Review Question - QID 108759

A 52-year-old G0P0 woman presents to her gynecologist for an annual exam. She has noticed a lump in her right breast over the last several months. She has not noticed any abnormal breast discharge or skin changes. The lump has not changed in size and is not particularly tender. The patient also reports feeling especially sweaty over the last three months and occasionally having sudden hot flashes. The patient has no medical problems, has a BMI of 18.4 kg/m^2, and takes no medications. She underwent menarche at age 16 and had a levonorgestrel intrauterine device inserted 3 years ago due to heavy menstrual bleeding. The patient has now been amenorrheic for 2 years. She has a family history of breast cancer in her cousin at age 61 and hypertension in her father. At this office visit, a 3x3 cm lump is palpated in the upper outer quadrant of the right breast. It is firm and not freely mobile. Her temperature is 98.6°F (37°C), blood pressure is 118/72 mmHg, pulse is 85/min, and respirations are 13/min. An ultrasound is obtained and shown in Figure A. A mammogram is also obtained as shown in Figure B. Which of the following risk factors is most closely associated with this patient’s condition?