October is Breast Cancer Awareness Month, the time of year you will see pink ribbons everywhere you look. That’s for good reason: the greater the awareness about breast cancer, how to detect it early and how to reduce risk, the more lives that will be saved.
Other than skin cancer, breast cancer is the type of cancer most likely to affect a woman – nearly 13 % of women will be diagnosed with breast cancer in their lifetimes. While the disease is possible in men, it is extremely rare. Breast cancer is most frequently diagnosed in women ages 55-64, with a median diagnosis age of 62.
The National Cancer Institute, a division of the National Institutes of Health, estimates that there will be 268,600 new cases of breast cancer diagnosed in 2019, representing slightly more than 15 % of all new cancer cases and 30 % of all cancer diagnoses in women. The Institute also projects that 41,760 women will die from the disease this year, accounting for 6.9 % of all cancer-related deaths.
The good news is that the incidence of women dying due to breast cancer is decreasing: the breast cancer death rate has dropped nearly 2% each year between 2007 – 2016. In 1975, the five-year survival rate for breast cancer was 75% and it is now nearly 90%. That means nine out of ten women diagnosed with breast cancer today will still be alive in five years and many will go on to live much longer than that.
“With greater awareness about the importance of early detection and significant advances in the treatment of breast cancer, we are making tremendous strides in the battle against this disease,” says Dr. Danielle Burkett, an obstetrician and gynecologist.
First Line of Defense: Early Detection
Changes or abnormalities in the breast can be detected in a variety of ways: through a mammogram or other imaging test, a clinical breast exam and through breast self-awareness.
The mammogram, which is an x-ray image of the breast, is usually the most effective way to screen for breast cancer. Because treatment is most effective when the cancer is at an early stage, periodic mammograms increase the odds of successful treatment.
The American College of Obstetricians and Gynecologists (ACOG) updated its guidelines for breast cancer screenings in 2017 and has reaffirmed them in 2019:
- All women age 40 and over should be offered mammography screenings beginning at age 40 and women who have a normal risk of breast cancer should consider having a mammogram screening every year or every other year beginning between the ages of 40-49.
- All women age 50 and older should have a mammogram every one or two years.
These are general recommendations, and your physician will make specific recommendations for screenings based upon your medical history and risk factors.
“Getting a mammogram at the times recommended by your physician is one of the most important things every woman can do for her health,” says Dr. Lindsay Breedlove Tate, an obstetrician and gynecologist. “Mammograms have saved countless lives because the earlier cancer is detected, the more effective treatment is likely to be.”
In some cases, a mammogram may be inconclusive, in which case the physician may order an additional diagnostic imaging exam, such as a 3-D mammogram, an ultrasound or an MRI to make a better assessment.
Clinical Breast Exams
For women with normal risk who are too young for mammograms, your physician may suggest a clinical breast exam as part of a regular check-up or well-woman exam. This is a physical examination at the doctor’s office in which the physician examines the breasts for any abnormalities.
ACOG’s guidance on clinical breast exams is:
- They may be offered for women with normal risk at ages 25-39, every 1-3 years.
- They may be offered annually for women age 40 and older.
Finally, a key component of early detection is breast self-awareness. The goal of breast self-awareness is for a woman to recognize any changes in the appearance or feel of her breasts. ACOG reports that a substantial percentage of breast cancers are initially detected this way – about half for women age 50 and older and more than 70 percent for women younger than 50. Breast self-awareness is recommended for women of all ages.
A breast lump does not necessarily mean cancer. Many women have lumps in their breasts that are not cancerous and not indicative of future cancer risk. For example, cysts and fibrocystic breast condition are two common causes of non-cancerous lumps. What’s most important is that a woman can recognize a change in her breast, such as a lump that was not there before. If you notice a change in the appearance or feel of your breasts, make an appointment with your physician as soon as possible.
Many breast cancer risk factors are outside anyone’s control. The major risk factor is getting older, as the greatest incidence of breast cancer is in women over 50. Some other risk factors associated with breast cancer include:
- Family history: A woman who has a history of breast cancer in her family, especially a first-degree relative such as a mother, sister or daughter who has had the disease, is at elevated risk.
- Genetic mutations: Inherited gene mutations, such as BCRA1 and BCRA2, known as the breast cancer genes, increase risk.
