How many women are affected by breast cancer? Even in absence of a genetic predisposition to breast cancer, a woman faces a 1 in 8 chance (about 12%) of getting breast cancer in her lifetime. That means, if you and seven of your girlfriends go to dinner, odds are that one of you will likely be affected by breast cancer in her lifetime. For women who are BRCA 1 carriers, this may increase to 55-65% chance of breast cancer by age 70, and it increases to 45% by age 70 with BRCA 2 mutation.
What are risk factors for breast cancer? Age (older than age 50), genetic mutations, early menses (starting your cycle prior to age 12), later or no pregnancy (first pregnancy after age 30), late menopause (after age 55), lack of physical activity, being overweight or obese after menopause, dense breast tissue, use of combination hormone therapy (estrogen and progesterone) after menopause, use of HIGH (not low) dose combination birth control pills (estrogen and progesterone), personal history or family history of breast cancer, personal history of atypical hyperplasia or lobular carcinoma in situ of the breast, previous radiation therapy, history of DES use and drinking alcohol.
What are warning signs of breast cancer? New breast lumps (although not all breast lumps are cancer); thickening or swelling of the breast; irritation, redness, flaking or dimpling of breast skin; pulling in of the nipple (retraction); painful nipples; discharge, including blood, other than breast milk; change in size or shape of the breast; and new breast pain.
Who should be screened and when? Screening guidelines vary depending on the organization’s guidelines are used. The American College of Obstetricians and Gynecologists (ACOG) suggests annual clinical breast exams and mammograms annually beginning at age 40 for women of average risk. Although this varies slightly in comparison to the US Preventive Task Force and American Cancer Society guidelines, given the frequency of affected women as well as the more rapid progression of breast cancer in comparison to cervical cancer, we generally use the ACOG guidelines. Lastly, self breast exams are recommended monthly in all women. This is generally best done in the shower while the tissue is softest.
What about BRCA testing? It may be considered in those with a close relative (i.e. mother, sister, grandmother) diagnosed with breast cancer earlier than age 50, cancer in both breasts in the same woman, breast and ovarian cancers in the same woman or same family, multiple breast cancers in the same family, two or more BRCA-associated cancers in the same family member, male breast cancer and Ashkenazi Jewish ethnicity.
Is there anything I can do to decrease my risk? Maintaining a healthy weight, exercising regularly, either avoidance of or limiting alcohol consumption, avoidance of carcinogens (chemicals that can cause cancer), limiting radiation exposure (except with medically indicated testing), breastfeeding children, limiting use of combined hormone replacement (use of estrogen and progesterone, used to avoid endometrial cancer in menopausal women with a uterus), and using lower-dose birth control pills when possible.
If you have any concerns about breast health, please be sure to contact your provider for more information. Once again, we would like to take a moment to honor those brave women (and the families of those women) who have faced, or are facing, breast cancer. While we certainly want to acknowledge you this month, know that you are in our thoughts all year.