What Should People Know About Breast Cancer
Breast cancer is one of the most common cancers among women in New York State. Each year in New York, over 16,400 women are diagnosed with breast cancer and about 2,500 women die from the disease. It is estimated that one in eight women will develop breast cancer during her life.
Men also get breast cancer, but it is very rare. About 160 men are diagnosed with breast cancer each year in New York State.
What Can I Do To Reduce My Chances Of Getting Breast Cancer
To help reduce the risk of getting breast cancer:
- Be aware of your family history and discuss any concerns with your health care provider.
- Discuss the use of hormone replacement therapy with your health care provider.
- If possible, breastfeed your baby. Studies have shown that breastfeeding for longer periods of time lowers the risk of getting breast cancer.
- Stay at a healthy weight.
- Exercise regularly.
- Discuss the risks and benefits of medical imaging, such as CT scans, with your health care provider to avoid unnecessary exposure to ionizing radiation.
Regular check-ups and screening tests can find breast cancer at an earlier stage, when treatment works best. The most important action women can take is to have routine breast cancer screenings. For more information on breast cancer screening, call the Cancer Services Program at 1-866-442-CANCER or visit the website at www.health.ny.gov/diseases/cancer/services/.
Risks For Breast Cancer
A risk factor is something that increases the risk of developing cancer. It could be a behaviour, substance or condition. Most cancers are the result of many risk factors. But sometimes breast cancer develops in women who dont have any of the risk factors described below.
Most breast cancers occur in women. The main reason women develop breast cancer is because their breast cells are exposed to the female hormones estrogen and progesterone. These hormones, especially estrogen, are linked with breast cancer and encourage the growth of some breast cancers.
Breast cancer is more common in high-income, developed countries such as Canada, the United States and some European countries. The risk of developing breast cancer increases with age. Breast cancer mostly occurs in women between 50 and 69 years of age.
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What Are The Risk Factors
Some women are at an increased risk of being diagnosed with breast cancer in their 20s or 30s. These risk factors include:
- having a close family member who was diagnosed with breast cancer before age 50
- having a close male blood relative with breast cancer
- having a BRCA1 or BRCA2 gene mutation
- having received radiation treatment to the chest or breast before age 30
Other risk factors that apply to women of any age include:
- having a high percentage of breast tissue that appears dense on a mammogram
- having had a previous abnormal breast biopsy
- having had your first menstrual period before age 12
- having your first full-term pregnancy after age 30
- never having a full-term pregnancy
- being physically inactive or overweight
- being of Ashkenazi Jewish heritage
- drinking excessive amounts of alcohol
What Are The Potential Harms Of Risk
As with any other major surgery, bilateral prophylactic mastectomy and bilateral prophylactic salpingo-oophorectomy have potential complications or harms, such as bleeding or infection . Also, both surgeries are irreversible.
Bilateral prophylactic mastectomy can also affect a womanâs psychological well-being due to a change in body image and the loss of normal breast functions. Although most women who choose to have this surgery are satisfied with their decision, they can still experience anxiety and concerns about body image . The most common psychological side effects include difficulties with body appearance, with feelings of femininity, and with sexual relationships . Women who undergo total mastectomies lose nipple sensation, which may hinder sexual arousal.
Bilateral prophylactic salpingo-oophorectomy causes a sudden drop in estrogen production, which will induce early menopause in a premenopausal woman . Surgical menopause can cause an abrupt onset of menopausal symptoms, including hot flashes, insomnia, anxiety, and depression, and some of these symptoms can be severe. The long-term effects of surgical menopause include decreased sex drive, vaginal dryness, and decreased bone density.
Women who have severe menopausal symptoms after undergoing bilateral prophylactic salpingo-oophorectomy may consider using short-term menopausal hormone therapy after surgery to alleviate these symptoms.
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Relative Risks Less Than 1
A relative risk less than 1 means the risk factor lowers the risk of disease.
For example, women who breastfeed for a year have a relative risk of breast cancer of about 0.94 compared to women who dont breastfeed.
You may see:
- Women who breastfeed have a 6 percent lower risk of breast cancer compared to women who dont breastfeed.
Are Lumps In Breasts Normal When Breastfeeding
Sometimes, when breastfeeding, a milk duct in the breast can become blocked. This may cause a small, painful, hard lump. Gently massaging the lump towards the nipple before feeding can help clear it. Breast cancer in women of child-bearing age is uncommon, so the vast majority of lumps in younger women will be benign. via
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Screening For Women At High Risk
If a woman has a lifetime risk of 20 to 25 percent or higher or a known BRCA1 or BRCA2 mutation, the ACS recommends a more intensive screening regimen, which includes annual MRI scans and mammograms.
