The persistent myth: “I examine myself regularly – if there’s nothing there, I’m safe.” This is dangerously simplistic. Many early forms of breast cancer are too small, too deep, or simply not palpable. This is where screening excels: systematic imaging detects changes before they cause symptoms – significantly improving prognosis. Guidelines recommend different starting times and methods depending on personal risk; those who know their profile can act earlier and more targeted ^[1].

Breast cancer arises when cells of the breast tissue grow uncontrollably. Early stages such as Ductal Carcinoma in situ (DCIS)cancer precursor in milk ducts, often asymptomatic, but visible in screening usually cause no discomfort. The term Risk Stratificationclassification into low, medium, or high probability of developing breast cancer encompasses factors such as age, family history, and gene variants. For individuals with high risk (e.g., BRCA1/2), adding MRImagnetic resonance imaging – a highly sensitive imaging method to mammography is often beneficial. Early detection means not just “one image per year,” but rather: the individually appropriate interval, the right method, and knowledge of one’s family history.

Early detection programs reduce mortality and morbidity because they detect tumors at treatable stages; expert panels evaluate the evidence yearly and adjust recommendations based on risk profiles ^[1]. With the introduction of structured mammography programs, the detection of DCIS increased significantly – an indication that silent precursors are becoming visible before they attract clinical attention ^[2]. Meanwhile, lifestyle counts: even light to moderate alcohol consumption measurably increases breast cancer risk in postmenopausal women, especially under hormone therapy ^[3]. In contrast, regular physical activity lowers the risk and improves outcomes, side effects, and survival in case of illness – through anti-inflammatory, hormonal, and immunological effects ^[4][5][6]. Those who know their family background can access counseling, genetic clarification, and tailored prevention sooner – an invaluable gain in time and options ^[7][8].

Current guideline analyses underscore: routine screening reduces mortality; mammography and digital tomosynthesis form the foundation, while for high-risk individuals, adding breast MRI may be advisable as early as 25–30 years. The recommendations are updated annually based on GRADE principles and expert consensus – central is the risk-adapted intensity ^[1]. A population-based analysis from Italy showed a significant increase in DCIS incidence with the introduction of screening in the invited cohorts. This does not indicate “more disease,” but rather improved visibility of early lesions and also reflects long-term trends in exposures and diagnostic attention ^[2]. Lifestyle factors remain crucial: in a large Norwegian cohort, each additional 12 g of alcohol per day increased the risk for postmenopausal breast cancer; the purported “safe” range of up to one drink per day received no support – especially not when menopausal hormone therapy was used ^[3]. Together, these studies sketch a consistent picture: early detection is most effective when it is risk-based, and prevention benefits when individual burdens (genetics, family, lifestyle) are seriously considered and actively managed.

- Starting from the recommended age for screening – but personalized: Clarify your risk profile with your doctor. Average risk: mammography/digital tomosynthesis according to guidelines. High risk (e.g., BRCA, strong family history): start earlier and add MRI (often from 25–30 years). This way, you identify abnormalities before they grow ^{[1] [2]}.
- Actively gather family history: Talk to relatives, document cancer diagnoses (type, age), and have a risk-adapted counseling evaluated. Digital platforms can expedite the route to genetic clarification and coordinate care ^[7]. In cases of strong burden, testing is worthwhile; relevant germline variants (e.g., BRCA1/2, PALB2, RAD51D) were found in family studies, particularly in cases of early onset – enabling targeted prevention for affected individuals and their relatives ^[8].
- Reduce alcohol, avoid tobacco: Set a clear upper limit or plan alcohol-free phases. Every reduction counts; even light to moderate amounts increase postmenopausal breast cancer risk – especially under hormone therapy. Quitting tobacco remains a cornerstone of cancer prevention ^[3].
- Exercise as a protective factor and performance booster: Aim for at least 150–300 minutes of moderate or 75–150 minutes of vigorous activity per week in addition to 2 strength training sessions. Exercise improves insulin sensitivity, reduces inflammation, and boosts anti-tumor immune functions – lowering breast cancer risk and supporting treatment success and quality of life ^{[4] [5] [6]}.
- Establish a healthy weight: Combine strength training with endurance and a protein-rich, plant-based diet to reduce visceral fat. This lowers hormonal and inflammatory drivers of breast cancer risk and stabilizes energy and cognitive performance in daily life ^{[5] [6]}.

The future belongs to precise prevention: risk-based programs with genomic testing, smart imaging, and digital pathways could further refine screening timing and intensity ^[1][9]. Meanwhile, research into behavioral levers – such as personalized exercise doses and alcohol avoidance in the context of hormone therapies – will make individual risk reduction even more targeted ^[3][5].