As terrifying as it used to sound, Breast Cancer is no longer as dreadful as it was several years ago. It’s still a serious disease but thanks to improvements in cancer treatments, millions of women are surviving breast cancer today.
Early detection and treatment are keys to breast cancer survival
When breast cancer hasn’t strayed outside the breast, the five-year survival rate is close to 100%. So early detection through regular examinations is crucial. Women should begin doing monthly self-exams at age 20 and ask their doctors to do clinical exams at least every three years. By age 40, women should have annual mammograms and breast exams by a physician, in addition to monthly self-exams.
Some women may need to start mammograms and clinical exams earlier if they have a family history of the disease or carry one of the mutated genes – BRCA1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2) – that predisposes them to breast cancer.
People who have Stage 0 (confined to the breast and not invading surrounding tissues) or Stage 1 (confined to the breast and invading surrounding breast tissue) have a five-year survival rate close to 100%. Higher stages (2, 3 and 4) mean that a more invasive tumor has spread to surrounding tissues, lymph nodes and/or to other organs. A woman with stage 4 cancer has a 20% chance of surviving for five years.
Mammography is the most reliable way to detect breast cancer.
The use of high-quality mammography is the most reliable way to detect breast cancer. In fact, because of its increased use, most women are diagnosed at early stages. Still, about 25% of breast cancers are first detected through a breast exam, about 35% by mammography and 40% through a combination of exam and mammography. Clearly, performing routine breast self-exams is still essential.
You can check for possible signs of breast cancer.
The three most common symptoms are:
1. Changes in the look or feel of the breast
2. Changes in the look or feel of the nipple
3. Nipple discharge
Sensitive or lumpy breasts (with or without fibrocystic disease) may make it harder for you to feel the lumps, hard knots of tissue or thickening in the breast that may be signs of breast cancer. Other signs include unusual swelling, warmth and pain that do not change with the menstrual cycle and/or do not go away. Lumps do not necessarily mean you have cancer; most are benign.
Possible changes to the skin include redness, darkening, puckering (a pulling that causes an indentation), or dimpling. The latter is often called peau d’orange, French for “the skin of an orange,” which resembles the slightly pebbled look the breast skin may have.
An inverted nipple – one that pulls inward – may be another sign. Nipples may also become itchy, scaly, sore, or have a rash or discharge. If you have any of these signs, see your doctor immediately.
Many factors are associated with an increased risk of breast cancer.
The presence of these risk factors does not mean you are likely to get the disease, and their absence does not offer absolute protection either. For example, a family history of breast cancer is considered a principal risk factor. Yet 80%-90% of women who get the disease have no known family history.
One of the most important factors is aging. The older you get, the greater the risk. At age 20 your risk is just 1 in 1,985. But at age 70, your risk skyrockets to 1 in 24. If you live to 85 years old, your odds increase to 1 in 8. The lifetime risk of breast cancer is 8%, or 1 in 12.
Approximately 5%-10% of breast cancers are due to inherited genetic mutations, like BRCA1 and BRCA2. People with these mutations have a 40%-80% risk of contracting breast cancer and a high risk of ovarian cancer. Other factors that increase risk are:
-First period before age 12; menopause after 55; excess weight after menopause
-First child after age 30; no children; taking birth control pills for five years or longer
-Drinking more than one alcoholic drink per day
-Current or recent use of combined estrogen and synthetic progestogen or progesterone hormone replacement therapy (HRT)
-High breast density; a previous biopsy showing hyperplasia (an excessive growth of tissue) or carcinoma in situ (a localized, microscopic form of cancer)
-Exposure to large amounts of radiation; treatment for Hodgkin’s disease at a young age
-History of breast or ovarian cancer.
Genetic mutations BRCA1 and BRCA2 raise your risk.
How do you estimate the likelihood of having a genetic mutation? Women with genetic mutations tend to get cancer before they are age 50. If you are older than 50 and do not have breast cancer, your odds of a genetic mutation are lower (but not zero).
