October is breast cancer awareness month; and for millions of women it is an opportunity to understand risk, know when screening should begin and recognize steps that could reduce the likelihood of developing cancer.

After skin cancer, breast cancer is the most common cancer among American women. This year alone, more than 320,000 American women will be diagnosed with invasive breast cancer, and more than 42,000 will die from it, according to the American Cancer Society . Overall, about 1 in 8 women will develop breast cancer in their lifetime.

Breast cancer incidence has been increasing about 1% annually overall, with a faster increase among women younger than 50. Despite this, mortality or death from breast cancer continues to decline, in large part from screening efforts and treatment.

Risk Is Not Simply About Family History

Age, female sex, genetics and family history are important risk factors. Having a mother, sister or daughter with breast cancer can significantly increase one’s risk. Certain inherited gene mutations, like the BRCA1 and BRCA2 can also dramatically increase lifetime risk of breast cancer.

Despite these well recognized risk factors, the vast majority of women who develop breast cancer do not have a family history. In fact, more than 85% of women diagnosed with it have no such family history, according to a recent survey of over 33,000 women conducted by the American Cancer Society. Other important risk factors include obesity, tobacco and alcohol consumption, chest radiation at a young age and physical inactivity.

The Disconnect Between Awareness And Action

The aforementioned survey also highlighted an important point—many women know about breast cancer risk factors, but this knowledge has not necessarily translated into modifiable behavior.

The largest gap involved physical activity. More than 90% of women in the survey recognized low physical activity increased breast cancer risk, but only 27% reported meeting ACS recommendations of 150-300 minutes of moderate-intensity exercise or 75-150 minutes of vigorous-intensity exercise per week. In addition, 85% of women acknowledged alcohol as a risk factor, while 69% reported drinking alcohol.

The data suggests that women are not proactively addressing modifiable risk factors for breast cancer, despite awareness that certain factors increase their risk for developing cancer.

When Should Women Start Getting Mammograms?

Screening recommendations vary for average-risk women among major organizations. However, the United States Preventive Services Task Force recommends that women should get screened with a mammogram every two years from ages 40 through 74. Screening mammography has been shown to decrease mortality and save lives, as I have written about previously in Forbes .

Women who have more than an average-risk of breast cancer need to be screened earlier. This includes those with the BRCA1 or BRCA2 gene mutation, those with certain hereditary cancer syndromes and women who have received chest radiation prior to the age of 30. For these women who have at least a 20-25% lifetime risk of breast cancer, the American Cancer Society recommends a mammogram and a breast MRI every year beginning at the age of 30.

Health Inequities For Breast Cancer

Breast cancer does not affect all American women equally. As an example, Black women are 40% more likely to die from breast cancer than White women, despite similar screening rates. Black women are also more likely to be diagnosed at more advanced stages of breast cancer compared to White women.

These disparities demonstrate why simply encouraging women to get mammograms may not be enough to improve positive health outcomes. Timely follow-up of abnormal results, access to imaging and biopsies and addressing barriers to care are all critical to decrease these health disparities.

The recent data from surveys highlights the need for more than just awareness of breast cancer. Knowing and understanding risk only matters if knowledge translates into action.