But the problem with MRIs is that they’re too sensitive and not specific enough, meaning an MRI can show numerous lesions that are not breast cancer, which can lead to unnecessary biopsies, Garber says. MRIs also require use of a contrast agent an injected medicine that makes lesions more visible which may have side effects.
Women at high risk may also have the option of taking medication to lower their risk. Tamoxifen and Evista , for example, are drugs that lower breast cancer risk by at least 50 percent, Garber says.
The most extreme options include preventive surgeries to remove your breasts and possibly ovaries, according to national guidelines.
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Breast Cancer And Birth Control
Some research has shown that taking hormonal birth control slightly increases the risk of breast cancer. However, once you stop using hormonal birth control, risk levels eventually return to normal.
The University of Texas MD Anderson Cancer Center also notes that the overall cancer risk for teens remains low, even though using hormonal birth control minimally increases the risk of developing cancer.
If you use hormonal birth control and youre concerned about your cancer risk, please discuss your options with your doctor before stopping your birth control.
According to research, including a , use of oral contraceptives increases the risk of early onset breast cancer in people under 25 years old who have a BRCA gene mutation.
Doctors should exercise caution before recommending oral contraceptives to someone in this group.
That said, an increased breast cancer risk is just one of many factors to consider before deciding on the right birth control method.
Teens going through the earlier stages of puberty may notice lumps near their nipples. Tenderness and soreness are also possible. These occur during normal breast development and arent a cause of concern on their own.
Your period can also cause tenderness and soreness in the breasts.
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How Common Is Breast Cancer
Breast;cancer is the most common cancer in American women, except for skin cancers. The average risk of a woman in the United States developing breast cancer sometime in her life is about 13%. This means there is a 1 in 8 chance she will develop breast cancer. This also means there is a 7 in 8 chance she will never have the disease.
Breast Cancer Recurrence Risk Lingers Years After Treatment Ends
Steady rates of recurrence in women with estrogen receptor-positive disease could influence decisions about long-term therapy.
Even 20 years after a diagnosis, women with a type of breast cancer fueled by estrogen still face a substantial risk of cancer returning or spreading, according to a new analysis from an international team of investigators published in the New England Journal of Medicine.
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Standard treatment for estrogen receptor-positive, or ER-positive, breast cancer includes five years of the endocrine-based treatments tamoxifen or aromatase inhibitors, both of which are taken daily as a pill.
Researchers from the Early Breast Cancer Trialists Collaborative Group analyzed data from 88 clinical trials involving 62,923 women with ER-positive breast cancer. The patients all received endocrine therapy for five years and were free of cancer when they stopped therapy.
Over the next 15 years, however, a steady number of these women saw their cancer spread throughout the body, as late as 20 years after the initial diagnosis.
Even though these women remained free of recurrence in the first five years, the risk of having their cancer recur elsewhere from years five to 20 remained constant, says senior study author Daniel F. Hayes, M.D., Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center.
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Taking Charge: Who Gets Breast Cancer
There are no rules about who gets this disease. The two most significant risk factors are being a woman, and increasing age. However, there are other factors that may increase your risk, and some that may lower it.
The development of breast cancer may be influenced by factors that affect the levels of female hormones that circulate in your body throughout life. These factors include the age when you began your menstrual period, the number of times you have been pregnant, your age at first pregnancy, whether you have breastfed your children, and your level of physical activity.
What Are The Benefits Of Genetic Testing For Brca1 And Brca2 Variants
There can be benefits to genetic testing, regardless of whether a person receives a positive or a negative result.
The potential benefits of a true negative result include a sense of relief regarding the future risk of cancer, learning that one’s children are not at risk of inheriting the family’s cancer susceptibility, and the possibility that special check-ups, tests, or risk-reducing;surgeries may not be needed.
A positive test result may;allow people to make informed decisions about their future health care, including taking steps to reduce their cancer risk.;
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Having Certain Benign Breast Conditions
Women diagnosed with certain 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 3 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.
For more information, see Non-cancerous Breast Conditions.
Lobular carcinoma in situ
General Considerations For Screening
The goal of screening for cancer is to detect preclinical disease in healthy, asymptomatic patients to prevent adverse outcomes, improve survival, and avoid the need for more intensive treatments. Screening tests have both benefits and adverse consequences .
