Risk Factors That You Cannot Control

Genetics. Between 5 and 10 percent of breast cancers seem to be triggered by inherited gene mutations -- known as BRCA1 or BRCA2. With either of these genes your chance of developing breast cancer before the age of 70 is around 50 to 60 percent.

The good news is that you can be screened for these genes. If you have one of them, once you are 20 or older, your doctor should give you a clinical breast exam every six months; and annual mammograms after age 25.

Previous breast disease. If you had cancer in one breast, you are more likely to develop cancer in the other. Women who have had non-invasive, pre-cancerous or cancerous cells in their milk glands or ducts are at increased risk as well.

Age. The older you are the greater the risk.

Age at time of your first period. If it occurred before the age of 12, you are at a slightly greater risk.

Age of first live birth. If you had your first full-term pregnancy after the age of 30 or have never had children, you are at increased risk.

Family history. Your risk increases if your mother, sisters, or daughters have had breast cancer.

Breast biopsy. If you have had a breast biopsy due to breast abnormalities, your risk increases, not from having the biopsy itself, but because of whatever reason led to the biopsy in the first place -- especially if you were then diagnosed with atypical hyperplasia (unusual changes in the breast tissue).

Race. Caucasian women are at a greater risk than African-American women.

Risk Factors That You Can Control

Alcohol. Some studies suggest a connection between even minor alcohol use and a higher incidence of breast cancer.

Diet. Research indicates that weight gained after the age of 18 is a strong predictor of postmenopausal breast cancer risk. Women who gain 14 pounds (30 kilograms) or more between the ages of 18 and 70 double their risk of breast cancer. The relationship of weight gain and breast cancer may have to do with increased insulin resistance (a precursor to diabetes) that develops with obesity. It may stimulate the growth of pre-cancerous lesions in those approaching menopause. In addition, weight gain during treatment for breast cancer seems to increase the risk of recurrence.

Exercise. Many studies indicate that exercise reduces the risk for all forms of cancer.

Birth control pills. There may be an increased risk among women who are currently using or who have used oral contraceptives within the past 10 years, but the risk seems to disappear once a woman has been off the pill for ten years or more. Research on the most recently developed pills (progestogen-only pills and other so-called third-generation low-dose estrogen pills) is not yet complete, although a few studies do indicate that they too may increase the risk slightly.

Does Hormone Replacement Therapy (HRT) Increase the Risk?

According to the American Cancer Society, studies show that HRT use for 10 years or more may increase the risk slightly. Also, in women who previously have been diagnosed with breast cancer, estrogen may stimulate the growth of cancer cells in certain types of tumors. For many women, however, there are important health benefits from hormone replacement therapy. Talk with your doctor about the risks and benefits.

Screening for Signs of Breast Cancer: Three Steps to an Effective Cure

If you are older than age 20, you are ready to take charge of your on-going screening. You can do a lot to make sure you don't develop breast cancer that goes undetected and untreated. The three elements of early detection are: breast self-exam, clinical breast exam and mammogram.

STEP ONE: Breast self-exam
All women age 20 and older should know how to examine their breasts and should do so monthly.You can ask your doctor for instructions -- many physicians have their own methods -- or contact the American Cancer Society at 1-800-686-4357, or at their website at www.cancer.org, for a copy of their instruction pamphlet.

STEP TWO: Clinical breast exam
If you are age 40 or older, your doctor should give you a physical breast exam once a year. If you have special risk factors such as a family history, you should start having the exam twice a year from the age of 20 to 30. Talk to your doctor about your concerns.

STEP THREE: Mammogram
A mammogram is an x-ray of the breast that is used to detect and diagnose breast disease. A mammogram can be used to identify the cause of problems if you have symptoms such as a lump, pain, or nipple discharge. It can also be used to detect cancer even if you do not have any symptoms. Early detection (before there are symptoms) increases the chance of effective treatment.

Who Should Have a Mammogram?

