds, rather than picked up by a screening mammogram itself. Around 25 to 35% of breast cancers diagnosed in women undergoing regular screening are interval cancers, and they are most often spotted by the woman herself, after noticing a change in her own breasts.
Interval cancers are not a sign that screening has failed. They are a known feature of how screening works: mammography catches a great majority of cancers but not all of them, and some cancers grow quickly enough between screenings to become noticeable in the time between scans. They are the strongest practical argument for why breast awareness matters even when you are screening on schedule.
A few things that can make the experience more comfortable: book your mammogram for the week after your period, when breasts are least tender; take paracetamol or ibuprofen an hour beforehand; ask the technologist to talk you through each compression. Newer mammography machines also have automated compression that adjusts to your individual tissue density, which can make a noticeable difference.
We often hear women avoid mammograms because of worry about radiation, and the underlying assumption that radiation exposure itself causes cancer. The concern is reasonable, but the actual numbers are reassuring. A screening mammogram delivers about the same radiation dose as two return flights from Sydney to London. The lifetime risk of mammography itself causing a cancer is real but extremely small, and is vastly outweighed by the benefit of detecting cancers early in the screening age group.
Mammograms are very good but they are not perfect. In women with average breast density, a screening 2D mammogram picks up around 75 to 85% of breast cancers. In women with dense breasts (more on this in Part Four), the pick-up rate drops further. Across all women being screened, this means approximately 1 in 5 to 1 in 6 breast cancers will not be visible on a screening mammogram.
A “normal” mammogram result means no cancer was visible on the imaging that day. It does not mean no cancer is present.
This matters particularly if you have higher than average risk. The standard screening interval and the standard screening modality may not be enough for you. Your screening plan should be designed around your risk, not the population average.
In all situations, this is why breast awareness still matters even when you are screening regularly. A new lump, or a change you notice in your own breasts between screening rounds, warrants assessment, regardless of when your last mammogram was.
Breast screening looks for cancer. Breast awareness notices change.
Dense Breasts: What They Are and Why They Matter.
Breast density is one of the most important things to understand about your own breasts, and one of the least known. It is not how big your breasts are, how they look from outside, or how they feel to touch, or whether you have lumpy breasts (a common misconception). The only way to know your density is from a mammogram report, which describes how much of your breast is (glandular and fibrous) tissue versus fatty tissue.
On a mammogram, fibroglandular tissue and fatty tissue look different: dense tissue appears white, fatty tissue appears dark. The proportion is what matters. Density is influenced by genetics, hormonal exposure across the cycle and across life, lactation history, age, and BMI. It tends to decrease with age and after menopause, but not always. Some women remain dense well into their 70s.
Density is reported on a scale called BI-RADS, with four categories: A (mostly fatty, around 10% of women), B (scattered density, around 40%), C (heterogeneously dense, around 40%), and D (extremely dense, around 10%). It is worth knowing that the categories are points along a continuum rather than discrete boxes: a C result near the boundary with B is different from a C result near the boundary with D, and the same is true between D and the upper end of C. The category gives you the broad picture; the underlying reality is a spectrum.
And one important framing: density is a risk factor and a screening consideration, not a diagnosis. Having dense breasts does not mean something is wrong. It is information that helps you and your doctor make the right decisions about screening for your specific breast type.
First, density makes mammograms work less well. Cancers and dense tissue both appear white on a mammogram, so a small cancer in dense tissue is harder to spot than the same cancer in fatty tissue: imagine looking for a snowflake on a snow-covered field versus looking for it on a dark roof. The result is that mammograms find more cancers in less dense breasts and miss more in denser ones. In numbers: 2D mammography picks up around 85% of cancers in women with non-dense breasts (A and B), and that drops to around 50 to 60% in women with extremely dense breasts (D). This drop in sensitivity is the reason density is part of the screening conversation.
Second, density itself raises the risk of developing breast cancer. Breast cancer starts in the glandular and connective tissue cells, so the more of that tissue you have, the higher the potential risk. Comparing the two extremes, women with extremely dense breasts (D) have a 4 to 6 times higher risk than women with mostly fatty breasts (A).
Density is one of the few risk factors that does double duty: it raises both the chance of developing cancer and the chance of mammography missing it if it develops.
Since 2025, BreastScreen NSW has begun reporting breast density on mammogram results. This is a meaningful change: a woman cannot make informed decisions about her own screening if she does not know her own density. Other states are catching up, and reporting is not yet uniform across Australia. If you have had a mammogram in NSW, your density category should be on the report. If your report does not include density, ask your GP about how to find out.
There are currently no Australian guidelines for routine supplementary screening in women with dense breasts. The international evidence is still emerging, and the question of which supplementary tool best suits which woman is an active area of research.
However, while we are waiting for consensus guidelines, this is still an area where informed, individualised decisions can be made well. Good medicine is not just a matter of following flow charts, and with so many variables to weigh, there may never actually be a simple flow chart to follow. The decision about supplementary screening for any given woman depends on her density, her individual risk profile, her family history, and what each option realistically offers her in terms of additional cancer detection. We also need to consider the false positive rate of each test (the chance of being recalled, biopsied, or creating worry about something that turns out not to be cancer) and the practical realities of cost and access.
A 61-year-old living in regional NSW with category C density, no family history, and an average personal risk on iPrevent might reasonably decide to add an ultrasound to her 2-yearly mammogram, because she cannot justify the time off work for the 6-hour round trip to access contrast-enhanced mammography. A 44-year-old in the same town with category D density, strong family history, and an intermediate iPrevent risk might choose to fly to Sydney every year for an MRI and breast surgeon review.
