Breast Cancer

Breast Cancer

Breast cancer is the most commonly diagnosed cancer of women, and the second leading cause of cancer deaths among American women between 40 and 55 years of age. Regular mammography and clinical breast exams are essential for early detection of breast cancer. For women between 50 and 69 years of age, having regular mammograms can reduce the chance of death from breast cancer by one-third or more. During the most recent 5-year period, mortality rates among Caucasian women declined for all decades between 30 and 79 years of age, and for all decades among African American women from 30 to 69 years of age. Despite these numbers, only about 30% of women actually have a regular mammogram.

Important Facts:

  • A woman’s chances of getting breast cancer changes with age: by age 40, 1 in 217 women will face breast cancer; by age 70, 1 in 14 will be diagnosed with the disease. Although death rates from breast cancer declined 4.6% between 1991 and 1995, breast cancer accounts for 31% of all cancers diagnosed among women.
  • Approximately 180,000 new cases of breast cancer are estimated for 1998, and about 43,500 women are expected to die from breast cancer. It is estimated that 1.5 million American women will be diagnosed with breast cancer this decade, and breast cancer will claim nearly half million lives.
  • With proper early detection and treatment, the chances of surviving breast cancer are improving. Breast cancer mortality trends among African American and Caucasian women have improved markedly since the 1980s. The greatest reductions in death rates were among younger women (7.6%) and Caucasian women (5.3%), with more modest reductions among African Americans (1.6%).
  • Over 2 million breast cancer survivors exist in the U.S. today!

Breast Cancer Incidence

Age Range Incidence (per 100,000 persons)
20-24 0.7
25-29 4.3
30-34 12.9
35-39 29.5
40-44 60.1
45-49 101.4
50-54 164.6
55-59 193.1
60-64 223.9
65-69 223.9
70-74 267.2
75-79 306.5
80-84 306.5
85+ 282.6
Ethnic Group
Whites 115.5
Blacks 101.5
White Hispanics 72.9
Nonwhite Hispanics 68.5
Asian/Pacific Islanders 78.1
American Indians/Alaska Natives 50.5

Breast cancer is a disease in which cancer (malignant) cells are found in the tissues of the breast. Each breast has 15 to 20 sections called lobes that have many smaller sections called lobules. Thin tubes called ducts connect the lobes and lobules. The most common type of breast cancer is ductile cancer. It is found in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma. Lobular carcinoma more often is found in both breasts than other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer. In this disease, the breast is warm, red, and swollen.

You should see your doctor if you notice changes in your breast. Women older than 50 years of age should also have a special x-ray called a mammogram that may find tumors that are too small to feel. Check with your doctor on how often you should have this x-ray. When breast cancer spreads outside the breast, cancer cells are often found in the lymph nodes under the arm (axially lymph nodes). If the cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body. Cancer that spreads is the same disease and has the same name as the original (primary) cancer. When breast cancer spreads, it is called metastatic breast cancer, even though the secondary tumor is in another organ.

Q. How is breast cancer treated?
A. There are treatments for all patients with breast cancer. Four types of treatment are used:

  • Surgery (taking out the cancer in an operation)
  • Radiation therapy (using high-dose x-rays to kill cancer cells)
  • Chemotherapy (using drugs to kill cancer cells)
  • Hormone therapy (using hormones to stop the cells from growing).
  • Biological therapy (using your body’s immune system to fight cancer) and bone marrow transplantation are being tested in clinical trials.

Treatment depends on the size and location of the tumor in the breast, the results of lab tests, and the stage (or extent) of the disease. The doctor is the best person to answer questions about treatment for a particular patient: what her treatment choices are, how successful the treatment is expected to be, and how much it is likely to cost.

Q. What are the risk factors for developing breast cancer?
A. The two most important risk factors are getting older and being a woman. In fact, almost 75 percent of women with breast cancer are over 50 years of age. The risk also is increased if a woman:

  • Has a history of breast cancer in her family
  • Has never had children
  • Has had her first child after age 30
  • Began menstruating before age 12
  • Completed menopause after age 55

It is important to keep in mind that these factors do not cause cancer but are merely associations that may increase cancer risk. Having one or more of the risk factors does not mean a woman is certain to develop breast cancer.

There is no proven way to prevent breast cancer, so finding the disease as early as possible is the goal. Used on a regular basis, a mammogram (with or without a breast exam by a doctor or nurse) offers the best chance of saving lives. Studies have shown that, for women 50 to 69 years of age, having a regular mammogram (with or without breast exams by a doctor or nurse) could reduce deaths from breast cancer by one-third or more.

