Besides skin cancer, breast cancer is the most common cancer among American women. Based on current breast cancer incidence rates, The National Cancer Institute estimates that one out of every eight woman born today will be diagnosed with breast cancer sometime during her lifetime.
Despite these high numbers, the good news is that approximately 90% of women diagnosed with invasive breast cancer have a five-year survival rate after the time of diagnosis. Additionally, the U.S. is seeing some positive trends: the breast cancer mortality rate for women has declined by nearly 7% since 1990. Why? An increased emphasis on screenings and early detection among health care providers and advocacy groups is saving thousands of lives each year.
By Rebecca Rochat
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Understanding Your Risk
The number one risk factor for breast cancer is age. Two out of three invasive breast cancers are found in women age 55 or older. The number two risk factor is a family history: having one first-degree female relative (mother, sister) with breast cancer nearly doubles your risk. Still, the majority of people diagnosed with breast cancer have no family history whatsoever.
A third important risk factor is an inherited gene mutation known as BRCA1 and BRCA2—around 5 to 10% of breast cancers are thought to be attributed to this genetic alteration. Angelina Jolie’s recent decision to have a double mastectomy after she was diagnosed with the mutation has brought this risk factor to the forefront of public discussion.
Race/ethnicity also plays an important role when it comes to a woman’s risk of breast cancer. In the U.S., breast cancer is more often diagnosed in white women than in African American, Hispanic, Asian/Pacific Islander, or Native American women. But that doesn’t mean that white women have the highest mortality rate. That goes to African American women, who have the highest breast cancer death rates of all racial and ethnic groups. The CDC attributes this to many factors, including fewer social and economic resources, and a smaller likelihood of getting prompt follow-up care and high-quality treatment.
Other risk factors worth mentioning include radiation exposure, obesity, beginning your period at a younger age, beginning menopause at an older age, having your first child at an older age, having never been pregnant, drinking alcohol, and postmenopausal hormone therapy.
Doctors believe that early screening for breast cancer saves thousands of lives each year. Early testing and detection efforts are crucial—even for women who have no family history or symptoms. Once breast cancer symptoms develop, cancer is more likely to have spread beyond the breast(s). There are several ways to do early breast cancer screening, from self-exams to clinical exams to mammograms. Screening guidelines usually depend on a woman’s age.
20s and 30s: Women in their 20s and 30s can begin performing monthly breast self-exams to look for unusual lumps and shape changes (The American Cancer Society suggests doing it right after your period). Other changes to look for include skin dimpling, nipple pain or retraction, redness or scaliness of the nipple, or a discharge other than breast milk.
Breast awareness and self-exams are key. Roughly 80% of breast cancers are discovered by women themselves. According to the American Cancer Society, women in their 20s and 30s should also have a clinical breast exam (CBE) by a health professional every three years. CBEs are usually a normal part of a wellness exam.
40s and 50s: Beginning at age 40, women should have a CBE and a mammography every year, according to the American Cancer Society.
There are two types of mammograms: screening mammograms and diagnostic mammograms. A screening mammogram is performed to detect breast cancer before it occurs, while a diagnostic mammogram is usually performed after a lump is found or other unusual breast symptoms occur. Screening mammograms take place in a clinic, hospital, or doctor’s office. During a screening mammogram, the breast is compressed between two plates to flatten breast tissue while x-rays are taken. Diagnostic mammography takes longer than screening mammography because more X-rays are needed to obtain views of the breast from several angles.
Most health insurance companies pay for breast cancer screening tests. For those who are not insured, the Centers for Disease Control’s National Breast and Cervical Cancer Early Detection Program offers free or low-cost mammograms. To see if you qualify, you can view eligibility requirements at www.cdc.gov/cancer/nbccedp/screenings.htm.
Staging and Treatment
Stage 0: In stage 0, the cancer is confined to the ducts, the lobules (milk production part of the breast), or the nipple. This stage is often called in situ (i.e., ‘in place’), because it hasn’t yet invaded the breast tissue or become life-threatening.
Stage 1: In stage 1, the tumor is less than two centimeters in diameter and has invaded the breast tissue, but has not spread beyond the breast.
Stage 2: In stage 2, the tumor is larger than two centimeters and/or has spread to the lymph nodes under the arm.
Stage 3: In stage 3, the tumor is either 5 centimeters or more, or is smaller and has spread to tissues near the breast or lymph nodes within the breast or under the arm. It has not spread to distant sites such as the lungs, liver, bones, or brain.
Stage 4: In stage 4, the cancer has spread to other parts of the body such as the lungs, liver, or bone.
Treatment methods will depend on the stage of the cancer. Options include: surgery, lymph node biopsy followed by surgery, radiation therapy, chemotherapy, hormone therapy, or targeted therapy. Most women with breast cancer will have some type of surgery to remove a breast tumor, whether it be a breast conserving surgery or a mastectomy (removal of the breast). Breast reconstruction can be done at the same time as surgery or later on.
Radiation to the breast is often given after breast-conserving surgery to help lower the chance that the cancer will come back in the breast or nearby lymph nodes. Radiation may also be recommended after mastectomy in patients with either a cancer larger than five centimeters, or when cancer is found in the lymph nodes.
Surviving breast cancer will depend on the stage of the cancer and the success of the treatment(s) required. Women who are cancer-free for five years or more are considered breast cancer survivors.
The American Cancer Society says that there is no sure way to prevent breast cancer. But there are things that all women can do that might reduce their risk. The Mayo Clinic has recommended these seven changes: limiting alcohol, not smoking, controlling your weight (a low-fat diet is best), exercising (at least 150 minutes/week of moderate aerobic activity or 75 minutes/week of vigorous aerobic activity, plus strength training), breastfeeding, limiting dosage and duration of hormone therapy, and avoiding exposure to radiation and environmental pollution.
Get Support Today!
If you are diagnosed with breast cancer, many local organizations offer free cancer seminars and support groups. For more information, contact Breast Cancer Support Services at (423) 629-2445. There are also many support services available on the national level, including: American Cancer Society (cancer.org), National Breast Cancer Coalition (breastcancerdeadline2020.org), National Breast Cancer Foundation (nationalbreastcancer.org), National Cancer Institute (cancer.gov), and Susan G. Komen Foundation (komen.org). Don’t wait to get help today.