What This Means For You
If youve been diagnosed with breast cancer, this study offers important information and supports current recommendations: Women with a history of breast cancer should not take any type of HRT.
We know that menopausal symptoms can dramatically reduce quality of life for some women. If youre experiencing troubling hot flashes, night sweats, or other symptoms, talk to your doctor about lifestyle changes, complementary and alternative medicine techniques, and non-hormonal medicine options that can help.
Your Race And Ethnicity
White and Black women have the highest risk of developing breast cancer in their lifetime. Asian/Pacific Islander and Hispanic/Latina womens breast cancer rates fall in between two major groupings while American Indian and Alaska Native women are on the lowest end of risk.
While white women are more likely to develop breast cancer than Black women overall, they tend to be diagnosed at an older age . Black women have the highest breast cancer rates among women under age 40. Black women make up a higher percentage of triple-negative breast cancer cases.
What to do: If your race or ethnicity places you at higher risk, make sure you follow all screening recommendations to improve your chances of catching cancer early.
Caution With Hormone Replacement Therapy
For most women, menopause begins at age 45. The production of the sex hormones estrogen and progestin then decreases. This can cause hot flashes, sleep disturbances and mood swings. Some women then turn to hormone preparations they can relieve these symptoms. However, a team of researchers found in 2019 that such hormone replacement therapy increases the risk of breast cancer in the long term. Therefore, treatment should preferably not last longer than one year.
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What Are The Risk Factors For Breast Cancer
Being a woman and getting older are the main risk factors for breast cancer.
Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.
Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.
What Is The Average American Womans Risk Of Being Diagnosed With Breast Cancer At Different Ages
Many women are more interested in the risk of being diagnosed with breast cancer at specific ages or over specific time periods than in the risk of being diagnosed at some point during their lifetime. Estimates by decade of life are also less affected by changes in incidence and mortality rates than longer-term estimates. The SEER report estimates the risk of developing breast cancer in 10-year age intervals . According to the current report, the risk that a woman will be diagnosed with breast cancer during the next 10 years, starting at the following ages, is as follows:
- Age 30 . . . . . . 0.49%
- Age 40 . . . . . . 1.55%
- Age 50 . . . . . . 2.40%
- Age 60 . . . . . . 3.54%
- Age 70 . . . . . . 4.09%
These risks are averages for the whole population. An individual womans breast cancer risk may be higher or lower depending on known factors, as well as on factors that are not yet fully understood. To calculate an individual womans estimated breast cancer risk, health professionals can use the Breast Cancer Risk Assessment Tool, which takes into account several known breast cancer risk factors.
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Why Dont All Of The Studies Agree
Induced abortion brings up many strong feelings in people, so it is often hard to study its long-term effects.
Before 1973, induced abortions were illegal in much of the United States. So when researchers asked a woman about past pregnancies, she may not have felt comfortable saying that she had an abortion. Even though abortion is now legal, it is still a very personal, private matter that many women do not like to talk about. This means that many women might not report having an abortion if asked for a study. In contrast, women with breast cancer are more likely to accurately report their reproductive histories, including a history of having an abortion. This recall bias could lead to retrospective studies finding links that arent found in prospective studies. Still, not everyone agrees that this is the reason that the different types of studies conflict.
In general, though, when prospective and retrospective studies conflict, experts generally accept the results of the prospective studies over the retrospective studies.
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Alcohol Metabolizing Genes And Breast Cancer
Ethanol is metabolized by ADH to AA and subsequently removed by aldehyde dehydrogenase to acetate . The genes that encode for ADH or ALDH are polymorphic, and depending on the activity of the enzymes they encode, determine the rate of ethanol metabolism and the concentration of intermediate metabolites including the carcinogenic AA . If the observed association between alcohol consumption and breast cancer is attributable to an unmeasured or a poorly measured confounder, we would not expect the strength of the alcohol and breast cancer association to change depending on the genotype of the enzymes that regulate ethanol metabolism unless the confounder also mapped to the genotype. Any modification of the association between alcohol intake and breast cancer by the activity of enzymes therefore offers additional support that the association is causal and not explained by confounding.
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Alcohol And Breast Density Marker
In addition to the carcinogenic role of its metabolites, alcohol has been shown to alter estrogen levels, which may lead to changes in breast density, affecting breast cancer risk . An intermediate marker of breast cancer risk that has also been linked with many hormonal breast cancer risk factors is mammographic density, a measure of epithelial and connective tissue in the breast. Higher density confers a 4-6 fold increase in breast cancer risk . Moreover, alcohol use has been shown to modify the mammographic density-breast cancer association in a dose-response way . Associations between alcohol use and intermediate markers such as breast density provide further evidence that alcohol is truly associated with breast cancer and that this association cannot be explained by bias alone.
