Many young women state that their biggest health fear when growing older is breast cancer. On the flip side, many women don’t worry about breast cancer because it doesn’t run in their families. This false sense of security can be a costly mistake if it keeps you from having preventative testing.
Let’s explore breast cancer risk factors, prevention, diagnosis and treatment.
Consider the following breast cancer facts:
- Globally, breast cancer is the most commonly diagnosed cancer among women and is the second leading cause of cancer death for women.
- About 1.2 million people worldwide are diagnosed with the disease each year with approximately 521,900 global deaths.
- Breast cancer is more common among women over the age of 40 and is rare in women under age 25.
- 58% of diagnosed breast cancer in developed countries is in women over age 65.
You can’t completely prevent breast cancer—everyone is at risk. Great strides have been made in breast cancer awareness in recent years, with more women aware of the symptoms and utilizing self-exam and diagnostic techniques regularly.
Understanding your risk
You can control some risks for developing breast cancer. Unfortunately, with breast cancer, the risks you can’t control outweigh the ones you can. For these reasons, early detection is important. The following are major risk factors for breast cancer:
- Gender: both men and women can develop breast cancer: Women are far more likely to develop breast cancer than men. The ration of women to men with breast cancer is 100 to one. The National Cancer Institute predicts that one in eight women born today will develop breast cancer in her lifetime.
Risk factors for men include age (the average age for breast cancer in men is about 67), obesity (obese men have higher levels of estrogens in their body), testicular and liver disease, and a disease called Kleinfelter’s syndrome, which occurs in men who are born with two or more “x” chromosomes. Exposure to high levels of radiation also increases men’s risk.
- Age: As your age increases, so does your chance for developing breast cancer. This is due to exposure to estrogen over your lifetime and the fact that there has been a longer time for cells to have cancerous changes. According to the National Cancer Institute, for women age is a factor as follows:
- Age 30 to 39—1 in 233 probability of breast cancer
- Age 40 to 49—1 in 69 probability of breast cancer
- Age 50 to 59—1 in 38 probability of breast cancer
- Age 60 to 69—1 in 27 probability of breast cancer
- Family history of cancer: A women’s risk of developing breast cancer increases if she has a first-degree relative (mother, sister, or daughter) diagnosed with breast or ovarian cancer before the age of 40. Other combinations of family history risk factors are moderate risks, such as having two close relatives from the same side of the family diagnosed with breast cancer (one must be mom, sister, or daughter, while the other can be an aunt, grandma, or even Uncle Bob).
Scientists have found that women with genetic mutations (random structural changes) to genes BRCA1 and BRCA2 (short for Breast Cancer 1 and Breast Cancer 2) have up to an 85 percent chance of developing breast cancer in their lifetime. Less than 10 percent of breast cancer cases are related to inheritable genes, however, if you do have a strong family history, your doctor may want you to have earlier or more frequent testing done.
- Long-term estrogen exposure: A strong correlation exists between breast cancer development and the hormone estrogen. Estrogen stimulates cancer cells to grow and divide rapidly. A woman’s estrogen levels rise during puberty, then decrease during menopause. The longer a women’s breasts are exposed to estrogen, the greater her risk for developing breast cancer. Therefore, breast cancer risk may be higher in women who started menstruating before age 12 or in women who went through menopause after age 55. Research has also implicated hormonal birth control—whether oral, injected, or implanted—as a risk, especially if used for more than five years. Hormone replacement therapy after menopause may be a risk factor as well, but studies are inconclusive.
- Drinking alcohol: Around one in fifty cases of breast cancer may be attributed to alcohol consumption in the U.S.: in countries where alcohol consumption is higher the risk may be as much as one in six cases. You can control this risk by watching your alcohol intake.
- Poor nutrition and being overweight: Evidence suggests that animal fat can increase the risk of breast cancer, but being overweight holds a much stronger correlation to the development of breast cancer and has an adverse effect on survival in post-menopausal women. You can curb this risk by taking better care of yourself.
Playing your part in prevention
“Know thy breasts” should be the defining statement for early detection of breast cancer. Breast cancer prevention starts with regular breast self-exams, beginning when you’re in your 20s. Using a step-by-step approach on a specific schedule, women can be aware of how their breasts normally look and feel.
Monthly self-exams provide you with a baseline; if anything changes from month to month, you’re the first to know. Report any breast changes to a health professional as soon as they’re discovered. Remember that a breast change doesn’t mean you have cancer!
The best time for a woman to examine her breasts is one week after her period is over, when her breasts aren’t tender or swollen, so she can feel any abnormalities or lumps that may be present. This examination is no small task at times; some women have very lumpy breasts and the lumps may change from month to month.
Women who are pregnant or breastfeeding should still keep examining their breasts regularly, even though the breasts may be tender. Women with breast implants should ask their surgeon to help them differentiate between breast tissue and the implant. To ensure proper technique, women should review their self-breast exam (SBE) process with their healthcare professional during their clinical breast exam.
Clinical breast exams should be done at every yearly gynecologic exam. At age 40, women need to have the first of their recommended annual mammograms as well as yearly breast exams, unless they had an abnormal breast exam or there’s a strong family history of breast cancer. Mammograms are currently the best and most reliable screening method, although it may take as many as six to ten years for breast cancer tumors to be detected by mammography. Your doctor may recommend an earlier screening if you have a personal or family history with breast cancer.