If you have a mother, sister or daughter who had breast cancer before age 50 or ovarian cancer at any age, or you have a woman in your family who has had both breast and ovarian cancer or cancer in both breasts, you may have an inherited mutation. You are also at higher risk if you are of Ashkenazi Jewish descent or if you have a male relative who has had breast cancer.
The presence of inherited genetic mutations is still low even in the higher risk groups. For example, in women who get breast cancer before age 45 and have a family history of breast cancer, the incidence of the BRCA1 mutation is 7.2%. In other words, such women still have greater than a 90% chance of not having the mutation.
If you are concerned and wish to be tested for genetic mutations, speak with your physician who may refer you to a genetic counselor.
Racial and ethnic differences affect breast cancer risk.
The incidence and mortality of breast cancer in American women varies by race and ethnicity, perhaps because of inherited risk factors, differences in the biology of the breast cancer or differences in breast cancer screening rates. Caucasian women have the highest incidence of breast cancer while Native Americans have the lowest. African-American women have the highest mortality rate, and Asian-Americans and Pacific Islanders are least likely to die from breast cancer.
BRCA1 and BRCA2 are more common among certain geographic or ethnic groups such as people of Ashkenazi (central or eastern European) Jewish heritage, Norwegians, Icelanders, and the Dutch.
Diet and exercise make a difference.
Weight gain after age 18 or after menopause is a risk factor. In turn, losing that added weight may decrease your chances of getting breast cancer. Diet combined with exercise can be important for managing your risk. In addition to fighting obesity, exercise lowers estrogen levels, which in turn may lower breast cancer risk. Physical activity also helps maintain a healthy immune system.
Lately, you may have heard a lot about the benefits of moderate amounts of wine. It’s true that a daily glass of wine may reduce heart attack risk. But that protection doesn’t extend to breast cancer; risk increases with more than one drink a day.
A few studies suggest a link between breast cancer and eating foods rich in fat, but that association has not been firmly established. Interestingly, the type of fat does not seem to matter. The evidence is clearer linking obesity after menopause and adult weight gain to breast cancer.
Hormone replacement therapy can raise breast cancer risk.
Lifetime exposure to estrogen provides a constant stimulus to breast cells. Early onset of puberty, late onset of menopause and having children after age 30 – all events associated with increased estrogen production – are risk factors. This does not prove, however, that estrogen causes breast cancer.
Follow-up Care
If you or one of your loved ones has breast cancer, here are few things to expect and look for after treatment.
When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects.
Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.
At first, your follow-up appointments will probably be scheduled for every 3 to 6 months. The longer you have been free of cancer, the less often the appointments are needed. After 5 years, they are typically done about once a year. If you had breast-conserving surgery, you will get a mammogram about 6 months after surgery and radiation are complete, and then every year. Women who had a mastectomy should continue to have yearly mammograms on the remaining breast.
If you are taking tamoxifen or toremifene, you should have pelvic exams every year because these drugs can increase your risk of uterine cancer. This risk is highest in women who have gone through menopause. Be sure to tell your doctor right away about any abnormal vaginal bleeding, such as vaginal bleeding or spotting after menopause, bleeding or spotting between periods, or a change in your periods. Although this is usually caused by a non-cancerous condition, it can also be the first sign of uterine cancer.
If you are taking an aromatase inhibitor or are pre-menopausal taking tamoxifen or toremifene, your doctor will want to monitor your bone health and may consider testing your bone density.
If symptoms, exams, or tests suggest a recurrence, imaging tests such as an x-ray, CT scan, PET scan, MRI scan, bone scan, and/or a biopsy may be done. Your doctor may also measure levels of blood tumor markers such as CA-15-3, CA 27-29, or CEA. The blood levels of these substances go up in some women if their cancer has spread to bones or other organs such as the liver. They are not elevated in all women with recurrence, so they aren't always helpful. If they are elevated, your doctor might use them to monitor the results of therapy.