Epidemiologic studies have used different measures to assess mammographic density with earlier studies using qualitative measures such as the Wolfe parenchymal patterns , and more recent studies using more quantitative methods that either use categories such as the Breast Imaging Reporting and Data System or use a continuous measure ranging from 0-100% based on computer threshold programs .
Your Personal History Of Breast Cancer
If youve been diagnosed with breast cancer in the past, you are more likely to develop a new cancer in the other breast or in another part of the same breast. This is not considered a recurrence but a new breast cancer.
What to do: Follow your cancer teams instructions on monitoring to stay on top of this risk. Ask your doctor whether you should see a genetic counselor.
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What Is The Average American Womans Risk Of Developing Breast Cancer During Her Lifetime
Based on current incidence rates, 12.9% of women born in the United States today will develop breast cancer at some time during their lives . This estimate, from the most recent SEER Cancer Statistics Review , is based on breast cancer statistics for the years 2015 through 2017.
This estimate means that, if the current incidence rate stays the same, a woman born today has about a 1 in 8 chance of being diagnosed with breast cancer at some time during her life. On the other hand, the chance that she will never have breast cancer is 87.1%, or about 7 in 8.
For men born in the United States today, the lifetime risk of breast cancer is 0.13%, based on breast cancer statistics for the years 2015 through 2017. This means that a man born today has about a 1 in 800 chance of being diagnosed with breast cancer at some time during his life.
Does Fertility Treatment Affect The Risk Of Breast Or Other Cancers
Women who have difficulty becoming pregnant or carrying a pregnancy to term may receive fertility treatment. Such treatment can include surgery medications to stimulate ovulation and assisted reproductive technology.Ovarian stimulation and some assisted reproductive technologies involve treatments that temporarily change the levels of estrogen and progesterone in a womans body. For example, women undergoing in vitro fertilization receive multiple rounds of hormone treatment to first suppress ovulation until the developing eggs are ready, then stimulate development of multiple eggs, and finally promote maturation of the eggs. The use of hormones in some fertility treatments has raised concerns about possible increased risks of cancer, particularly cancers that are linked to elevated levels of these hormones.Many studies have examined possible associations between use of fertility drugs or IVF and the risks of breast, ovarian, and endometrial cancers. The results of such studies can be hard to interpret because infertility itself is linked to increased risks of these cancers . Also, these cancers are relatively rare and tend to develop years after treatment for infertility, which can make it difficult to link their occurrence to past use of fertility drugs.
Colditz GA, Baer HJ, Tamimi RM. Breast cancer. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
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If You Have Had Breast Cancer Before
Your risk of developing invasive breast cancer is increased if you have had breast cancer or ductal carcinoma in situ before.
In this case, you will have regular follow-up appointments. Any changes in the same breast or the other breast can be checked quickly.
Having certain breast conditions can also increase the risk of developing breast cancer:
- Lobular carcinoma in situ
LCIS is also called lobular neoplasia. This is when there are abnormal cell changes in the lining of the lobules.
- Atypical ductal hyperplasia
This is when there are slightly abnormal-looking cells in the milk ducts in a small area of the breast.
Women with these non-cancerous conditions are usually monitored regularly, so any changes can be found early.
A Family History Of Breast Cancer
Having someone in your family with breast cancer doesnt automatically mean your own risk is increased. For most people, having a relative with breast cancer does not increase their risk.
However, a small number of women and men have an increased risk of developing breast cancer because they have a significant family history.
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Family History And Breast Cancer Risk
Most women who get breast cancer do not have a family history of it. Or if you have only one female relative diagnosed with breast cancer over the age of 40, your risk is unlikely to be very different from other women the same age as you.
But sometimes breast cancer can run in families. The chance of there being a family link is bigger when:
- a number of family members have been diagnosed with breast cancer or related cancers, such as ovarian cancer
- the family members are closely related
- the family members were diagnosed at a younger age
- a man in your family has been diagnosed with breast cancer.
Fewer than 1 in 10 breast cancers are thought to be caused by a change in a gene running through the family. In hereditary breast cancer, BRCA1 and BRCA2 are the two genes most often found to have a change.
Women with triple negative breast cancer are sometimes offered genetic testing. This is offered even if they do not have a family history of breast cancer. Most breast cancers caused by a change in the BRCA1 gene are triple negative. Your doctor or breast care nurse can explain more about this to you.
If you are worried about breast cancer in your family, talk to your GP or breast specialist. They can refer you to a family history clinic or a genetics clinic.