The point is that there is no single right answer. There is the right answer for you, with consideration of your risk, your situation, and your preferences.
Below are the supplementary screening modalities currently available for women with dense breasts. Each adds something different, each has trade-offs, and the right combination depends on the individual factors discussed above.
| Modality | What it adds | Trade-offs | Cost & access |
|---|---|---|---|
| Ultrasound | Helps pick up additional breast cancers that mammography misses in dense breasts. The cancers most often picked up are small, early invasive cancers obscured by dense tissue on the mammogram. | Higher false positive rate than mammography, meaning more women require biopsy for findings that turn out not to be cancer. Most of these biopsies return benign results, but the process involves additional imaging, the biopsy itself, and the wait for results. | Not Medicare-rebated for screening. Usually self-funded (around $150 to $250). Widely available in private radiology clinics. |
| Contrast-enhanced mammography (CEM)(a mammogram performed after an iodine-based contrast dye is given through a cannula in the arm) | Helps pick up significantly more cancers than mammography alone, particularly in dense breasts. The contrast highlights areas with unusual blood flow, which is one of the features of cancer. Often used alongside ultrasound for additional sensitivity. Detection rates similar to those of MRI. | Higher false positive rate than mammography. Small risk of contrast reaction (rare). Involves an IV cannula. | Not Medicare-rebated for screening. Usually self-funded (around $300 to $500). Available in selected private radiology centres, not yet widespread. |
| Breast MRI | The most sensitive imaging test for breast cancer detection in dense breasts. Picks up cancers missed by mammography and ultrasound. Standard practice for women at high genetic risk (BRCA carriers and similar). | Highest false positive rate of any breast imaging modality, meaning more women require biopsy for findings that turn out not to be cancer. Not suitable for women with certain implants or claustrophobia. | Medicare-rebated for women at high genetic risk. For women with dense breasts and average-to-moderate risk, MRI is sometimes used but is not Medicare-funded for screening in this group (around $500 to $1,000 self-funded). Available in major private radiology centres. |
| BCAL Breastest Plus | Not a diagnostic test, meaning it does not tell you whether you have cancer. It is designed to add reassurance: a low result strongly suggests that no breast cancer was missed by your recent mammogram. Useful for women with dense breasts who have had a normal mammogram but remain concerned about whether something was missed. | Does not replace imaging. A non-low result does not mean cancer is present, but it would prompt further investigation. | Self-funded (around $300). Currently available in Sydney only but expanding. Can be ordered by any GP. |
Breastest Plus is not the same as the multi-cancer blood tests (such as Galleri-style tests) that have been marketed direct to consumers in recent years. These multi-cancer tests claim to screen for many cancers from a single blood draw, but they are not currently validated for screening use in Australia, are not endorsed by Cancer Council Australia, and should not replace evidence-based screening for individual cancers.
Breastest Plus, by contrast, is a specific test designed as an adjunct to mammography in women with dense breasts, with growing evidence behind it. If you have heard about “a blood test for cancer” and are not sure what is being offered, please come and have the conversation with us before paying for anything.
MHT and Breast Cancer: A Brief Note.
Menopausal Hormone Therapy (MHT) and breast cancer risk is one of the most loaded topics in women’s health, largely because of the legacy of the 2002 Women’s Health Initiative (WHI) study. We cover this in detail in our MHT Deep Dive and Menopause Deep Dive.
The headline summary: for most healthy women, the absolute increase in breast cancer risk from combined MHT is at most around 4 additional cases per 1,000 women using combined therapy for over 5 years. This figure does not account for the type of MHT, and we know that body-identical MHT carries a lower risk than older synthetic formulations. Compared to other risk factors, this increase is less than the risk associated with drinking two or more standard drinks per day, and considerably less than the risk associated with carrying excess weight after menopause.
How We Approach Breast Health.
Breast health is one of the areas where individual conversations matter most. The gaps in clinical guidelines, the volume of conflicting information online, and the common misconception that family history is what determines breast cancer risk all leave women facing this without the structure they deserve. Our approach is built around three things.
First, individual risk assessment. iPrevent is free online and is the most useful thing you can do to prepare for a conversation about your breast health. It takes around 20 minutes, you can do it before your appointment, and it gives us a starting point that the rest of the conversation builds on.
Second, a clear screening plan. For most women we recommend mammography from age 40, with frequency and supplementary imaging tailored to risk, density, accessibility, and affordability. For women with higher risk, that may include earlier and more frequent screening, MRI, or referral to a breast specialist or genetic clinic. For women with dense breasts, that often includes additional ultrasound, a discussion about Breastest Plus, and consideration of contrast-enhanced mammography on alternating cycles.
Third, the lifestyle factors that move the needle on breast cancer risk. Alcohol, weight after menopause, and physical activity are the three modifiable factors with the strongest evidence behind them. The conversation we have with patients about lifestyle is grounded in what is realistic for their life, not a list of perfect behaviours that nobody can sustain.
If you have not had a breast health conversation in the last few years, or if you have dense breasts and are unsure what to do, please come and have the conversation with us. This is the kind of conversation that benefits from time, all the relevant information, and looking at your breast health as a whole picture rather than a series of one-off decisions.
You now have what you need to think clearly about your own breast health: knowledge of how your body works, awareness of what increases your risk, an understanding of where the screening tools fit, and a sense of where the gaps are. The rest is the conversation. Whether that conversation is with us, your GP, or your specialist, you can now have it with the depth of understanding to make it count.