1. Is it true that one in eight women will get breast cancer?
The one-in-eight statistic doesn’t accurately reflect the average woman’s breast cancer risk. Age is the most important risk factor for breast cancer. That means the older a woman is, the greater her risk of developing the disease. Statistics from the US National Cancer Institute show that a woman’s chance of being diagnosed with breast cancer by age is:
From age 20 to age 30 . . . 1 in 2,000
From age 30 to age 39 . . . 1 in 229
From age 40 to age 49 . . . 1 in 68
From age 50 to age 59 . . . 1 in 37
From age 60 to age 69 . . . 1 in 26
Ever . . . . . . . . . . . . . . . 1 in 8
“Ever” is lifetime risk. This means a woman has a one-in-eight chance of getting breast cancer after the age of 70.
2. Is it necessary to do monthly breast self-exam?
Breast self-exam (BSE) has been widely hailed as a technique that can help women find breast cancer early—with the implication that finding it early will save lives. There’s just one problem: No study ever has found that BSE reduces breast cancer deaths. That’s why after many years of supporting BSE, the American Cancer Society, in May 2003, revised its breast cancer screening guidelines and now calls BSE optional.
Many women do find their cancers themselves. But very few find them while doing BSE. More typically, the woman just rolled over in bed, or felt a lump while soaping up in the shower, or had it pointed out by a lover.
This is why it is important for women to become acquainted with their breasts, to know what they look like, and to know what lumps and bumps are normal for them. (It’s best to do this soaped up in the shower or bath.) But there’s a crucial difference between getting acquainted with your breasts and BSE. BSE is like a search-and-destroy mission. It often makes women tense. And it’s all about trying to find cancer. In contrast, getting acquainted with your breasts gives you a good, integrated sense of your body, which will help you know when something doesn’t feel right. Some women like to do BSE, and that’s fine. But no one should be made to feel guilty for not doing it—especially if they are well acquainted with their breasts.
3. What are the risk factors for breast cancer?
Risk factors are identifiable traits or habits that make some people more susceptible than others to a particular disease. Although we have identified some of the risk factors for breast cancer, we still don’t fully understand what increases breast cancer risk. In fact, 70 percent of the women who develop breast cancer have no risk factors in their background.
Known Breast Cancer Risk Factors:
Gender- Breast cancer is 100 times more common in women than it is in men.
Age- The older you are, the greater your chance of getting breast cancer. Most breast cancer—about 80 percent of all cases—occurs in women over 50.
Race- White women are slightly more likely to develop breast cancer than are African American women, but African American women are more likely to die of the disease. Asian, Latina, and Native American women have a lower risk than white women of developing breast cancer.
Family history- About 30 percent of women who develop breast cancer have a family history of the disease.
Reproductive factors- The younger a woman is when she gets her first period and the older she is when she goes into menopause, the more likely she is to get breast cancer.
Pregnancy- Women who have never been pregnant are at higher risk than are women who have had a child before 30. However, women who have their first pregnancy after 30 are more at risk than those who have never been pregnant.
Radiation exposure- Radiation is a known risk factor for cancer in general. Several major studies have confirmed the link between radiation and increased risk of breast cancer.
Previous abnormal breast biopsy- If a biopsy indicates that a woman has atypical hyperplasia, she has about a four times greater risk of developing breast cancer. What does this mean? In a group of 100 women who did not have benign breast disease, 5 of them would be expected to go on to develop breast cancer. In a group of 100 women with atypical hyperplasia, 19 of them would be expected to develop breast cancer.
Diethylstilbestrol (DES) - In the 1940s through the 1960s, doctors gave some pregnant women DES because it was thought to reduce the risk of miscarriage. These women have a slightly increased risk of developing breast cancer.
Hormone replacement therapy (HRT) - Long-term use (several years or more) of HRT slightly increases breast cancer risk.
Alcohol- Studies indicate that drinking alcohol slightly increases risk.
Obesity- Studies indicate that being overweight increases breast cancer risk, especially for postmenopausal women. This is because fat tissue increases estrogen levels and high estrogen levels increase breast cancer risk.
Physical activity—Recent studies indicate that exercise appears to reduce both breast cancer risk and the risk of a cancer recurrence.
4. Do most women die of breast cancer?
Women fear breast cancer more than any other disease. And many people believe that most women die of breast cancer. But that’s not the case. In the US, breast cancer is the fifth leading cause of death for women. Heart disease is first.
Five leading causes of death for American women in 2002:
Heart disease: 356,000
Lung cancer: 68,000
Chronic obstructive pulmonary disease: 64,000
Breast cancer: 42,000
Approximately 212,920 women will be diagnosed with invasive breast cancer in the United States in 2006, and approximately 40,970 women will die of the disease.
5. When should I start having mammograms, and how often should I have them?
Everyone agrees that women age 50 and older should have mammograms. But there has been quite a controversy for a number of years now as to whether women between the ages of 40 and 49 should also have annual mammograms. The problem is that women between 40 and 49 typically still have dense breasts, and on a mammogram, this dense breast tissue shows up as white—which is the same color as a cancer appears on a mammogram. With menopause, which typically begins around age 50, the dense tissue in women’s breasts is replaced with fatty tissue, which looks gray on a mammogram. It is much easier to see the white cancer against this gray background. That’s why mammography works better on women aged 50 and older.
