Patient Health Resource: Breast Cancer

Risk  

Some risk factors for breast cancer are within your control. Other factors are not. Factors that may increase the chances of developing breast cancer include:

• Age and gender — The risk of developing breast cancer increases as you get older. Most cases of advanced breast cancer occur in women over the age of 50.
• Family history of breast cancer — If a close relative has had breast, uterine, ovarian or colon cancer, your risk for breast cancer is higher.
• Menstrual cycle — According to breastcancer.org, women who start their periods early (before age 12) or go through menopause late (after age 55) have a higher risk for breast cancer.
• Childbirth — Women who never had children or who had them only after age 30 have a higher risk of breast cancer compared to women who gave birth before age 30.
• Dense breasts – Dense breast tissue is an independent risk factor and common to nearly half of all women over 40 who get mammograms. While breast density is often inherited, other factors can also play a part, such as hormone therapy or having a low body mass index. Factors associated with lower breast density include increasing age and having children.
• Obesity — Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.
• Radiation — A study published in the Journal of Clinical Oncology demonstrated the risk of breast cancer is higher in women who were treated for a childhood cancer with chest irradiation.
• Genetics — If you’ve inherited a gene mutation in the BRCA1 or BRCA2 gene, your risk increases. White women have a higher risk of breast cancer than Black, Hispanic or Asian women, but Black women are more likely to develop aggressive, advanced-stage breast cancer that’s diagnosed at a young age.
• Alcohol use — Alcohol consumption is one of the most modifiable risk factors for breast cancer. Research indicates 15-30 grams per day of alcohol consumption (one to two drinks) increases breast cancer risk by 30 to 50 percent.
• Diethylstilbestrol (DES) — Women who took DES to prevent miscarriage may have an increased risk of breast cancer after age 40. Women who were exposed to DES while their mothers were pregnant with them also may have a slightly higher risk. This drug was given to women from 1940 to the 1960s.
• Hormone Replacement Therapy (HRT) — Estrogen replacement therapy or menopausal hormone therapy can be an effective treatment for menopause symptoms but some types of HRT also increase your risk of breast cancer. Because risks and benefits will vary for each woman, it’s recommended you talk with your doctor to understand if HRT is right for you.

Prevention

As noted above, multiple factors can influence your breast cancer risk. You may be able to lower your risk of breast cancer by caring for your health in the following ways:

• Maintain a healthy weight.
• If you smoke, quit. (If you don’t smoke, don’t start.)
  • The CDC offers free support to help you quit smoking, including coaching sessions, a customized “quit plan,” educational materials, plus referrals to local resources. Call 1-800-QUIT-NOW (1-800-784-8669).
• Be physically active.
• A study reported by the American Institute for Cancer Research recommends consuming a healthy diet rich in leafy greens and cruciferous vegetables such as broccoli, cauliflower, cabbage and Brussels sprouts. More studies are needed to fully understand the impact of dietary behaviors.
• Choose not to drink alcohol or drink alcohol only in moderation.
• If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and determine if it is right for you.
• Breastfeed your children, if possible. The longer you breastfeed, the more the risk is reduced.
• If you have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, talk to your doctor about other ways to lower your risk.

Staying healthy throughout your life will lower your risk of developing cancer and improve your chances of surviving cancer if it occurs.

Signs and symptoms

It’s recommended you become familiar with your breasts so you’re able to detect visual or textural changes that occur. Signs of breast cancer may include:

• A lump or firmness in your breast or under your arm
• The size or shape of your breast changes
• Your nipple suddenly becomes inverted, pointing or facing inward
• The skin on your breast, areola or nipple becomes scaly, red or swollen
• You experience nipple discharge, or an abnormal fluid coming from the nipple

Many diagnosed breast cancers are first detected by women who feel a lump, so conducting a monthly self-examination is important.

Clinical detection

Once a woman turns 40, she should talk with her primary care physician about scheduling a mammogram. Mammography uses X-rays to create an image of breast tissue and can reveal abnormalities such as tumors or cysts long before a patient or doctor can feel them.

With digital mammography, the images are recorded directly into a computer. The image can then be viewed on a computer screen, and specific areas may be enlarged or highlighted. If there is a suspicious area, the radiologist can use the computer to take a closer look.

The two types of mammograms are:

• Screening mammograms, for women without symptoms. These consist of two views of each breast. For some women, more than two pictures might be needed to include as much tissue as possible.
• Diagnostic mammograms, for women with symptoms or suspicious findings on a screening exam. These are performed under the direction of a breast-imaging radiologist and can involve specialized views of the breast tissue.

A breast ultrasound may also be used as a diagnostic tool to assist in characterizing abnormalities identified on a mammogram or from palpable lumps. Breast MRI is used to further evaluate abnormalities identified by a mammogram and/or sonogram and to screen people who are at higher risk for breast cancer or who have had a diagnosis of breast cancer.

Treatment

If diagnosed with breast cancer, your medical oncologist – someone who specializes in cancer – will work with you to create a treatment plan.

• Chemotherapy – This treatment uses special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines provided intravenously during a hospital or cancer center visit. Some treatments include both courses of medicine.
• Hormonal therapy – This treatment blocks cancer cells from getting the hormones they need to grow.
• Biological therapy – Works with your body’s immune system to fight cancer cells or to control side effects from other cancer treatments.
• Radiation therapy – Radiation utilizes high-energy rays (similar to X-rays) to kill the cancer cells.
• Lumpectomy – Also known as breast-conserving surgery, a lumpectomy removes only the tumor and a small rim of healthy tissue around it. It leaves most of the breast skin and tissue intact.
• Mastectomy – This is a surgical operation to remove a breast. It’s commonly recommended if the tumor size is large compared to breast size, if there is more than one area of cancer in the breast or if the patient cannot undergo radiation therapy.
  • Breast reconstruction – Following a mastectomy, you may choose to pursue a plastic surgery technique to restore the breast area to near-normal shape, size and appearance. 

Sources:
Texas Health Resources
UT Southwestern Medical
World Health Organization
Susan G. Komen Foundation
NIH: National Cancer Institute
American Institute for Cancer Research
Centers for Disease Control and Prevention