- Early menstruation/late menopause: Women whose periods began before age 12 or who begin menopause after age 55 are at a slightly higher risk of breast cancer. In both cases, the woman is exposed to estrogen hormones for a longer period of time, increasing risk.
- Late pregnancy or never having been pregnant: Becoming pregnant for the first time after age 35 or never having a full-term pregnancy can increase risk.
- Dense breasts: Women with denser breasts – those with more connective tissue than fatty tissue – are at elevated risk.
- Race: Black and Pacific Islander women are at greater risk of breast cancer.
There are additional risk factors for breast cancer that can be managed or reduced, including:
- Hormone replacement therapy: Taking hormones to replace estrogen and progesterone during menopause may increase breast cancer risk. Your physician can help advise you on the best course of action when considering hormone replacement therapy.
- Oral contraceptives: Some types of birth control pills may contribute to breast cancer risk. If taking birth control, this is something to ask your health care provider about.
- Weight: Women who are overweight or obese after menopause are at a greater risk. Maintaining a healthy weight helps to reduce risk.
- Alcohol consumption: The more alcohol consumed, the greater the risk for breast cancer. Consume alcohol in moderation, if at all. It is recommended that women do not consume more than one alcoholic beverage a day.
- Smoking: Smoking cigarettes is a known cause of many types of cancer, as well as heart disease. Quitting will reduce the impact of this risk factor.
- Sleep: Inadequate nighttime sleep can increase the risk of breast cancer. Get a good night’s sleep each night, and if you are having trouble sleeping, see a doctor.
- Breastfeeding: Women who nurse their babies have been shown to have a lower risk of breast cancer.
Breast cancer often produces no noticeable symptoms initially, which is why following recommended screening schedules is so important. When the disease does produce symptoms, those may include:
A new lump in the breast or armpit area
Pain in any part of the breast
Thickening or swelling of part of the breast
Irritation or dimpling of breast skin
Redness or flaky skin in the nipple area or the breast
Pain in the nipple area
Nipple discharge other than breast milk, including blood
Any change in the breast’s size or shape
Having one or more of these symptoms does not necessarily mean cancer is present but is reason to see a doctor right away.
Diagnosis & Treatment
If a mammogram indicates an abnormality that may be cancerous, the patient will be referred to a breast specialist or surgeon. Additional imaging tests, such as an MRI or ultrasound may be conducted, and a biopsy may be performed to take a sample of tissue or fluid from the breast to test it for cancer.
“Treatment for breast cancer varies based on how advanced the cancer is, the patient’s medical history and other factors,” explains Dr. Anita Chow, a breast oncology surgeon. “Treatment often involves a combination of surgery to remove the cancer, as well as chemotherapy or radiation therapy to shrink and kill remaining cancerous cells.”
The scope of surgery to treat breast cancer varies from patient to patient and will depend in part on how advanced the cancer is, as well as if and how much it has spread. Chemotherapy may be used before surgery to first shrink the cancerous tumor.
In breast-conserving surgery, the cancerous tumor and surrounding tissue are removed from the breast. In other cases, the entire breast must be removed, a procedure known as a total mastectomy. Finally, in a modified radical mastectomy, the breast is removed, as well as some of the lymph nodes under the arm and lining of the chest muscles. In the event of a mastectomy, reconstructive surgery is sometimes performed at the same time. In other cases, breast reconstruction may take place later.
Additional treatments include hormonal therapy, which blocks the cancer cells from getting the hormones they need to grow and spread. This treatment may be effective if the patient has one or more breast cancer receptors: estrogen, progesterone and HER2. Breast cancer in which none of these receptors are present is known as triple-negative breast cancer. Surgery and chemotherapy are the most effective ways to combat triple-negative breast cancer. Finally, biological therapy helps the body’s immune system fight cancer cells and cope with side effects from chemotherapy and radiation treatment.
“While chemotherapy is effective, it is one of the most difficult aspects of cancer treatment,” explains Dr. Sunny Glenn, an obstetrician and gynecologist. “The common side effects of nausea, hair loss and extreme fatigue are tough physically and emotionally, making the support of family and friends especially crucial during chemo.”
Be Aware & Get Screened
“We can’t say it too often: early detection of breast cancer saves lives,” says Dr. Ingrid Kohlmorgen, an obstetrician and gynecologist. “All women should see their primary care provider on an annual basis and know what their personalized schedule for screenings is. If you are age 40 or older and have not discussed the appropriate time to begin mammograms with your physician, make an appointment today.”
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