To date, eight randomized controlled trials have found that mammography screening for women between 40 and 49 had no effect on mortality. Even so, some health organizations continue to recommend annual mammography for women between the ages of 40 and 49. At first glance, there would seem to be little harm in this recommendation. But there is a downside. Many abnormalities seen on mammograms may not be cancer (these are called false positives), but they will prompt additional testing and anxiety. In fact, as many as three out of 10 women who begin annual screening at age 40 will have an abnormal mammogram during the next decade, and the majority of these will end up having biopsies—only to learn that the test was a false positive.
The bottom line: Even in older women, mammography is far from a perfect screening tool. It may help you find your cancer early, but finding a cancer “early” is not a guarantee that your life will be saved. New data suggests that there are different types of cancers and that how quickly a cancer progresses has more to do with the type of cancer it is than when it is found. Probably the best way to decide when you should begin having mammograms is to discuss your personal risk factors for breast cancer with your physician.
You can learn more about the risks and benefits of mammography for women between the ages of 40 and 49 on this UCSF website. You can find information about Medicare coverage and how to find an FDA-approved mammography center, on the FDA’s website.
6. If no one in my family has had breast cancer, can I still get it?
Yes, you can. When women learn that breast cancer can be a genetic disease, they often think this means it is a disease that must be inherited. But that’s not the case. A genetic disease is one that is caused by a genetic mutation that is either inherited or arises spontaneously. Only about 30 percent of the women who develop breast cancer have a family history of the disease. The other 70 percent have what is called a “sporadic occurrence.” This means there is no known family history of the disease.
7. Is there a way to prevent breast cancer?
There is nothing that you can do to ensure that you absolutely do not get breast cancer. But studies indicate that there are some lifestyle choices that appear to help reduce breast cancer risk. Right now, some of the most important appear to be: eating a healthy diet that is low in animal fat and high in whole grains and fruits and vegetables (there is no data indicating that a specific diet, per se, can help reduce breast cancer risk); losing weight (if you are overweight); not gaining weight after menopause; getting regular exercise; and using hormone replacement therapy (HRT) for the shortest time period necessary, it at all.
Other things you can do to reduce your breast cancer risk:
Take a multivitamin and make sure it includes adequate folic acid.
Have your children before 35, if you have a choice.
Breastfeed your children.
Avoid unnecessary X-rays.
Drink alcohol in moderation and make sure you take folic acid when you do drink.
Evaluate any breast symptoms or changes that develop.
Have mammograms when appropriate.
Consider raloxifene if you need to take a drug to prevent bone loss postmenopausally.
If you have a family history of breast cancer or for other reasons are at high risk of getting breast cancer, visit our section for High-Risk Women.
8. Can I have children if I have had breast cancer?
If you are still menstruating after your cancer treatment, you may still be able to become pregnant. Can getting pregnant decrease your chances of surviving breast cancer? No one knows. There are no randomized studies (you can’t conduct a study where you randomly decide who should get pregnant). There are reports from cancer centers that have followed the outcome of women who have had pregnancies following breast cancer that show no difference in survival. But this could be because only the women who had a good prognosis decided to get pregnant in the first place.
We do know that getting pregnant won’t cause the cancer to spread; either it has spread or it hasn’t before you’ve gotten pregnant. But if you had a tumor that left microscopic cells in your body, it’s possible that pregnancy, with its attendant hormones, could make them grow faster than they would have if you weren’t pregnant. This could decrease the time you have left, so that, for example, if you would have died of breast cancer four years from now, you’ll die in three years instead.
You can find more information about fertility, pregnancy, and cancer in the Young Women’s section of the Dr. Susan Love Research Foundation website.
Two other excellent resources are Fertile Hope and the Young Survival Coalition.
9. Can bras or antiperspirants cause breast cancer?
Two Internet rumors continue to perpetuate the belief that bras and antiperspirants can cause breast cancer. Some of these Internet rumors claim that bras allow toxins in the lymph fluid to accumulate in the breast, which leads to breast cancer. Others claim that the leading cause of breast cancer is the use of antiperspirants, which keep the body from purging toxins. This, they say, leads to a high concentration of toxins in the lymph nodes below the arms, resulting in breast cancer. Neither rumor is true. Learn more about these Internet myths here.
10. Are there alternative treatments that can cure breast cancer?
The National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine distinguishes between complementary medicine—which it defines as any medical system, practice, or product not thought of as standard care but used along with standard medicine—and alternative medicine, which is used in place of standard treatments.
Purely alternative approaches include high-dose vitamin therapy, antineoplastons, macrobiotic diet, some herbal remedies, metabolic therapies, and detoxification. The use of these therapies is often based on certain beliefs that may not be totally accurate. One such belief is that the body has self-healing properties. This is true—but only to a point. The body does have defense mechanisms that we try to supplement in cancer therapy and there certainly is a mind–body connection, but there are also forces beyond our control. Another belief is that certain things can increase the immune system and help cure a cancer. Again, there’s some truth in this. But there is no known alternative treatment that can cure cancer.
For all its limitations, Western medicine is still probably the most important component of any successful effort to cure cancer or to put it into significant remission. But there are complementary therapies that can help during and after the treatment process.
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