WRITTEN AND COMPILED BY OLYA FESSARD OCT 2015
Risk, Symptoms, and New Revelations in Early Detection
In the U.S., breast cancer is the second most common cancer in women after skin cancer, according to the National Cancer Institute (NCI). It can occur in both men and women, but it is very rare in men. Each year there are about 2,300 new cases of breast cancer in men and about 230,000 new cases in women, the Institute states. Women in the United States today have about a one in eight (12.6%) chance of developing breast cancer by the time they reach their 80s. Hence, the many reminders for women to keep up with the latest studies and the reason for Breast Cancer Awareness Month.
RISK FACTORS
Although a significant number of women with breast cancer have a family history of the disease, causing inherited gene mutations, only five to ten percent of all cases of breast cancer are due to heredity. Still, you are two to three times more likely than the general population to develop breast cancer if a first-degree relative (your mother, sister, or daughter) has had the disease.
The breast cancer risk increases with age: Women in their 30s have a one in 233 (less than half a percent) chance of developing breast cancer, while the risk for women in their 60s is one in 27 (3.7%), according to Memorial Sloan-Kettering Cancer Center. Eighty percent of all breast cancers are found in women over the age of 50. In addition to age and genetics, several other factors seems to slightly increase your risk.
There are several other uncontrollable risk factors for breast cancer, including women who have had breast cancer before, menstruating before age 12, going through menopause after age 50, having a first child after age 30 or having had no children, or having benign breast disease, such as atypical hyperplasia. Having had breast cysts or fibrocystic changes in the breast (lumpy breasts) does not increase the risk of breast cancer, according to Sloan-Kettering.
Some risk factors are unchangeable, but should be taken into account in developing a screening plan. Other risk factors are lifestyle-related. Therefore, women, especially those already at higher risk, should consider those factors they can control:
- Taking estrogen replacement therapy, although the increased risk seems to disappear about a decade after you stop taking them
- Being overweight or obese
- Drinking alcoholic beverages
- Exposure of breast tissue to radiation. According to Sloan-Kettering, this risk factor is particularly associated with exposure during the first two or three decades of your life. Mammograms do not increase your risk.
To assess your own risk Online, take NCI’s Breast Cancer Risk Assessment Tool at cancer.gov/bcrisktool/.
Women who breastfeed reduce their risk of breast cancer. And the greater the total length of time spent breastfeeding during child rearing years, the greater the protection.
Still, the simple presence of risk factors does not mean a woman will go on to develop breast cancer. Likewise, lack of risk factors doesn’t mean a woman won’t develop the disease. For this reason, all women should be aware of the risks and symptoms and what screening does and doesn’t do.
SYMPTOMS YOU MAY FIND
One of few leading cancer centers, MD Anderson Cancer Center, states on their website, “Breast cancer symptoms vary from person to person. Once you have strongly in your mind what is ‘normal’ for your breasts, you will notice changes more easily. If you notice any changes, tell your doctor. However, many breast cancers are found by mammograms before any symptoms appear.”
MD Anderson offers these breast cancer symptoms:
- A new lump or mass in your breast
- Enlarged lymph nodes in the armpit
- Changes in breast size, shape, skin texture, or color
- Skin redness
- Dimpling or puckering
- Nipple changes or discharge
- Scaliness on the breast
- Nipple pulling to one side or a change in direction
These symptoms do not always mean you have breast cancer. However, it is important to discuss any symptoms with your doctor, since they may also signal other health problems. Screening for cancer is looking for cancer before you have any symptoms. If changes in tissue or cancer are found early, it may be easier to treat. In addition to your self screening described above, you need to know exactly what other screening you should have according to your risk type. Keep in mind that both false-positive and false-negative screening can happen with any screening.
Until recently, recommendations for breast cancer screening have been the same for women from different breast cancer-risk groups. However, Memorial Sloan Kettering investigators have now developed separate breast cancer screening guidelines for women at average risk and for those at increased risk because of familial or genetic predisposition. Sloan Kettering offers the following screening tests and screening guidelines, according to each woman’s risk type:
BREAST CANCER RISK TYPES
Average-risk women have:
- No symptoms
- No history of invasive breast cancer (breast cancer that has spread beyond the milk ducts, or lobules), ductal or lobular carcinoma in situ (cancers that are confined to the milk duct or lobule), or atypia, which is also known as atypical hyperplasia (a form of benign breast disease)
- No family history in a first-degree relative (parent or sibling), or no suggestion/evidence of a hereditary syndrome
- No history of mantle radiation (a radiation therapy used to treat Hodgkin disease)
Recommended screenings for average-risk women:
- Monthly breast self-examination (BSE) beginning at age 20 is optional. Awareness of breast changes is encouraged.
- Annual clinical breast examination (CBE) beginning at age 25.
- Annual mammography beginning at age 40. Screenings are an important means for detecting breast cancer, hopefully in its early stages.
Above-average risk women have any of the following:
- Family history of breast cancer (i.e., one first-degree relative—a parent or sibling—who had breast cancer)
- Diagnosis of atypia, also known as atypical hyperplasia (a form of benign breast disease), or lobular carcinoma in situ (cancers that are confined to the milk duct or lobule)
- History of having been treated with mantle radiation (a radiation therapy used to treat Hodgkin disease) before the age of 32
ABOVE-AVERAGE RISK WOMEN
women with A FAMILY HISTORY
- Monthly BSE beginning at age 20 is optional. Awareness of breast changes is encouraged.
- Clinical breast exam every three to six months. If a family history risk, this should start no later than ten years before the earliest diagnosis in the family. If atypical hyperplasia, lobular carcinoma in situ, or mantle radiation, then this should take place every three to six months.
- Annual mammography starting ten years prior to the earliest diagnosis in the family (but not earlier than age 25 and not later than age 40). If risk is mantle radiation, this should begin eight years after radiation treatment.
- Consider annual MRI. (Consider having MRI and mammography at alternating six-month intervals. Consult with your physician.)
women with a diagnosis of atypical hyperplasia or lobular carcinoma in situ
- Monthly BSE beginning at age 20 is optional. Awareness of breast changes is encouraged.
- CBE every three to six months
- Annual mammography beginning at the time of diagnosis.
- Consider annual MRI. (Consider performing MRI and mammography at alternating six-month intervals. Consult with your physician.)
Women with a History of Mantle Radiation
- Monthly BSE beginning at age 20 is optional. Awareness of breast changes is encouraged.
- CBE every three to six months beginning at the time of diagnosis.
- Annual mammography starting eight years after radiation treatment.
- Consider annual MRI.
The main thing to remember is that while breast cancer is not the most deadly cancer of women, it is the most common cancer. Take care when gathering information about the disease on the Web. Incorrect information can cost you your life. Just because a breast cancer organization is a non-profit does not necessarily mean their major interest is preventing and curing breast cancer, so their information might be careless. The National Institutes of Health, the Merck Manual, the major cancer centers are by far the safest places to go to get the most accurate information available today.
WHERE TO CALL FOR HELP
Cancer Information Service of the National Cancer Institute (900.4.CANCER) www.nationalcancerinstitute.org
National Cancer Institute has a tool for assessing your risk: cancer.gov/bcrisktool/.
American College of Surgeons’ Commission on Cancer (312.202.5000 or 800.621.4111). Gives information on medical centers that have been accredited by the college.