 Breast cancer continues to be the most common cancer diagnosed in females in the United States. In 2023, for example, we expect approximately 300,000 new invasive breast cancer diagnoses in the U.S. It is not a disease exclusive to females. I think that is a common myth. In fact, about 3,000 of those cases, around 1%, will be diagnosed in men. However, certainly it is females who are at most risk, and we estimate that approximately 13% of females, or 1 in 8, will be diagnosed with breast cancer at some point in their life. There was certainly a large increase in breast cancer diagnoses in the 1980s that kind of corresponded to when we really started integrating population mammogram screening. And then it was pretty steady. And in the mid-2000s, actually we're seeing another uptrend in rates. And we think this may be related to excess body weight, particularly among post-menopausal women, potentially changes in reproductive trends, such as later child births. And in general, we're seeing an increase of approximately a half percent per year. And certainly better understanding how certain lifestyle and or environmental risks are contributing to this is very important and certainly an active area of research. So the two most important risk factors for breast cancer are being born female and getting older. In fact, 50% of breast cancers are diagnosed in patients that have no other identifiable risk factor except for that. However, we do know that certain things will increase your risk. These include family history of breast cancer, a known pathogenic genetic mutation, a personal history of breast biopsies that demonstrate atypical lesions, such as atypical ductal hyperplasia or lobular personum in situ, having dense breasts and certain hormone factors, essentially your lifetime exposure to estrogen, as well as some modifiable factors like lifestyle factors like excess weight and not getting enough exercise. Well, when you think about how family history modifies risks, for example, one affected first-degree relative can increase a personal risk by about two-fold, whereas two first-degree family members on the same side will increase an individual's risk by about four-fold. So it's the number of relatives on the same side of the family and how close they are to you, i.e. first-degree, second-degree, etc., that really clarifies the risk associated with that family history. Genetic mutations are problems with genes or your DNA that is passed down from parents. Specifically regarding breast cancer risk, these genetic problems can increase susceptibility to getting a breast cancer. The genetic mutations explain really a minority of breast cancer cases in that we find a mutation in less than 10% of patients who are diagnosed with breast cancer. However, it's important to detect them because patients who have these mutations can have substantially elevated lifetime risk of breast cancer and other cancers. The two most common genes associated with breast cancer are BRCA1 and BRCA2, and families with these mutations have up to a 70-80% lifetime risk of getting breast cancer. Other genes that may contribute to breast cancer risk in our less-penetrating group CalV2, ATM, and some mutations in CHEC2 and several others. The lifetime risk in these patients ranges between 20-50% depending on their family history and where the mutation is along the gene. But the key in uncovering these is that there's specific elevated screening recommendations in this population. And sometimes we even consider prophylactic surgery in these patients to really significantly reduce that risk. So oftentimes a family history will tip a primary care physician on to offering it for a patient. So anyone that has a kind of pattern of cancers in a family will certainly identify individuals who should get tested. But really anyone can get tested and a large panel of genes is around $200 or $300 out of pocket if your insurance company doesn't cover it. Everything that we've talked about with the family history, the genetic mutation, being a female, these are things you can't modify. The things we can modify are our weight, and this is particularly in postmenopausal women. So prior to menopause, your ovaries are making the substantial amount of estrogen in your body. But once your postmenopausal and the ovaries shut down, the estrogen in your body actually comes from fat cells. So the more fat cells you have, the more estrogen your body is exposed to and this will increase your risk. So for postmenopausal women, weight loss is very important in decreasing your risk of breast cancer. Also alcohol in excess of more than two to three drinks per week or one beverage per day. And then exercise. Exercise is the most significant lifestyle factor that can decrease your risk of getting a cancer. This is in many cancers that we see this, including GI cancers, colorectal cancer, and certainly breast cancer. And we've also found that exercise will decrease your risk of a recurrence if you've had one of these cancers. We recommend you get at least 30 to 40 minutes of exercise a day, most days of the week.