Hrt And Breast Cancer Whats The Link
There are two types of HRT available. In the short term, estrogen-only HRT appears less risky. This is according to an analysis of studies covering more than 100 000 women with breast cancer, and the risk of developing breast cancer within 20 years of use of HRT. Indications include:
- Combination HRT contains the hormones oestrogen and progesterone. It increases the risk of breast cancer significantly .
- Eestrogen-only HRT contains only estrogen. This increases the risk of breast cancer by only moderately .
It must be emphasized that being diagnosed with breast cancer doesnt necessarily mean that you will die of it. If you are on HRT, and for at least 10 years after that, you should have regular annual screening mammograms. Virtually all screen-detected breast cancers will be cured with appropriate multidisciplinary treatment. Remember, too, that HRT also has benefits such as the prevention of osteoporosis and severe hot flushes, to name but two.
Is there a risk?
Research suggests that, since breast-cancer risk is dependent on the duration of HRT use, its advisable to request whether you can take a lower-dose formula. Further, speak to your doctor about the chance of taking it for the shortest time possible. If youve been diagnosed with breast cancer or have tested positive for a genetic abnormality that causes breast cancer, such as disease-causing BRCA1 or 2 mutations, HRT should not be used.
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About Hormone Replacement Therapy
Many postmenopausal women take HRT to ease menopausal symptoms, such as hot flashes, night sweats, and fatigue.
There are two main types of HRT:
estrogen-only HRT, which contains only estrogen
Medical guidelines say that women who have been diagnosed with breast cancer should not take HRT of any type. This is because the hormones in HRT can cause hormone-receptor-positive breast cancers to develop and grow.
Still, only a few small studies have looked at HRT use in women with a personal history of breast cancer. The researchers who did this study wanted to review all the available research to offer the most up-to-date information on the safety of HRT for women with a history of breast cancer.
How Has The Risk Of Being Diagnosed With Breast Cancer Changed In Recent Years
For a woman born in the 1970s in the United States, the lifetime risk of being diagnosed with breast cancer, based on breast cancer statistics from that time, was just under 10% .
The last five annual SEER Cancer Statistics Review reports show the following estimates of lifetime risk of breast cancer, all very close to a lifetime risk of 1 in 8:
- 12.83%, based on statistics for 2014 through 2016
- 12.44%, based on statistics for 2013 through 2015
- 12.41%, based on statistics for 2012 through 2014
- 12.43%, based on statistics for 2011 through 2013
- 12.32%, based on statistics for 2010 through 2012
SEER statisticians expect some variability from year to year. Slight changes may be explained by a variety of factors, including minor changes in risk factor levels in the population, slight changes in breast cancer screening rates, or just random variability inherent in the data.
Howlader N, Noone AM, Krapcho M, et al. . SEER Cancer Statistics Review, 19752017, National Cancer Institute. Bethesda, MD, , based on November 2019 SEER data submission, posted to the SEER web site, April 2020.
- Reviewed:December 16, 2020
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Having Certain Benign Breast Conditions
Women diagnosed with certain types of benign breast conditions may have a higher risk of breast cancer. Some of these conditions are more closely linked to breast cancer risk than others. Doctors often divide benign breast conditions into different groups, depending on how they affect this risk.
Non-proliferative lesions: These conditions dont seem to affect breast cancer risk, or if they do, the increase in risk is very small. They include:
- Fibrosis and/or simple cysts
- Mild hyperplasia
- Epithelial-related calcifications
- Other tumors
Mastitis is not a tumor and does not increase the risk of breast cancer.
Proliferative lesions without atypia : In these conditions theres excessive growth of cells in the ducts or lobules of the breast, but the cells don’t look very abnormal. These conditions seem to raise a womans risk of breast cancer slightly. They include:
- Usual ductal hyperplasia
- Several papillomas
- Radial scar
Proliferative lesions with atypia: In these conditions, the cells in the ducts or lobules of the breast tissue grow excessively, and some of them no longer look normal. These types of lesions include:
Breast cancer risk is about 4 to 5 times higher than normal in women with these changes. If a woman also has a family history of breast cancer and either hyperplasia or atypical hyperplasia, she has an even higher risk of breast cancer.
Lobular carcinoma in situ
Having Radiation To Your Chest
Women who were treated with radiation therapy to the chest for another cancer when they were younger have a significantly higher risk for breast cancer. This risk depends on their age when they got radiation. The risk is highest for women who had radiation as a teen or young adult, when the breasts were still developing. Radiation treatment in older women does not seem to increase breast cancer risk.
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