Learning about risk factors and screening are important steps toward prevention.
Breast cancer has reached near-epidemic proportions in the United States with one in seven women affected by the disease. It is the most common malignancy and the second leading cause of cancer death in women, according to the National Breast Cancer Foundation. In fact, breast cancer is three times more common than all gynecologic malignancies put together.
Moreover, the incidence of breast cancer is on the rise. In 1960, one in 20 women was affected by the disease as opposed to today's rate of one in seven, according to NBCF statistics. The American Cancer Society estimates that 211,000 new cases of invasive breast cancer will be diagnosed this year, and 43,300 patients will die from the disease. (Although this disease mainly strikes women, breast cancer affects men as well.)
 Breast cancer affects women of all ages and is a more aggressive disease in younger women, while older women typically have a much less aggressive form of the disease. According to breastcancer.org, breast cancer is the leading cancer among white and African-American women, but African-American women are more likely to die from this disease.
While these statistics are alarming, there are steps women can take to help reduce their chances of getting the disease or detecting it while still in the early stages, when treatment is most effective.
Understanding the risk factors, having screenings, and learning the causes and symptoms are essential to prevention as well as early intervention and treatment.
RISK FACTORS
Understanding your risk factors can help you make healthy lifestyle changes that may work to prevent the disease.
According to the NBCF, the following factors may be indicators of breast-cancer risk:
- Early onset of menses and late menopause: Onset of the menstrual cycle before the age of 12 and menopause after 50 causes increased risk of developing breast cancer.
- Diets high in saturated fat:
The types of fat are important. Monounsaturated fats such as canola oil and olive oil do not appear to increase the risk of developing breast cancer as do polyunsaturated fats, corn oil and meat.
- Family history of breast cancer: Patients with a family history of breast cancer are at increased risk for developing the disease. Family history only includes immediate relatives (mother, sisters and daughters).
- Late or no pregnancies: Pregnancies before the age of 26 are somewhat protective. Nuns have a higher incidence of breast cancer.
- Moderate alcohol intake: More than two alcoholic beverages a day.
- Estrogen-replacement therapy: Most studies indicate that taking estrogen for more than 10 years may lead to a slight increase in risk for developing breast cancer. However, these studies indicate that the positive benefits of taking estrogen as far as reducing the risk for osteoporosis, heart disease and now, more recently, Alzheimer's and colon cancer, far outweigh the slight increase in risk that may be associated with estrogen-replacement therapy.
- History of prior breast cancer: Patients with a history of breast cancer are at increased risk for developing breast cancer in the other breast. This risk is 1 percent a year, or a lifetime risk of 10 percent. The reason for close clinical follow-up after the diagnosis of breast cancer is not only to detect recurrence of the disease, but also to detect breast cancer in the opposite breast.
- Being female: Merely being female increases the risk of developing breast cancer. However, for every 100 women with breast cancer, one man will develop the disease.
- Therapeutic irradiation to chest wall, as for Hodgkin's Disease (cancer of lymph nodes): Patients who have had therapeutic irradiation to the chest are at increased risk for developing breast cancer approximately 10 years later, and consideration should be given to earlier screening.
- Moderate obesity: The relationship of breast cancer to obesity is more complex, but associated with an increased risk.
SCREENINGS
There are many reasons why routine screening for breast cancer is important. At the top of the list is that screening will help detect cancer early, so it can be treated early. And treatment is more likely to work when the cancer is detected early.
Types of screenings include a mammogram, clinical breast exam and breast self-exam. Ask your doctor when you should begin screening and how often.
SCREENING GUIDELINES
The National Cancer Institute recommends the following screening guidelines:
Mammograms
Women in their 40s and older should have mammograms every one to two years. Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.
Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium called microcalcifications. Lumps or specks can be from cancer, precancerous cells or other conditions. Further tests are needed to find out if abnormal cells are present.
If an abnormal area shows up on your mammogram, you may need to have more X-rays. You also may need to have a biopsy. A biopsy is the only way to tell for sure if cancer is present.
While mammograms are the best tool doctors have to find breast cancer early, the test is not perfect. A mammogram may miss some cancers or may show things that turn out not to be cancer. Also, some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.
Mammograms (as well as dental X-rays and other routine X-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated X-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each X-ray. You should also ask for shields to protect parts of your body that are not in the picture.
Clinical Breast Exam
During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides or press your hands against your hips.
Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling or other abnormal signs. Your nipples may be squeezed to check for fluid.
Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.
A thorough clinical breast exam may take about 10 minutes.
Breast Self-Exam
You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.
Your doctor can also teach you how to properly conduct a self-exam.
Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.
SYMPTOMS
Thanks to the use of mammography, many breast cancers are found before they actually cause any symptoms. But this is not always the case. The most common sign of breast cancer is a new lump or mass, according to breastcancer.org.
According to the NBCF, symptoms of breast cancer may include the following:
- A lump is detected, which is usually single, firm and most often painless.
- A portion of the skin on the breast or underarm swells and has an unusual appearance.
- Veins on the skin surface become more prominent on one breast.
- The breast nipple becomes inverted, develops a rash, changes in skin texture or has a discharge other than breast milk.
- A depression is found in an area of the breast surface.
Women's breasts can develop some degree of lumpiness, but only a small percentage of lumps are malignant. A lump that is painless, hard and has uneven edges is more likely to be cancer, according to breastcancer.org. But sometimes cancers can be tender, soft and rounded. Don't be afraid to have anything unusual checked by your
doctor.
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