Sometimes ultrasound is used and is good for distinguishing whether a detected lump is a cyst (likely to be benign) or a solid mass (which could indicate a tumor). This technique is good to use in women with breast implants and dense breasts because a mammogram sometimes has difficulties “seeing” through dense tissue or implants. Ultrasound is also a great method for guiding physicians to do needle biopsies of suspicious lumps.
In 2007, the American Cancer Society recommended that women at high risk such as a previous history of breast cancer or a strong family history for breast cancer should have a magnetic resonance imaging (MRI) scan in addition to their mammograms. MRIs are more sensitive, picking up more spots than a mammogram, and may result in more false positive results. The two tests together give better data to evaluate a woman for breast cancer. If your doctor detects any abnormalities, he may schedule a follow-up biopsy or some other doctor-recommended procedure.
Recognizing the symptoms
When feeling for a lump in a breast, keep in mind the following things:
- Cancer cells are an abnormal overgrowth—meaning irregular in shape. The lump will be hard and have a bumpy texture.
- The lump may not move during your self breast exam, but because it may be small and covered with healthy tissue, you may have a hard time telling if it moves or not.
- Although cancerous masses have some particular characteristics, any lump no matter what it feels like should be checked out by a healthcare professional.
- Look for dimpling of the skin, retraction of the skin or nipple, thickening of the skin, or nipple discharge.
The technique recommended for self-breast exams has changed. There’s evidence that the woman’s position (lying down), area felt, pattern of coverage of the breast, and use of different amounts of pressure increase the sensitivity of the self-exam.
To perform a SBE, use these steps:
- Standing in front of a mirror, look at your breasts for any changes of size, shape, contour, dimpling, pulling, redness, or flaking skin around the nipple or surrounding skin.
- Lie on your back and place your right arm comfortably behind your head.
When you lie on your back, your breast tissue spreads more evenly and thinly over your chest. This position makes feeling for lumps or abnormalities easier.
- Place the three middle fingers of your left hand on your right breast.
- Using the pads of your fingers, make small circular motions over your breast tissue to feel for lumps.
You should circle the tissue three times and use varying levels of pressure before moving on to the next area.
- Start lightly to feel the skin’s surface.
- Use medium pressure to feel the tissue just under the skin and then
- Press more firmly to feel the tissue closest to your chest and ribs.
Use enough pressure to feel all the breast tissue, but don’t cause yourself pain.
- Manipulate your fingers over the entire breast area in an up and down pattern starting from under your arm and across your breast to the middle of the chest bone making a large square.
Use this pattern to help:
- Draw an imaginary square (from just under your arm along your neck to your collar bone, then down your breast bone and over your rib cage and back up).
- Using the pads of your fingers, walk them up and down imaginary rows of the square like a BINGO card, feeling the breast tissue for any abnormalities or lumps.
This up-and-down pattern is the most effective method for not missing any tissue.
- Now repeat the process of Steps 2 to 5 on your left breast, using the fingers on your right hand.
- When you’re done examining your breasts from a reclining position stand up.
- Standing in front of the mirror, place your hands on your hips and look at your breasts for any changes of size, shape, contour, dimpling pulling, redness, or flaking skin around the nipple or surrounding skin.
The act of pressing down on your hips contracts the muscles in your chest. This makes any changes in your breast more apparent.
- Place your arms by your side and look; raise your hands above your head and press your palms to one another and look again.
This completes your monthly exam. Report any lumps or abnormalities to your doctor.
Following up on a lump
Most of the lumps that you can feel are benign (not cancer); most often the first sign of breast cancer is abnormalities found on a mammogram when it can’t be felt on SBEs or by a medical professional. In fact, the American Academy of Family Physicians indicates as many as 90 percent of breast lumps are benign. Have any lumps or changes evaluated by your doctor.
After you find a lump in your breast, here’s what happens during a typical physician evaluation:
- You give a full health history, including the mention of an immediate family member with breast cancer (mother, sister, daughter).
- You have a full breast exam, with the doctor palpating your breasts for any lumps or abnormalities.
- You schedule a mammogram, ultrasound, or breast MRI (one or more of these may be done).
If the physician workup reveals any suspicious lumps you may be scheduled for one of the following procedures:
- A needle to remove cells from the lump to test for cancer
- A core biopsy to remove part of the lump for evaluation
- A lumpectomy to have the lump surgically removed and tested
If your lump is breast cancer, the earlier you can begin treatment, the better your survival rate.
Treating breast cancer and considering the prospects
Treatment options for breast cancer include surgery, chemotherapy, hormone therapy, and radiation. The five-year survival rate for localized breast cancer is 98 percent. Unfortunately, advanced metastatic cancer has a higher mortality rate. If the cancer has spread regionally this survival rate drops to 81 percent and those with distant metastases have a 26 percent five-year survival rate. After the five-year mark, the overall survival rate drops to 80 percent.
*Agin, Brent, and Sharon Perkins. Healthy Aging for Dummies. Hoboken, NJ: Wiley Pub., 2008. Print.
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