Q. Is breast cancer inherited?
A. The genes in your cells carry the hereditary information that you got from your parents. Sometimes, a test can be done to look for a gene that may be associated with a certain hereditary trait. Recently, a gene was found to be defective in 5% of breast cancer patients. Hereditary breast cancer makes up approximately 5 to 10% of all breast cancer cases. Relatives of breast cancer patients who carry this defective gene may be more likely to develop breast or ovarian cancer. Tests are being developed to determine who has the genetic defect long before any cancer appears.

Q. If I do not have a family history of breast cancer, am I still at risk for developing it?
A. Yes. In fact, 80% of women who develop breast cancer have no family history of the disease. While chances of getting breast cancer increase if a family member also has had it, this does not mean that a woman is free from risk if no one in her family has had breast cancer.

Q. What about estrogen (hormone replacement therapy) and breast cancer?
A. A major issue surrounding hormone replacement therapy and estrogen replacement therapy is the influence of estrogen on breast cancer. Researchers believe that the longer a woman is exposed to naturally occurring estrogen, the greater risk of developing breast cancer. It has not been proven, however, that estrogen administered at menopause has the same effect. There is disagreement because of wide variations in the populations studied, as well as the doses, timing, and types of estrogen used. An analysis of previous studies suggests that low-dose estrogen taken on a short-term basis (10 years or less) does not pose increased risk of breast cancer. Long-term use (more than 10 years) at a high dose may significantly increase the risk. By how much is still a matter of heated debate. At the very most, researchers think long-term use could possibly increase the risk of getting breast cancer by 30%. This means that incidence would rise from 10 women per 10,000 each year to 13 women per 10,000 each year.

The WHI is a large-scale study of estrogen and combination estrogen plus progestin as preventive therapies for postmenopausal women, designed to access the long-term risks and benefits of estrogen replacement therapy (ERT) and combination HRT. It enrolled 27,000 women between 1993 and 1998, scheduled to conclude in 2005. A total of 16,608 women were randomized to combination HRT and placebo.

The combination HRT arm of the study was discontinued, citing as the main factor an increased risk of invasive breast cancer in the group receiving continuous combined HRT compared with the placebo group after an average follow-up of 5.2 years. This, combined with an increase in cardiovascular events in women and active drug vs. those on placebo that began in the first year and persisted, outweighed the benefits, which included a reduced incidence of colon cancer and hip fractures.

The fear of cancer is one of the most common reasons that women are unwilling to use hormone replacement therapy. Interestingly, actual death rates for breast cancer have not risen at all. This may be because estrogen users have more frequent medical visits and obtain more preventive care including yearly mammograms. The WHI study conitnues to monitor women who are on estrogen alone and do not take progestin (progesterone).

While no one can determine who will eventually develop breast cancer, there are certain risk factors you should be aware of when considering hormone replacement therapy. A family history of breast cancer (sister or mother) is probably the most important risk factor of all. You may also be at an increased risk if: you menstruated before age 12; delayed motherhood until later in life; or have a late menopause (after age 50). Also, the older you are, the higher the risk.

To use or not use hormone replacement therapy is a personal decision to be made by each woman with help from her doctor. Regular breast examinations by a health care professional and self-examination are recommended for women receiving estrogen therapy, as they are for all women.

Best Bet For Detection and Survival

Breast Self Examination – Breast Self Examination (BSE) takes just a few minutes and you only need to do it once a month. If you are menstruating, perform BSE 7 to 10 days after the first day of your period when your breasts are least tender. If you no longer menstruate, choose the same day each month to remind yourself to do BSE. As you do your examination, keep in mind that your goal is to become acquainted with how your breasts normally look and feel. Look for:

  • A lump or thickening in or near the breast or underarm area
  • A change in the size or shape of the breast
  • A puckering, dimpling, or redness of the breast skin

Screening – Regular mammogram screening and breast examinations by a medical professional. More than 20% of breast cancers are diagnosed in women over age 50 after a regular mammogram. Mammograms are recommended annually for women age 50 and older. The age that initial mammogram screening is recommended depends upon personal history and a doctor’s recommendation. Some women start as early as age 30. Most start around age 40.

Tissue sampling – The sampling of a lump by performing a biopsy (removal of a small sample by a very thin needle inserted into the lump) has proven to be a very effective method of determining breast cancer. Over 80% of breast biopsies prove to be benign (non-cancerous). Advancement in technique allows for most procedures to be done in the doctor’s office or as an outpatient procedure.

Early detection is the key to beating breast cancer. Advances in surgery, medications, and radiation therapy have allowed more and more women to leave their breast tissue in tact with little scarring. The 5-year survival rate when the cancer is detected early is more than 97%.

Thomas G. Stovall, M.D.

Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women’s Health Specialists, Inc.