October is National Breast Cancer Awareness Month

EHE Newsletter - October 6, 2009

The American Cancer Society (ACS) estimates that 192,370 American women will be diagnosed with invasive breast cancer in 2009 and 40,170 will die from this disease. Breast cancer is the second leading cause of cancer death among women in the United States; only lung cancer is more deadly. October is Breast Cancer Awareness Month, a month dedicated to educating women about the importance of the early detection of breast cancer. Breast cancer is a disease in which malignant cells form in the tissues of the breast. According to the National Cancer Institute (NCI), each breast contains fifteen to twenty lobes — structures within the breast that are composed of small lobules, or milk–producing glands. Milk flows from the lobules to the nipple through thin tubes called ducts. The spaces between the lobules and ducts are filled with fat, and most of the remaining breast tissue is made up of blood vessels, nerves, and lymph vessels.

The various types of breast cancer can be categorized as either non–invasive cancers (carcinoma in situ) or invasive cancers.

Non–invasive breast cancers: Non–invasive breast cancers are cancers that are confined to lobules or ducts and do not spread to surrounding tissues. The two types of non–invasive breast cancers are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). DCIS is the most common type of non–invasive breast cancer. With this form of cancer, abnormal cells grow inside the milk ducts but do not spread elsewhere. Nearly all women diagnosed with DCIS can be cured, and a mammogram is often the best way to find DCIS early.

LCIS is characterized by abnormal cell growth within the lobes/lobules. It is not considered to be a cancer, but it is a warning sign that may signal an increased risk of developing an invasive breast cancer in the same or opposite breast.

Invasive breast cancers: Invasive breast cancers are cancers that have spread beyond normal breast tissue (ducts and lobules) and have invaded surrounding areas. These cancers are much more serious than non–invasive cancers because they can spread to other parts of the body such as the bones, liver, lungs, and brain. The most common type of invasive breast cancer is invasive ductal carcinoma (IDC). IDC is a cancer which forms in a duct(s), spreads through the duct walls, and then invades fatty breast tissue. It can then spread to other parts of the body (this spreading is called metastasis). IDC accounts for approximately 80 percent of all breast cancer cases.

Invasive lobular carcinoma (ILC) is a cancer which forms in the lobes/lobules and spreads to surrounding tissues. It accounts for 15 to 20 percent of all breast cancers. According to the NCI:

• One in eight women will be diagnosed with breast cancer.
• Over 30 percent of women are diagnosed after breast cancer has spread beyond the localized stage.
• When breast cancer is detected early, the five year survival rate is 98 percent.

Early detection of breast cancer saves lives. Having regular screening tests performed is the best way for women to lower their risk of dying from breast cancer. Such tests can find breast cancer early, when it is most treatable. According to the ACS, breast cancers that are discovered because they can be felt tend to be larger and are more likely to have already spread beyond the breast. In contrast, breast cancers found during screening exams are more likely to be small and still confined to the breast. The size of the breast cancer and the degree to which it has metastasized are important factors in the prognosis for a person with this disease.

The most common symptoms of breast cancer are a lump in or on the breast, abnormal thickening of the breast, or a change in the shape or color of the breast. Finding a lump or change in the breast, however, does not necessarily indicate breast cancer.

The following are the ACS’s recommendations for early breast cancer detection in women without any specific symptoms:

• Women aged 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.
• Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional every three years. Starting at age 40, women should have a CBE annually.
• Women should understand breast self–examination (BSE) and be informed of its benefits and limitations.
• Women should report any breast changes to their health professional immediately.
• Women at high risk (greater than 20 percent lifetime risk) should have an MRI and a mammogram performed every year. Women at moderately–increased risk (15-20 percent lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15 percent.

The American Cancer Society believes that the combined use of mammograms, MRIs (for women at high risk), and clinical breast exams — as well as finding and reporting breast changes early (as outlined above) — offers women the best chance to reduce their risk of dying from breast cancer. This combined approach is more effective than any one exam or test alone. The exact causes of breast cancer are unknown. Research has shown, however, that women with certain risk factors are more likely than others to develop the disease. An individual’s risk for breast cancer can also change over time due to changing factors such as aging or lifestyle. Risk factors for breast cancer include:

• Being a woman. This is the single greatest risk factor for breast cancer. Men can develop breast cancer too, but this disease is approximately 100 times more common in women than in men.
• Growing older. The risk for breast cancer increases with age. Approximately one out of every eight invasive breast cancers are found in women younger than 45, while about two out of three invasive breast cancers are found in women aged 55 or older.
• Having an inherited mutation in the BRCA1 or BRCA2 breast cancer genes. Women with this gene mutation have up to an 80 percent chance of developing breast cancer during their lifetimes.
• Certain breast changes. Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and LCIS) increases the risk of breast cancer.
• A family history of breast cancer. Having one first–degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk. Having two first–degree relatives with the disease increases her risk about five–fold.
• High breast density. Women with denser breast tissue have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer.
• Radiation therapy to the chest. Women who have had radiation therapy to the chest before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin’s lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer is later in life.
• A personal history of breast cancer. A woman with cancer in one breast is three to four times more likely to develop a new cancer in the other breast or in another part of the same breast.
• Race. White women are slightly more likely to develop breast cancer than African–American women. African–American women, however, are more likely to die of this cancer.
• Menstrual cycles. Women who have had more menstrual cycles because they started menstruating at an early age (before age 12) and/or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer.
• Never having children or having your first child after age 30. Having many pregnancies and becoming pregnant at an early age reduces breast cancer risk.
• Being overweight after menopause or gaining weight as an adult.
• Having more than one drink of alcohol per day. Compared with non–drinkers, women who consume one alcoholic drink per day have a very small increase in risk. Those who have two to five drinks per day have about one–and–a–half times the risk of women who do not drink.
• Currently or recently using combined estrogen and progesterone hormone replacement therapy (HRT). Large studies have found that there is an increased risk of breast cancer related to the use of combined HRT. Combined HRT also increases the likelihood that the cancer may be found at a more advanced stage, possibly because it reduces the effectiveness of mammograms.
• Current or recent use of birth control pills. Studies have found that women using oral contraceptives have a slightly greater risk of breast cancer than women who have never used them. This risk seems to decline, however, once the usage has stopped.
• Not breast-feeding. Some studies suggest that breast–feeding may slightly lower breast cancer risk, especially if breast–feeding is continued for one–and–a–half to two years.
• Smoking. A recent study found that smoking 100 or more cigarettes may substantially increase a woman’s odds of developing breast cancer.

Having one or more risk factors does not mean that an individual will develop breast cancer. Most women who have one or more breast cancer risk factors never develop the disease. There are also many women with breast cancer, however, who have no apparent risk factors other than being a woman and growing older.

There is no sure way to prevent breast cancer. There are, however, things that all women can do to help reduce their risk and increase the odds that, if cancer does occur, it is found at an early, more treatable stage. Women can help protect themselves by staying away from known risk factors whenever possible. Many risk factors for breast cancer can be avoided by making lifestyle changes such as limiting alcohol use, exercising regularly, and maintaining a healthy body weight. Other than lifestyle changes, the most important step a woman should take is to follow the ACS’s guidelines for the early detection of breast cancer.

Today, there are approximately 2.5 million breast cancer survivors living in the United States. Encourage the women in your life to become informed about breast cancer and to schedule the recommended screening tests that can best protect their health.

MEDICAL DISCLAIMER: The information is not intended to constitute medical advice and is not a substitute for consultation with a physician or other health care provider. Individuals with specific complaints should seek immediate consultation from their personal physicians.