Breast cancer is a deeply personal and challenging health concern that touches the lives of one in eight women. Breast cancer conversation often centers around familiar risk factors like genetics and family history. While these are important, there are other lesser-known risks that deserve attention too.

Dr. Michelle O'Shea, a breast surgeon and breast surgical oncologist at Houston Methodist, shares expert insight into these less talked about breast cancer risk factors — and how you can take control of your health.

Weight after menopause: what role does it play?

One of the most overlooked risk factors for breast cancer is weight gain after menopause, Dr. O'Shea notes. Having a high body mass index (BMI) post-menopause can significantly increase a woman's risk of breast cancer — anywhere from 20% to 60%.

"Women can gain weight in menopause due to changing metabolism, and that excess weight leads to higher estrogen levels," Dr. O'Shea explains. "After menopause, your estrogen is made in fat cells. So having extra fat cells means extra estrogen, which increases your risk for breast cancer."

This risk is not just limited to women who have never had breast cancer. Breast cancer survivors with excess weight are also at a higher risk for recurrence, with 35% to 40% increased chances of the cancer returning and an increased likelihood of worse outcomes.

A sedentary lifestyle: how does it impact you?

Weight gain is often linked to inactivity, and Dr. O'Shea points out that a sedentary lifestyle can increase the risk of heart disease and multiple cancers, not just breast cancer. The good news? This is a risk factor you can control.

The American Cancer Society recommends 300 minutes of moderate exercise weekly to help reduce cancer risk, which breaks down to about 42 minutes each day. This can include low impact activities such as brisk walking, cycling, Pilates or swimming.

If you're up for vigorous activities — think jogging, playing tennis, jumping rope, taking aerobics classes or hiking — then that overall number drops down to just 22 minutes each day.

Moderate to vigorous activity not only helps in managing weight and reducing your cancer risk, but also boosts your overall health.

Alcohol consumption: how much is too much?

Alcohol intake is another often underestimated cancer risk factor. Many people enjoy a glass of wine with dinner or a drink at social events, but Dr. O'Shea emphasizes that regular alcohol consumption is strongly associated with increasing your risk for developing breast cancer.

"More than one drink per day can significantly increase the risk," Dr. O'Shea warns. "For women who are at high risk of breast cancer or for breast cancer survivors, we recommend averaging less than one drink per day."

While this may seem restrictive, Dr. O'Shea encourages balance. It's okay to indulge occasionally by enjoying a glass of wine during a special event or the open bar on vacation. However, it's important to compensate with a few alcohol-free days and keep daily drinking in check to minimize risk.

Hormone replacement therapy: do the benefits outweigh the risks?

For many women, hormone replacement therapy (HRT) is a common treatment to manage menopause symptoms. However, there is much confusion and controversy surrounding its safety and impact on breast cancer risk. Dr. O'Shea outlines a few types of hormone therapies and some of the key concerns:

• Hormone Replacement Therapy (HRT): This includes any form of therapy where estrogen or progesterone, or a combination of both, is used to alleviate menopause symptoms. Not to be confused with hormone therapies that are used to treat certain types of breast cancers.
• Combined Hormone Replacement Therapy: When women take both estrogen and progesterone, the risk of breast cancer increases. A study done by the Women's Health Initiative found that women on combined HRT of natural estrogen and natural progesterone had a 24% higher risk of developing breast cancer.
• Estrogen-Only Therapy: Interestingly, estrogen alone has been found to reduce breast cancer risk, but it increases the risk of uterine cancer. Therefore, this therapy is typically more suitable for women who have had a hysterectomy.
• Estrogen Patches: In some European studies, women who used estrogen patches (following a hysterectomy) showed a decreased risk of breast cancer.

"Hormone replacement therapy is really a discussion for each woman to have with her doctor — usually her gynecologist or primary care physician — about what options are out there," explains Dr. O'Shea. "Hormone replacement is important, because it can help maintain weight, improve bone density, fight fatigue and hot flashes and insomnia, menopause symptoms that really affect women's everyday lives."

For women navigating the complexities of menopause and considering hormone replacement therapy, the key takeaway is to discuss your personal risk factors with your doctor to find the right balance of risk versus benefit. Every woman is different, and your treatment should be tailored to your specific health needs.

Hormone replacement therapy duration: what you need to know

The duration of hormone replacement therapy is another critical factor when considering breast cancer risks. Short-term use of HRT — typically two to five years — may offer relief from menopause symptoms without significantly increasing the risk of breast cancer. However, longer-term use can escalate the risk substantially.

For example, the average 50-year-old woman has a 1.4% risk of developing breast cancer within the next five years. That translates to 14 out of 1,000 women. Adding estrogen-only hormone therapy raises that risk to 1.7%.

When both estrogen and progesterone are used, the risk increases to 2.2%. Over a decade, those numbers rise significantly, with a woman on combined hormone therapy having a 6.1% risk compared to 2.8% for those not on hormones.

"The goal is to find symptom relief within two to five years and then reassess," says Dr. O'Shea. "As time goes on, it's crucial to work with your healthcare provider to determine if the benefits of continuing therapy outweigh the risks."

After stopping hormone therapy, a woman's breast cancer risk gradually decreases, and within five years it returns to the level of women who never took hormones.

Family history and hormone replacement therapy: who should avoid it?

Women with a family history of breast cancer or those who are BRCA gene carriers should approach hormone replacement therapy with caution. While some studies show that HRT may not dramatically increase the risk in women with just one relative affected by breast cancer, the risks accumulate with more family members affected.

For BRCA carriers, estrogen-only hormone therapy after a hysterectomy can be an option, even for breast cancer survivors. But it must be carefully evaluated.

"There's really no situation where hormone replacement therapy is an absolute no, but it requires a thorough discussion about each woman's specific risk and benefit," Dr. O'Shea advises.

Empowering women to control their risk factors

While there are many cancer risk factors outside a woman's control, Dr. O'Shea emphasizes that there are many lifestyle factors women can influence.

"We can't control being a woman or family history, and we can't easily control our hormone levels," she says. "But we can control our lifestyle. If we want to reduce breast cancer risk, we can make changes that have a significant impact."

Here are the top lifestyle changes Dr. O'Shea recommends for women wanting to reduce their chances for developing breast cancer:

• Maintain a healthy weight: Especially after menopause, controlling weight is key to managing estrogen levels
• Exercise regularly: Aim for 45 minutes of moderate exercise per day
• Limit alcohol consumption: Stick to an average of less than one drink per day
• Stay informed about hormone therapy: Discuss your options with your doctor and weigh the risks and benefits based on your personal health profile
• Get regular screenings: Mammograms and other screenings can catch breast cancer early — when it's most treatable

(Related: Can You Really Reduce Your Breast Cancer Risk?)

By shedding light on these less talked about concerns, we hope to empower you to take meaningful steps toward reducing your risk of breast cancer and protecting your health. Every person's health journey is unique, and by staying informed you can make choices that prioritize your well-being and give you peace of mind.