WOMEN'S HEALTH

Breast Cancer:

AWARENESS, SCREENINGS AND REDUCING YOUR RISK by Lisa Sousou, RPA-C

October is National Breast Cancer Awareness Month. Did you know that one in eight women will be diagnosed with breast cancer in their lifetime? Breast cancer is the second leading cause of cancer deaths among U.S. women. However, its overall death rate in the U.S. has been decreasing steadily over time, due to improvement in treatments and to increased early detection. Learn about the symptoms of breast cancer, factors that increase and decrease your risk, and how to maximize the chance of early detection. Then spread the news!

Symptoms of breast cancer

One of the most common symptoms is a lump, but breast cancer does not always present with a mass. Other symptoms can include thickening of the breast tissue, change in shape of the breast, dimpling of the skin, or a rash or even an “orange-peel” appearance to the skin. A newly inverted nipple or a bloody nipple discharge can also be a symptom.

Not all of these symptoms definitely mean cancer, but any change to the breast should be examined by a medical provider.

Risk factors

Most women are aware that a family history of breast cancer can increase one’s own risk. A woman’s risk nearly doubles if she has one first-degree relative who was diagnosed. Families with many breast cancer cases are more likely to carry mutations of a gene called BRCA, which can increase lifetime breast cancer risk to as high as 70 percent. Some BRCA mutations also increase risk of ovarian cancer.

However, only 5 to 10 percent of breast cancers are associated with a BRCA mutation, and more than 85 percent of breast cancers occur in women with no family history at all.

Besides family history, other risk factors include:

Age: Incidence increases with age, and most cases are found in women aged 55 or older.

Race: Ashkenazi women are more likely to carry BRCA mutations, and among women under 45 years old, Black women are more commonly diagnosed than non-Black women.

Starting menstrual periods early, before age 12, or menopause later than age 55.

Having dense breasts- a common, not abnormal, finding on mammogram- which increases risk by 1.5 to 2 times.

Taking menopausal hormone therapy containing both estrogen and progestin (the risk is low- an increase of eight breast cancers per 10,000 women taking estrogen plus progestin for a year). Estrogen therapy alone has not been shown to increase breast cancer risk.

Contrary to common belief, neither aluminum-containing antiperspirants nor wearing a bra has been linked to breast cancer risk.

Maintaining a healthy weight, being physically active, avoiding alcohol - or at least limiting it to no more than one drink per day - and breastfeeding may help reduce risk.

Screening

For optimal chance of successful treatment, early detection is key. Regular breast cancer screenings can help increase the likelihood that a cancer will be detected early. For most women, this means mammograms every one to two years. For some higher-risk women, breast MRIs and/or ultrasounds may also be recommended.

Mammogram recommendations have changed in recent years, and differ somewhat among medical organizations. In general, average-risk women should start mammograms at age 40-50 and continue them every one to two years until at least age 75. Some organizations, like the American College of Obstetricians and Gynecologists, recommend starting at age 40, while the American Cancer Society recommends starting at age 45; the U.S. Preventative Services Task Force advises starting at age 50.

For women at high risk, the American Cancer Society advocates mammogram and breast MRI yearly starting at age 30. High risk is defined as lifetime risk of 20 to 25 percent or greater (as determined by different screening “tools” which assess risk factors), BRCA mutation in one’s self or one’s first-degree relative, history of radiation therapy to the chest, or certain genetic disorders.

In addition, for women with dense breasts on mammogram, a screening breast ultrasound is sometimes offered as an option. Dense breast tissue appears white on a mammogram, possibly obscuring some cancers, which also appear white. Adding an ultrasound can pick up cancers which may have otherwise been missed on a mammogram of dense breast tissue. However, ultrasounds also increase the chances of detecting abnormalities which lead to biopsies but end up not being cancer. Ultimately, the choices surrounding breast cancer screening are best made after a discussion between each woman and her own healthcare provider.

Finally, clinical breast exams and breast self-exam can be additional tools to help catch early breast cancers. In general, recommendations have moved away from strict monthly selfexaminations in favor of “breast self-awareness”- meaning a purposeful familiarity with the appearance and consistency of one’s own breasts, and a vigilance for any changes as well as willingness to report any changes promptly to a healthcare provider. While neither self-exams nor yearly clinical breast exams has been found to definitely correlate with an increase in breast cancer survival rates, a large percentage of breast cancers are found by women themselves, so being alert for changes is definitely best.

Knowledge is power! Arm yourself with the knowledge of signs and symptoms and awareness of your own breasts, and discuss with your medical provider the best screening plan for you. Then keep up on those screenings and take charge of your breast health. Breast cancer is common, but with vigilance, early detection is more likely and treatment is more likely to be a success. SWM