All women age 40 or older should have an annual mammogram. It is important to begin in your 40s because that is when about 18 percent of all breast cancers occur. However, if women in their 40s have mammograms, they reduce their risk of death from breast cancer 17 percent!

Is Radiation from Mammograms Dangerous?

The very low dose of radiation is not thought to pose any risk to a woman.

What's the Next Step?

If the mammogram identifies an area that may be diseased, your doctor will suggest a biopsy. A biopsy is a surgical procedure in which a very small sample of cells or tissue is removed from the breast so it can be examined for cancer cells.

Over a lifetime of annual mammograms, a woman has a 25 percent chance of having some tissue identified as suspicious that turns out NOT to be cancerous. This is a relative high rate of false alarms. You should know that just because the mammogram identifies a suspicious area, there is no need to panic. It may well be nothing.

What You Need to Know

The news about breast cancer is good: Although this year 175,000 women in the U.S. will be newly diagnosed with invasive breast cancer, when the disease is detected early it is almost 100 percent curable.

Even better news! You can do a great deal to make sure that breast cancer is detected early and treated promptly. The information in this brochure will give you the edge you need to make sure your health is protected.

Breast Cancer Basics
Breast cancer is a disease that causes cells in the breast to change and to grow without any orderly pattern. It can appear in various parts of the breast -- the milk-secreting glands, the ducts that carry the milk to the nipple, or in the breast tissue itself. Symptoms can include breast pain or discharge, dimpling of the skin or open sores that will not heal.

What's the Risk?

• Breast cancer is the second leading cause of cancer death among women today; only lung cancer claims more lives.
• Breast cancer is the second most common form of cancer affecting women today; only skin cancer occurs more frequently.
• Approximately 43,000 women will die from breast cancer this year.

What Causes It?
No one knows exactly what causes breast cancer. Certain conditions increase the risk for some women, but overall 70 to 80 percent of women who have breast cancer have no known risk factors for the disease.

Treatment Options

The most common treatments for breast cancer are surgery (most women with breast cancer will have some type of surgery), radiation therapy, hormone therapy and chemotherapy.

Surgery
A lumpectomy is the removal of the cancerous portion of the breast and a small amount of surrounding tissue.

• A partial mastectomy removes one quarter or more of the breast.
• A total mastectomy removes the entire breast.
• A modified mastectomy removes the entire breast and the lymph nodes under the arm.
• A radical mastectomy removes the entire breast, the lymph nodes under the arm, the mammary lymph nodes and the chest wall muscles underneath the breast.

Radiation therapy
Radiation is used to kill cancer cells or to reduce the size of a tumor before operating.

Hormone therapy
Estrogen can spur the growth of breast cancer, so certain drugs have been developed that prevent the estrogen from affecting the cancer cells. One drug, tamoxifen, has been used for many years in women with estrogen-dependent breast cancer. A recent study found that taking tamoxifen for five years reduces breast cancer recurrence 42 percent and mortality 22 percent. It also seems to give women the health benefits of estrogen (decreased risk of heart disease and thinning bones). Tamoxifen is now being used experimentally by women at high risk for developing breast cancer to see if it prevents it. It does have serious side effects, however, and women should discuss the risks and benefits with their doctors. Another estrogen-like medication is raloxifene, now used to prevent bone loss (osteoporosis) in postmenopausal women. Initial research indicates it may be able to prevent breast cancer -- in women tested, it slashed the incidence of invasive breast cancer by 75 percent or more. In the not too distant future, women can expect these and other methods of detection and treatment to become more and more effective.

Male Breast Cancer

Each year around 1,300 men develop breast cancer and 400 die from it. Awareness of and research into male breast cancer is important not only because men are usually diagnosed in later stages when the outcome is not as good, but also because it helps us understand more about female breast cancer as well.

The mission of The Partnership for Womenís Health at Columbia is to improve the health of women and men around the world through research and education. It will accomplish this by using new information about womenís unique physiology and the way they experience disease, to generate a better understanding of the differences between women and men and to help establish the new discipline of gender-specific medicine.