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Breast Cancer Awareness

October is Breast Cancer Awareness Month, one of the best-known and highest-profile health observances in our country. Before October is over, we will see a lot of pink everywhere we look.

This level of attention is for good reason: breast cancer, unfortunately, affects a lot of people. Apart from skin cancer, breast cancer is the most common cancer to affect women. Some 13% of all women – one out of eight – will get breast cancer at some point in their lives. It is possible for breast cancer to affect men, but it’s very rare.

The National Cancer Institute at the National Institutes of Health (NIH) projects that there will be 287,850 new cases of breast cancer in the United States in 2022, comprising some 15% of all new cancer cases. More than half of female breast cancers are diagnosed between the ages of 55-74, with a median diagnosis age of 63.

NIH modeling forecasts 43,250 deaths from breast cancer this year, representing 7.1% of all cancer deaths. Breast cancer is the fourth-leading cause of all cancer deaths. Roughly one in five women who get breast cancer will die because of the disease. Black women have a sharply higher risk of death due to breast cancer (27.6%), while Hispanic and Asian women have a somewhat lower risk.

Despite these sobering statistics, there is plenty of good news in the fight against breast cancer. Thanks to increased awareness and the early detection of breast cancer, deaths attributed to the disease continue to decline. In 1975, the five-year survival rate for breast cancer was just 75%. Today, it is 90.6%. That means more than nine out of ten women diagnosed with breast cancer this year will still be alive five years from now – and many will live for much longer.

Survival Begins with 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.

Mammograms

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 in its early stages, periodic mammograms increase the odds of successful treatment.

The American College of Obstetricians and Gynecologists (ACOG) provides the following guidance for mammography screenings:

All women 40 and older should be offered mammography screenings beginning at age 40 and women who have an average 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 50 and older should have a mammogram every one or two years. Screening should continue until at least age 75.

These are general recommendations, and your physician will make specific recommendations for screenings based upon your medical history and risk factors.

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. Women who have dense breasts – those with more fibrous and glandular tissue compared with fatty tissue – may be more likely to need additional diagnostic imaging. That’s because dense breast tissue may conceal tumors on a mammogram.

Clinical Breast Exams

For women with average 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 average risk at ages 25-39, every 1-3 years.
They may be offered annually for women aged 40 and older.

Breast Self-Awareness

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% 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 breasts, 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.

Breast Cancer Risk Factors

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. It is important to remember that having one or more risk factors does not mean you will get breast cancer. It is also possible to be diagnosed with breast cancer without having known risk factors.

In addition to age, other known 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 somewhat 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 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: Drinking too much alcohol increases the risk of 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.
Breastfeeding: Women who nurse their babies have been shown to have a lower risk of breast cancer.

Breast Cancer Symptoms

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 of 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.

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 breast cancer 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 has been shown to be an effective breast cancer treatment, it is also very difficult on the patient. The common side effects of nausea, hair loss and extreme fatigue are tough physically and emotionally, making the continuous support of family and friends especially important.

More Awareness = Better Outcomes

In addition to raising money for research, the main point of Breast Cancer Awareness Month is to increase awareness of the importance of screenings and early detection. By embracing the screening guidelines set forth by ACOG – for mammograms but also for Clinical Breast Exams and Breast Self-Awareness – more women will be able to identify potential changes in their breasts early on. If there is cancer present, the sooner it is detected, the more effectively it can be treated.

In addition to screenings, understanding and mitigating the risk factors under your control are important aspects of breast cancer awareness. Drinking alcohol in moderation, getting plenty of exercise and leading a healthy lifestyle will all help to reduce your risk.

This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.

This article contains information sourced from:

The American College of Obstetricians and Gynecologists