Breast Cancer Awareness

October is Breast Cancer Awareness Month, and since this subject is near and dear to my heart, I want to make sure that all YBPs know what’s going on. Here are the basics: Breast cancer is the most common malignancy in women and the second leading cause of cancer death (exceeded by lung cancer in 1985). Breast cancer is three times more common than all gynecologic malignancies put together. The incidence of breast cancer has been increasing steadily from an incidence of 1:20 in 1960 to 1:7 women today.

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. Breast cancer is truly an epidemic among women and we don’t know why.

Breast cancer is not exclusively a disease of women. For every 100 women with breast cancer, 1 male will develop the disease. The American Cancer society estimates that 1,600 men will develop the disease this year. The evaluation of men with breast masses is similar to that in women, including mammography.

The incidence of breast cancer is very low in the twenties (age) gradually increases and plateaus at the age of forty-five and increases dramatically after fifty. Fifty percent of breast cancer is diagnosed in women over sixty-five indicating the ongoing necessity of yearly screening throughout a woman’s life.

Breast cancer is considered a heterogenous disease, meaning that it is a different disease in different women, a different disease in different age groups and has different cell populations within the tumor itself. Generally, breast cancer is a much more aggressive disease in younger women. Autopsy studies show that 2% of the population has undiagnosed breast cancer at the time of death. Older women typically have much less aggressive disease than younger women.

Risk factors:

Early onset of menses and late menopause: Onset of the menstrual cycle prior to 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 like polyunsaturated fats; corn oil and meat.

Family history of breast cancer: Patients with a positive family history of breast cancer are at increased risk for developing the disease. However, 85% of women with breast cancer have a negative family history!

Family history only includes immediate relatives, mother, sisters and daughters. If a family member was post-menopausal (fifty or older) when she was diagnosed with breast cancer, the lifetime risk is only increased 5%. If the family member was premenopausal, the lifetime risk is 18.6%. If the family member was premenopausal and had bilateral breast cancer, the lifetime risk is 50%.

Late or no pregnancies: Pregnancies prior to the age of twenty-six are somewhat protective. Nuns have a higher incidence of breast cancer.

Moderate alcohol intake: Greater than two alcoholic beverages per day.

Estrogen replacement therapy: Most studies indicate that taking estrogen longer than ten 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.

Caution should be exercised in those women with a significantly positive family history of breast cancer or atypical intraductal hyperplasia. Women with breast cancer are not currently give estrogen replacement. There are no scientific studies currently justifying this practice. However, until those studies are available, by convention, women are taken off estrogen.

History of prior breast cancer: Patients with a prior history of breast cancer are at increased risk for developing breast cancer in the other breast. This risk is 1% per year or a lifetime risk of 10%. 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.

Female: The mere fact that being female increases the risk of developing breast cancer. However, for every 100 women with breast cancer, 1 male will develop the disease.

Therapeutic irradiation to chest wall i.e., for Hodgkins 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 in this population.

Moderate obesity: The relationship of breast cancer to obesity is more complex but associated with an increased risk.

Prevention:

For the majority of women, lifestyle changes, a healthy diet, cautious use of selected antioxidants, exercise, and weight reduction can also help reduce the chance of developing breast cancer. To date, the most important strategy in improving survival is still breast cancer screening and early detection. Mammography is an x-ray examination of the breast that has the ability to detect a cancer in the breast when it is quite small, long before it may be felt by breast examination. Eighty-five to 90% of all breast cancers are detectable by mammography. Early detection by mammography has reduced the mortality rate from breast cancer by 20% to 30% in women over 50 years of age.
The American Cancer Society recommends a baseline mammogram for all women by age 40 and annual mammograms for women 40 and older for as long as they are in good health. All women over age 20 should perform breast self-examination monthly. Those over age 40 should also have annual breast examinations by their doctors.Those younger than 40 years can have breast examinations by their doctors every 3 years. For women with higher than normal risk, a good program would include monthly breast self-examination and twice yearly focused physician examination. Any palpable changes in the breasts would require further evaluation with mammography and ultrasound.

In the month of October, breast cancer is recognized by survivors, family and friends of survivors and/or victims of the disease. A pink ribbon is worn to recognize the struggle that sufferers face when battling the cancer. Many foundations raise money year round to fund breast cancer research, but in October many more companies and retail stores participate in fundraising activities to support the cause. To help fight the disease, you can buy just about anything with a pink ribbon on it, from pens to golf bags to cookies. You name it, if it can fit a pink ribbon on it, retailers are selling it and donating a portion to one of the many foundations raising money for breast cancer research.

For more than 20 years, the Susan G. Komen Breast Cancer Foundation has been a global leader in the fight against breast cancer through its support of innovative research and community-based outreach programs. Millions of people participate in their Race for the Cure events every year. Other organizations such as The National Breast Cancer Foundation, Inc, The Breast Cancer Site, Y-Me National Breast Cancer Organization, Making Memories Breast Cancer Foundation, the American Breast Cancer Foundation, and the National Breast Cancer Foundation (Austrailia). Yes, they all have similar names, but more importantly they have similiar missions, to raise enough money to fund a cure for breast cancer.