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.
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.