Breast cancer is the second most common cancer among US women after skin cancer. It is the second leading cause of death from cancer among American women, with lung cancer being the first. One in eight women will be diagnosed with breast cancer in her lifetime assuming that she lives to be 90. The incidence of breast cancer in women increases with age. The risk that a woman will be diagnosed with breast cancer during the next 10 years starting at the following ages, is as follows:
• Age 30- 1 in 227
• Age 40- 1 in 68
• Age 50- 1 in 42
• Age 60- 1 in 28
• Age 70- 1 in 26
About 80% of women who get breast cancer have no known family history of breast cancer. The most critical element in increasing survival is early detection.
Do you have these high-risk factors?
• First-degree relatives (mother, sisters, daughters) with breast cancer
• Hereditary breast cancer – BRCA1 and BRCA2*
• Onset of first period before age 12
• Menopause after 50 years of age
• Late age at first full-term pregnancy (>30 years)
• No full-term pregnancies
• Never breastfed a child
• Hormonal replacement therapy
• Denser breast tissue
*Approximately, 5-10 % of breast cancer cases are inherited. Two of the most commonly tested genes are BRCA1 and BRCA2. Women with mutations in BRCA 1 are estimated to have a 65% chance of developing breast cancer by age 70 and a 45% chance if they have mutations in BRCA2. Cutting edge fertility diagnostic tools enable us to now test for the presence of BRCA1 and BRCA2 in embryos.
Factors you can modify to lower your risk
• Weight: Weight gain of 22 pounds or more after menopause is associated with an increased risk of 18%, whereas losing 22 pounds after menopause is associated with 57% lower breast cancer risk.
• Exercise: Vigorous exercise for 45 to 60 minutes on 5 or more days per week.
• Alcohol use: Drinking 2 alcoholic drinks a day increases the risk of breast cancer by 21%.
• Preventive (prophylactic) surgery: Removal of both breasts (mastectomies) and/or ovaries in women who are carriers of BRCA mutations reduces the risk of cancer formation.
When to seek medical attention
The most common presentation is that of a painless lump. Other findings include breast pain, redness, swelling and nipple discharge. In some cases the nipple may have lesions and becomes inverted. You should consult your physician if any of these changes occur.
Diagnostic guidelines
• Monthly breast self-examination
• Annual mammogram in women over age 40
• Magnetic resonance imaging (MRI) which is especially important in women at high risk
• Breast biopsy
Treatment options
Treatment options will be individualized according to the stage and type of breast cancer. These include:
• Surgery to remove the lump or the breast
• Radiation therapy
• Hormonal therapy in the form of SERMs and/or aromatase inhibitors
• Targeted therapy such as Herceptin in patients with an over expression of the HER2/neu oncogene
• Traditional chemotherapy
For further information
www.nih.gov; www.natlbcc.org; www.komen.org; www.HER2support.org
