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Published: October, 2007; Vol 4, Num 5

 

Breast Cancer Risks Highlighted in October

Aside from skin cancer, breast cancer is the most common cancer affecting women. Men can get breast cancer, too.

It is estimated that more than178,000 women and 2,000 men in the U.S. will be diagnosed with breast cancer in 2007. Of those diagnosed, almost one in four (22 percent) will die from the disease. Currently, 2.3 million American women are living with a breast cancer diagnosis.

What is Breast Cancer?

Each organ in the body is made up of living cells. When new cells are needed, existing cells divide to create them. Normally, this is an orderly process, but sometimes cell division gets out of control. When this happens, excessive tissue builds up, forming a tumor.

Eighty percent of breast tumors are benign, meaning they do not spread outside the breast and are not life-threatening. They can usually be removed and, in most cases, they do not come back. However, scaring and disfigurement are possible.

The other 20 percent are malignant tumors that divide and grow out of control, invading and damaging nearby tissues. Sometimes, cancer cells in these tumors break away, enter the bloodstream or lymphatic system and then spread to and infect other parts of the body. This spread of cancer is known as metastasis.

Nearly all breast cancer usually starts in the cell lining of the ducts that carry milk to the nipple or in the lobules, the glands that make milk. This is true even in men as their breast tissue also contains ducts. Rarely, the cancer forms in other breast tissue.

Detection

There is no specific way to protect against breast cancer, so early detection is key to effective treatment. All women should conduct breast self-examinations regularly, feeling for unusual lumps, abnormal thickening, changes in shape or changes in color. 

Other possible signs – for men as well as women – include dimpling or puckering of breast skin; swelling, redness or warmth that does not go away; steady pain in one spot (for women, the pain does not vary with the monthly menstrual cycle); pulling in of the nipple; nipple discharge that starts suddenly and appears only in one breast and an itchy, sore or scaling area on one nipple.

As 80 percent of breast tumors are not cancerous, finding a change does not mean you have cancer. However, all changes should be reported to your health care provider.

Because the earliest growths of breast cancer are so small that they are likely to go undetected in a woman’s own examination, all women age 40 or older should have an annual mammogram, a breast x-ray that can detect tiny growths. Many health and welfare fund benefits cover the procedure. If you would like to receive an annual email reminder when it is time for your mammogram, you can register on the American Cancer Society website; click on “mammogram reminder.”

Prevention

While there is no specific way to protect against breast cancer, many daily, lifestyle decisions may reduce the risk. The American Cancer Society’s recommendations are:

  • Decrease your daily fat intake - especially saturated or hydrogenated fats. Eat leaner meats and limit red meat. Reducing your fat intake helps prevent other health problems such as heart disease and stroke and may reduce your chance of developing breast and colon cancers.
  • Increase fiber in your diet. Fiber is found in whole grains, vegetables and fruits. This type of diet is beneficial for your heart and can help prevent other cancers such as colon cancer.
  • Eat fresh fruits and vegetables. In addition to their fiber content, fruits and vegetables have antioxidant properties and micronutrients that may help prevent some cancers.
  • Limit alcohol. Evidence suggests that a small increase in risk exists for women who average two or more drinks per day (beer, wine and distilled liquor).
  • Stay active. The U.S. Surgeon General has recently reported that you can help prevent many health problems by engaging in a moderate amount of physical activity (such as taking a brisk, 30-minute walk) on most days of the week. Strive to maintain the body weight recommended by a health professional, since excess fat may stimulate estrogen production.
  • Don't smoke. Although smoking doesn't cause breast cancer, it can increase the chance of blood clots, heart disease and other cancers that may spread to the breast.

Risk Factors

No set of factors accurately predicts whether a person will be diagnosed with breast cancer, but there are strong indicators. The American Cancer Society says these are the most common factors:

  • Sex. The highest risk factor for breast cancer is being female; the disease is about 100 times more common among women.
  • Age. The risk of breast cancer increases as a woman grows older. The risk is especially high for women age 60 and older. Breast cancer is uncommon in women younger than age 35, although it does occur. There is some evidence to suggest young African American women are at greater risk for breast cancer than young Caucasian women.
  • Personal History. Women who have had breast cancer and women with a history of breast disease (not cancer, but a condition that may predispose them to cancer) are at a greater risk of a recurrence or the development of breast cancer.
  • Family History. The risk of developing breast cancer increases for a woman whose mother, sister, daughter or two or more close relatives have had the disease. It is important to know how old they were at the time they were diagnosed.
  • Breast Cancer Genes. Some individuals, both women and men, may be born with an "alteration" (or change) in one of two genes that are important for regulating breast cell growth. Individuals who inherit an alteration in the BRCA1 or BRCA2 gene are at an "inherited" higher risk for breast cancer. They also may pass this alteration on to their children. It is very rare. Scientists estimate that only about five to ten percent of all breast cancers are due to genetic changes. One out of two women with these changes are likely to develop breast cancer. Women with a family history of breast cancer are encouraged to speak to a genetics counselor to determine the pros and cons of genetic testing.

    The next 5 risk factors all involve estrogen, a hormone that naturally occurs in men and women. However, at the time menstruation begins, women start to produce larger amounts of estrogen and will continue to do so until they reach menopause. Estrogen appears to play a key role in breast cancer. Although estrogen does not actually cause breast cancer, it may stimulate the growth of cancer cells. Estrogen-related risk factors are:
  • Having an early menarche (first period or menstrual bleeding). Women who begin menstruating before age 12 are at increased risk of developing breast cancer. The more menstrual cycles a woman has over her lifetime, the more likely she is to get the disease.
  • Having a first pregnancy after age 25 and especially after 35. Although early pregnancies may help lower the chances of getting breast cancer, particularly before the age of 25, these same hormonal changes after age 35 may contribute to the incidence of breast cancer.
  • Having no children. Women who experience continuous menstrual cycles until menopause are at a higher than average risk.
  • Use of Hormone Replacement Therapy (HRT). Based on the Women's Health Initiative Study (2002), women do appear to have an increased risk of breast cancer while they are on HRT and a short time thereafter, compared to those who have never used postmenopausal HRT. This is based on a study of 16,000 healthy postmenopausal women aged 50 to 79 who were taking either estrogen plus progestin as HRT or a placebo (an inactive pill).
  • Use of Oral Contraceptives (OCs) and Breast Cancer. Current or former use of OCs among women ages 35 to 64 did not significantly increase the risk of breast cancer. The findings were similar for Caucasian and African-American women. Data also show that former OC use does not increase the risk of breast cancer later in life.  

Stages and Treatment

Once detected, the stage of development of breast cancer is determined through an assessment of the tumor size, whether it has involved nearby lymph nodes and whether it has spread to other areas of the body. It is labeled as Stage 0 through IV, with Stage IV being the most serious.

Depending on the stage of development, doctors recommend a variety of treatments. These include hormonal therapy, surgery, radiation and chemotherapy. Through participation in clinical trials, a number of experimental treatments, known as biologically targeted therapy, may also be available.

If you are newly diagnosed with breast cancer, learning all you can about the disease and your treatment options is vital to feeling in control of your situation. The sponsors of National Breast Cancer Awareness Month offer some sources of support. Additional help may be found through the National Breast Cancer Foundation.

[Steve Clark]