1 in 8 women (about 13 percent) who live to be 80 will have breast cancer at least one time. That figure rises if there is a history of breast cancer in the family. Breast cancer is the second most common form of cancer in women, behind only non-melanoma skin cancer. It is the number one cause of cancer death in Hispanic women, and the second most common cancer death (behind lung cancer) in white and black women. Each year, over 190,000 women are diagnosed with breast cancer, while more than 40,000 women die from it. About 2,000 men are diagnosed with invasive breast cancer each year, making up less than one percent of all new breast cancer cases each year. The good news is that the rate of deaths from breast cancer in women has been declining in the last few years. This is thought to be due to the result of advancements in treatment, earlier detection through screening, and increased awareness. Today, over 2.5 million women in the United States have survived breast cancer. The good news is that, with better screening methods—including regular mammograms and self-examinations—the number of deaths from breast cancer has been decreasing.
12 out of 100 average women will get breast cancer. If there is a family history of breast cancer, out of 100 women between 24 and 60 will get breast cancer, depending on how strong the family history is. Having a family history makes it 2 to 5 times more likely that a woman with a family history of breast cancer than the average woman with no family history of breast cancer. If you are at a high risk of developing breast cancer, you will need extra examinations and testing. Taking certain anti-cancer drugs may help some women prevent breast cancer. You can have surgery to remove both breasts, which prevents most incidents of breast cancer. You may also have surgery to remove your ovaries, as this will help to prevent both breast and ovarian cancer.
Breast cancer cases were on a twenty-year increase until 1999, when the amount of breast cancer cases declined. One theory for this decrease is that the decrease is due to women’s reduced use of hormone replacement therapy (HRT). A large study, called the Women’s Health Initiative, was published in 2002, which suggested a connection between HRT and an increased risk of breast cancer.
Risk Factors
The top risk factors for developing breast cancer are being a woman and your age. By age group, 4 out of 1,000 women in their 30s develop breast cancer; 15 out of 1,000 women in their 40s; 26 out of 1,000 women in their 50s; and 37 out of 1,000 women in their 60s. Other conditions that increase the risk of developing breast cancer include a personal history of cancer (including previous cancer in the same breast), a family history of breast cancer in the woman’s mother, sister, daughter, or two or more other close relatives such as cousins, especially if they were diagnosed with breast cancer before age 50. Women who inherit specific genetic mutations in the BRCA1 and BRCA2 genes are more likely to get breast cancer, as well as an increased risk of colon or ovarian cancer. Genetic tests are available to determine whether a woman has the gene mutations long before any cancer appears. Genetic testing can show whether a woman has the specific genetic changes known to greatly increase the risk of breast (or ovarian) cancer.
Race is a factor in developing breast cancer. More white women than black, Hispanic, or Asian women get breast cancer. Black women, however, tend to get breast cancer at an earlier age and are more likely to die from breast cancer. This is thought to be due to black women getting a more aggressive form of breast cancer, and receiving lower quality health care.
Another factor in developing breast is the exposure of the woman’s breast to significant amounts of radiation at a young age, especially among women who were treated for Hodgkin’s lymphoma. Studies show that the younger a woman was when she received the radiation treatment, the higher her risk for developing breast cancer later in life. Women who had their children before the age of 30 have a lower risk of developing breast cancer than women who have children after 30. A woman who breast feeds her baby also has a lower risk of developing breast cancer; the longer she breast feeds her baby, the lower her risk of breast cancer. Women who do not have children have an increased chance of developing brain cancer.
The use of hormone therapy with estrogen and progestin or estrogen and testosterone have an increased risk of developing breast cancer. The risk of breast cancer is less if the woman is being treated with estrogen alone. This increased risk returns to normal over time after the hormones are stopped. A woman who begins menstruation before age 12 and begins menopause after 55 increases the risk of developing breast cancer. The experts in this field believe that the longer you have higher estrogen, the more risk you have for breast cancer. Having extra fat and drinking alcohol both lead to higher levels of estrogen. Women who have gone through menopause should avoid long-term, high-dose hormones. If they do use hormone therapy for menopause symptoms, they should use a low dose for as short of time as possible.
A woman’s risk of breast cancer doubles if she has a first-degree relative (mother, sister, or daughter) who has been diagnosed with breast cancer. 20 to 30 percent of women diagnosed with breast cancer have a family history of breast cancer. Five to 10 percent of breast cancers are caused by gene mutations inherited from one’s mother or father. Women with mutations of certain genes have up to an 80 percent risk of developing breast cancer during their lifetime, and they are often diagnosed at a younger age (below 50). About 90 percent of breast cancers are not due to heredity, but to genetic abnormalities resulting from the aging process and life in general.
If you undergo a total or complete mastectomy (removal of the breast), you should be aware that the surgeon will also take some or all of the lymph nodes under the arm to determine whether the cancer has spread to other parts of the body. Your doctor may prescribe medication to control the nausea and vomiting that many women endure while being treated for breast cancer.
Testing for Breast Cancer
Women who are 40 years old and older should have a mammogram every year for as long as the woman is in good health. Women should have clinical breast examinations about every three years for women in their 20s and 30s, and every year for women 40 and older. Women should know how their breasts normally look and feel and promptly report any changes in their breast(s) to their health care provider. Starting in their 20s, women should conduct breast self-examinations. You should ask your physician to show you how to conduct a breast self-exam. Some women, because of their family history, a genetic tendency, or certain other factors, should be screened with an MRI in addition to mammograms. The number of women who fall into this category in the United States is two percent.
