Campus Life

The Medical Minute: Breast Cancer Awareness Month

By John Messmer
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine

Awareness

October is Breast Cancer Awareness Month. Breast cancer is the most common cancer in women and the second-leading cause of cancer death, following lung cancer. People will hear a lot of statistics this month that may seem a bit frightening. The goal of sharing the statistics on breast cancer is not to frighten women or their families; rather it is to get them to think seriously about the risk of breast cancer and what they should do about it.

Statistics

According to authorities on breast cancer, women have a one in eight chance of developing breast cancer. That chance varies from woman to woman once specific risk factors such as age and family history are taken into account. An average 40-year-old woman could have a risk as high as one in eight or as low as one in 85 depending on such factors. For statistical purposes, breast cancer risk is spread out over the lifetime of a hypothetical woman who lives to be 110. More than half the risk occurs after age 60 and a third of the risk occurs after age 75. A woman's risk is affected by environmental and genetic factors such as family history of breast cancer in a mother or sister, when the woman went through puberty and her first pregnancy.

Detection

Regardless of how the statistics are interpreted, the threat of breast cancer must be taken seriously. While researchers constantly are working toward better treatments, prevention and early detection remain the most effective means of beating the disease. Regular and thorough monthly self-exams still are highly recommended, starting in early adulthood. Women should become familiar with the normal contours and irregularities of their own breast tissue. Doing so will help them recognize changes early. In addition, annual exams by a health-care professional improve the chances of early diagnosis.

Regular mammograms are an excellent tool for detecting early breast cancer. Most authorities agree that annual mammograms for women older than 50 save lives. There remains some disagreement over the value of routine mammograms for women between the ages of 40 and 50, mostly because breast tissue is denser and can create shadows that reduce the accuracy of reading the mammogram.

Because some tumors cannot be seen well on mammography, ultrasound examinations may be done as a companion procedure. In high-risk women, some physicians will order magnetic resonance imaging (MRI). MRI is not for every woman because it tends to have too many false-positive results. For women under the age of 40, mammography is recommended only on a case-by-case basis. Those at high risk might benefit from a mammogram between ages 35 and 40. After age 75, each woman must weigh her own risk of breast cancer against her life expectancy. A woman in good health should consider continued annual mammograms.

Because there is no perfect test, each woman should discuss her individual circumstances with her physician to determine what is the best method of evaluation for her.

Genetics

The BRCA genes are two genes that have been identified as being associated with breast cancer. Having a breast cancer gene increases the risk, but does not cause the disease. Testing for the BRCA genes is not a straightforward decision. At a cost of about $3,000, it should be considered only for women whose medical and family history put her at higher risk for breast cancer according to current research.

Hormone therapy

Many women have received hormone replacement at menopause. In the last couple of years, medical research has shown an increase in the risk of breast cancer for women taking hormone replacement for more than five years, particularly for the combination of estrogen and progesterone, which is used for women who have not had a hysterectomy. The risk is less for estrogen alone. Currently the only accepted reason for using hormone replacement is postmenopausal hot flashes. Women at high risk for breast cancer must weigh the need for treatment of hot flashes against the risk of cancer.

Although hormone therapy after menopause is a risk, birth-control pill-use does not appear to be associated with an increased risk in the long term. There is a slight increase in breast cancer while women are using birth-control pills, but breast cancer is rare in women young enough to be on birth control. Ten years after use, the risk is equal to non-users and tumors that do arise seem to be less aggressive in former birth-control users. The exception is women with the BRCA1 gene, who do have a higher risk from birth-control pills.

Because breast cancer is a complex issue every woman should discuss her own risk of the disease with her physician and work out a plan for risk reduction and surveillance for breast cancer.

For more information go to http://www.hmc.psu.edu/healthinfo/b/breastcancer.htm and to calculate breast cancer risk, go to http://bcra.nci.nih.gov/brc/ (requires some medical knowledge).

Last Updated March 19, 2009

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