Breast self-examination, breast self-awareness, clinical breast examination, and mammography all have been used alone or in combination to screen for breast cancer. In general, more intensive screening detects more disease. Screening intensity can be increased by combining multiple screening methods, extending screening over a wider age range, or repeating the screening test more frequently. However, more frequent use of the same screening test typically is associated with diminishing returns and an increased rate of screening-related harms. Determining the appropriate combination of screening methods, the age to start screening, the age to stop screening, and how frequently to repeat the screening tests require finding the appropriate balance of benefits and harms. Determining this balance can be difficult because some issues, particularly the importance of harms, are subjective and valued differently from patient to patient. This balance can depend on other factors, particularly the characteristics of the screening tests in different populations and at different ages.
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How Can A Person Who Has Inherited A Harmful Brca1 Or Brca2 Gene Variant Reduce Their Risk Of Cancer
Several options are available for reducing cancer risk in individuals who have inherited a harmful BRCA1 or BRCA2 variant. These include enhanced screening, risk-reducing;surgery;, and chemoprevention.
Enhanced screening. Some women who test positive for harmful BRCA1 and BRCA2 variants may choose to start breast cancer screening at younger ages, have more frequent screening than is recommended for women with an average risk of breast cancer, or have screening with magnetic resonance imaging in addition to mammography.;
No effective ovarian cancer screening methods are known. Some groups recommend transvaginal ultrasound, blood tests for the CA-125 antigen , and clinical examinations for ovarian cancer screening in women with harmful BRCA1 or BRCA2 variants. However, none of these methods appear to detect ovarian tumors at an early enough stage to improve long-term survival .;
The benefits of screening men who carry harmful variants in BRCA1 or BRCA2 for breast and other cancers are not known. Some expert groups recommend that such men undergo regular annual clinical breast exams starting at age 35 . The National Comprehensive Cancer Network guidelines recommend that men with harmful germline variants in BRCA1 or BRCA2 consider having a discussion with their doctor about prostate-specific antigen testing for prostate cancer screening starting at age 40 .
Risk For Different Age Groups
Although females are more likely to develop breast cancer after they reach the age of 50 years, younger women can also develop this condition.
According to the NCI, the risk that a doctor will diagnose breast cancer in a female in the United States within the next 10 years is:
- 1 in 227 for those aged 30 years
- 1 in 68 for those aged 40 years
- 1 in 42 for those aged 50 years
- 1 in 28 for those aged 60 years
- 1 in 26 for those aged 70 years
The also report that of the 437,722 females that doctors diagnosed breast cancer in between 2012 and 2016:
- 1.9% were aged 2034 years
- 8.4% were aged 3544 years
- 20.1% were aged 4455 years
- 25.6% were aged 5564 years
- 24.8% were aged 6574 years
- 13.7% were aged 7584 years
- 5.6% were aged 84 years+
Age is just one risk factor for developing breast cancer. Some other risk factors that people cannot control include:
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Metastatic Breast Cancer Statistics
The number of women under 40 being diagnosed with metastatic breast cancer is increasing.
Metastatic breast cancer means that the cancer has advanced to stage 4 and has moved beyond the breast tissue into other areas of the body, such as the bones or the brain. Survival rates are lower for cancer that has metastasized to other parts of the body.
According to the American Cancer Society , the 5-year survival rate for those with breast cancer that has spread to other parts of the body is 27 percent for women of all ages. However, one found no significant differences in median survival rate between younger and older women with metastatic breast cancer.
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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Can A Woman Have Risk
Yes. Some women who have been diagnosed with cancer in one breast, particularly those who are known to be at very high risk, may consider having the other breast removed as well, even if there is no sign of cancer in that breast. Prophylactic surgery to remove a contralateral breast during breast cancer surgery reduces the risk of breast cancer in that breast , although it is not yet known whether this risk reduction translates into longer survival for the patient .
However, doctors often discourage contralateral prophylactic mastectomy for women with cancer in one breast who do not meet the criteria of being at very high risk of developing a contralateral breast cancer. For such women, the risk of developing another breast cancer, either in the same or the contralateral breast, is very small , especially if they receive adjuvant chemotherapy or hormone therapy as part of their cancer treatment .
Given that most women with breast cancer have a low risk of developing the disease in their contralateral breast, women who are not known to be at very high risk but who remain concerned about cancer development in their other breast may want to consider options other than surgery to further reduce their risk of a contralateral breast cancer.