Catching Breast Cancer Early
If breast cancer is caught at an early stage, the doctor may treat it with chemotherapy to shrink it prior to its removal. This is known as neoadjuvant therapy. If it is necessary to remove your breast, you will have to undergo chemotherapy, radiation, or hormone therapy or a combination of them to destroy any cancer cells that might be left in the body after breast surgery. This is called adjuvant therapy and is used to reduce the chances that your cancer will return. Before starting any treatment, talk with your doctor openly and frankly to learn of the benefits of the different treatments, their rate of success, and their side effects.
If the breast cancer is found at an early stage and surgery is the preferred method of treatment, it might be able to save the majority of the breast by doing a simple or total lumpectomy (known as breast-conserving surgery), which is the removal of only the cancerous lump in the breast along with some of the tissue around it. After surgery, you will have to have additional treatment, such as radiation or medicine, to kill off any rogue cancer cells that were not removed by the lumpectomy. In a “modified radical mastectomy,” the surgeon removes some of the lymph nodes under the arm and sometimes part of the chest wall muscles. A course of radiation is usually prescribed after the lumpectomy to make sure the surgeon got all the cancer cells and destroy those cancer cells that he or she may have missed. There is also the radical mastectomy in which the surgeon removes the breast, chest muscles, and all of the lymph nodes under the arm. While once a common procedure, radical mastectomy is rarely used now because it does not improve the survival rate or risk for recurrence when compared with other surgical treatments.
Besides what the doctor can do for you, there is much you can do for yourself to reduce your chances of developing breast cancer. First, you should eat a healthy diet with plenty of fruits, vegetables, and whole grains. A low-fat diet with limited red meat may lower your breast cancer risk. Second, be active. Try to get 30 to 60 minutes of exercise at least five days a week. Staying active may reduce your breast cancer risk. Third, do not drink more than one alcoholic drink a day. Alcohol leads to extra estrogen in the body, which raises your risk of developing breast cancer.
If you have a strong family history of breast cancer or are otherwise at a high risk of developing breast cancer, you should discuss with your doctor taking medication (e.g., tamoxifen or an aromatase inhibitor) as a prophylactic measure to reduce your chances of developing brain cancer. If you are at an extremely high risk of developing breast cancer, you may choose to undergo breast removal before you develop breast cancer. For example, the actress Christina Applegate underwent breast removal surgery even though she had no sign of cancer, but was at a high risk of breast cancer. A preventive or “prophylactic mastectomy” reduces the woman’s chances of developing breast cancer by 90 percent. A cancer risk assessment, genetic test, and psychological counseling are all recommended for women who may be considering this treatment option.
Breast Reconstruction
When you are going to have a breast removed, one important consideration is whether you are going to have reconstruction of the area of the removed breast. You should talk about your options with the surgeon before the mastectomy is performed. Reconstructive surgery can be done immediately after the breast, tissue, and lymph node are removed, or it can be done at a later date. Instead of reconstructive surgery, you may choose to use a breast prosthesis. If you can’t make up your mind on whether or not to have reconstructive surgery and what kind, you should have the surgery performed as soon as possible to prevent the cancer from spreading. You can always make up your mind as to whether or not to have an implant or reconstructive surgery at a later date.
There are basically two methods of reconstruction, which are done by a plastic surgeon. One method is to use a saline or silicone implant. The other method is to use fat, muscle, and skin from your buttocks, thighs, abdomen, and other areas in what is known as “tissue flap surgery.” This type of surgery is more complicated than implant surgery, but the results look and feel more natural and last longer than implants. Breast implant is an easier surgery with a quicker recovery time, and creates less scarring than tissue flap surgery. A tissue flap surgery should last for the rest of your life and because it uses your own tissue, you will most likely have more feeling in the new breast than with an implant. While most women are good candidates for breast reconstruction surgery, some are not. Breast reconstruction surgery should not be done if the woman is obese, has blood flow problems (bad circulation), or other serious health problems, such as diabetes, high blood pressure, or heart disease. Sit down with the plastic surgeon and discuss in detail the benefits and risks of both procedures. For instance, silicon implants may leak without causing any symptoms; hence, the U.S. Food and Drug Administration recommends that women who get silicone implants have MRI tests three years after the implant, and every two years after that.
After you have had breast removal surgery that is not the end of the story. Depending upon your unique situation, you will have to undergo radiation or medication therapy. You will have to see your doctor for follow-up visits every 3 to 6 months for 3 years and then every six months until 5 years have passed since you were diagnosed with breast cancer. You will also undergo regular mammograms to see if there is any return of the cancer. The doctor will also investigate lumps that can be felt during a breasts exam.
The diagnosis of breast cancer and the removal of a breast is a physically and emotionally traumatic event in a woman’s life. It is not at all unusual for the woman to feel a sense of denial, anger, loss, and grief over the removal of one or both breasts. Women who have had one or both breasts removed should be watched for signs in her change of personality and other evidence of mental health issues. If the woman is becoming depressed, not “her old self,” not doing the things she used to enjoy doing, a therapist or group of breast cancer survivors can be of immeasurable help. The American Cancer Association has support groups throughout the nation of people dealing with cancer, and it is often a good idea to join such a group to learn how to adapt to your new situation.