The breast cancer pathway, step by step
About 1 in 8 U.S. women will develop breast cancer, yet death rates have fallen 44% since 1989. When to start mammograms, whether your family history changes the plan, and matching treatment to the tumor are the decisions that matter most.
Step 1: Lower the risks you can change
Alcohol raises breast cancer risk from about one small drink a day. Being overweight raises risk after menopause, while being active and breastfeeding are linked to lower risk. Combined estrogen-plus-progestin hormone therapy raises risk, which falls back after stopping, and birth control pills raise it slightly while you take them, a rise that fades after stopping.
Some worries have been tested and found to have no link: antiperspirants, bras, and abortion or miscarriage. Soy foods such as tofu and edamame may even lower risk, says the American Cancer Society.
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Step 2: Mammograms: three guidelines, one decision with your doctor
Every major guideline recommends regular mammograms, but they differ on when to start and how often. The U.S. Task Force (April 2024) advises every two years from 40 to 74. The American Cancer Society (revised July 2026) gives the option of yearly mammograms from 40, advises them every year from 45 to 54, then every year or every other year. The American College of Physicians (April 2026) advises every two years from 50 to 74. Decide with your doctor when to start, based on your own risk.
Since September 2024, every U.S. mammogram summary says whether your breasts are dense, as they are in more than 40% of women screened. Dense tissue raises risk and makes cancer harder to see, but there isn’t yet enough evidence to say whether extra MRI or ultrasound helps women whose only added risk is density. In Task Force modeling, 3D mammograms (tomosynthesis) meant fewer false alarms than standard ones.
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Step 3: Check your family history
Up to 10% of breast cancers are thought to be hereditary. One mother, sister or daughter with breast cancer almost doubles a woman’s risk, and two can triple it. The U.S. Task Force advises a brief risk assessment for women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or ancestry linked to BRCA changes, followed by genetic counseling and, if indicated, testing. About 2% of people of Ashkenazi Jewish descent carry a harmful BRCA change.
Women at high risk can start yearly MRI plus mammogram, typically from 30, and can consider risk-reducing medicines or surgery. Men get breast cancer too: a harmful BRCA2 change raises a man’s risk to between about 2% and 7% by age 70, compared with about 0.1%.
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Step 4: If diagnosed: the tumor’s type decides the plan
Surgery is either a lumpectomy, usually followed by radiation, or a mastectomy. Treatment after that is matched to the tumor: hormone therapy, usually for at least five years, if it is hormone receptor-positive; trastuzumab, sometimes with pertuzumab, for up to a year if it is HER2-positive; and for triple-negative cancer, chemotherapy that may include pembrolizumab before and after surgery.
For some small, low-risk cancers, large trials now show less treatment can be enough. Skipping armpit lymph node surgery gave the same five-year results with less arm swelling, and women 65 or older with small hormone-positive cancers who take hormone therapy can consider skipping radiation.
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Step 5: Higher-risk or advanced breast cancer: what’s new
For hormone-positive cancer with a higher risk of returning, adding ribociclib or abemaciclib to hormone therapy after surgery lowers recurrence. For early triple-negative cancer, pembrolizumab with chemotherapy improved five-year survival. Trastuzumab deruxtecan is now approved before and after surgery for HER2-positive cancer and, with pertuzumab, as a first treatment when it has spread. For advanced hormone-positive cancer, camizestrant slowed growth when people switched to it as soon as an ESR1 mutation appeared during their first treatment.
Ask which tests your tumor needs, such as HER2 level, ESR1 and BRCA, and whether a clinical trial fits.
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Step 6: Living well during and after treatment
Being active is strongly and consistently linked to a lower risk of dying from breast cancer, and ASCO recommends aerobic and strength exercise during treatment for cancer that hasn’t spread. Obesity after diagnosis is linked to the cancer coming back. A healthful diet may help overall survival, but it hasn’t been shown to prevent recurrence: in the WHEL trial, a diet very high in vegetables and fruit made no difference. Acupuncture is guideline-recommended for joint pain from aromatase inhibitors.
Skip antioxidant pills during chemotherapy: in a breast cancer trial, taking them before and during treatment was linked to more recurrence.
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Everything rated for breast cancer
All 27 options that apply to breast cancer, including options rated 4 or 5 that apply to every cancer, grouped by how strong the evidence is.