Pushing Pink Elephants
 

Great Resources For Breast Cancer Information

Breast Cancer

 

Most of us can think of at least one person who has been diagnosed with breast cancer. This may be a grandmother who had lived a full life and was not diagnosed till 80. Or perhaps it was someone in their 30’s or 40’s, a young woman who has only really started living her life, getting settled into a career, just starting to think about a starting family. Maybe it’s a young mother who has small children at home and who works hard to keep them safe from harm. Perhaps it’s even a male family member or co-worker who was diagnosed with breast cancer. The sad truth is, the potential for  breast cancer is a risk every woman and man should understand. It is however, difficult to sift through the literature and really understand what your risk really is.

 

Average Risk

 

Most of us have heard the risk of breast cancer today is 1 in 8, which equates to approx 12.5%. But, what does this really mean? Based on current rates of breast cancer in the entire U.S. population of women, 1 of 8 women born now will develop the disease by age 85. This estimate represents the average woman’s risk for breast cancer but this is not necessarily your current risk. If you are 20 years old now with average risk for breast cancer, you have a 1 in 8 chance of being diagnosed in your lifetime. For women who are have average risk, the current recommendation provided by the American Cancer society is below.

  • Age 40 – yearly mammograms
  • Age 20’s-30’s – clinical breast exam every 3 years, 40’s and forward yearly
  • Age 20’s forward – breast self-exams

Multiple diagnoses in a family will increase a woman’s risk. A family history of breast cancer, even when these are no evidence of genetic dispositions also increase breast cancer risk.

 

Male breast cancer, although rare can and does happen. Malignancies in the small amount of breast tissue behind the male nipples account for fewer than 2,000 total cases in the US each year. This equates to about one man diagnosed for every one hundred women with the disease. Estimated male lifetime breast cancer risk to age 80 without a known genetic disposition, is about 0.1%. By the time men see a doctor, however, their tumors are often more advanced, with a poorer outcome.

 

Increased/High Risk

 

What about someone who is above average, someone who’s risk is higher? For these women the statistic above is no longer relevant. They do not fall in the 1 in 8 category. But how do we know the difference between average or high risk? A genetic pre-disposition for breast cancer increases your risk substantially but is considered rare. Inherited genetic changes called mutations cause about 5%-10% of breast cancers. These genetic mutations are referred to as BRCA1 and BRCA2 which run in families and are passed down from generation to generation by either the mother or father.

  • Signs of hereditary breast cancer within a family;
    • Any blood relative from either side (mother or father)with;
      • Ovarian or fallopian tube cancer at any age
      • Breast cancer at age 50 or younger
      • Breast cancer in both breasts at any age
      • Both breast and ovarian cancer
      • Male breast cancer
    • More than one relative on the same side of the family with;

      • Breast cancer
      • Ovarian or fallopian tube cancer
      • Prostate cancer
      • Pancreatic cancer

If you see any of these patterns within your family we highly encourage you to discuss your family history with your doctor. Talk to a genetic counselor, they will analyze your family history and can recommend the best ways to monitor your health. Genetic counseling is a great option and is available to everyone, it does not automatically mean you need to get tested for the BRCA1 or BRCA2 genes. The counselors specialize in risk and are a great place to start understanding your family history and what you should watch out for.

 

Lifetime breast and ovarian cancer risk as a percentage

  • No family history or BRCA – average risk (1 in 8 breast and 1 in 70 ovarian)
    • 12.5% Breast Cancer
    • 1.4% Ovarian Cancer
  • Family history, no BRCA – higher risk than average, but not as high as BRCA (no % provided)
  • BRCA1
    • 34-86% Breast Cancer
    • 42-67% Ovarian Cancer
  • BRCA2
    • 24-83% Breast Cancer
    • 16-51% Ovarian Cancer

 

Estimated male lifetime breast cancer risk to age 80

  • Men with a BRCA1 mutation – 2%
  • Men with a BRCA2 mutation – 8.4%
  • Men with no BRCA mutation - 0.1%

New studies have linked dense breast tissue with elevated risk. It is important to understand what dense breasts mean and if you have them. The State of Maryland recently passed a law that will be effective October 2013. This law will require imaging facilities to notify patients if dense breast tissue is identified during mammograms. Dense breast tissue can make it difficult to see cancer cells or abnormal spots within the breast. Knowing your density can be very beneficial if you understand what this means for your specific risk. Learn more at Are You Dense.

 

Types of Breast Cancer

 

Breast cancer is complex, no two cases are the same and diagnosis, staging and treatment will all depend on the type of tumor you have. For more information on diagnosis or staging check out breastcancer.org

  • Ductal carcinoma in situ (DCIS) – develops in the milk ducts. About 1 in 5 new breast cancers fall in this category. Too small to be felt, DCIS is usually found by mammography or MRI. Early detection is important because some DCIS develop into invasive cancers and may metastasize. If you have DCIS, your risk of developing a new breast cancer or recurrence is higher than that of someone who has never been diagnosed.
  • Lobular carcinoma in situ (LCIS) – isn’t considered a true breast cancer. Usually diagnosed in premenopausal women, LCIS involves abnormal cells that signal a higher-then-average risk of developing invasive breast cancer. Rarely found by mammography, LCIS is usually discovered during a breast biopsy to explore a lump, microcalcificaion or other abnormality.
  • Invasive ductal carcinoma (IDC) – is cancer that has spread beyond the ducts to the surrounding breast tissue. It’s the most common breast cancer, accounting for about 80% of all cases.
  • Invasive lobular carcinoma – begins in the lobules and spreads to the breast tissue. Only about 10% of invasive breast cancers are ILC.
  • Inflammatory breast cancer (IBC) – accounts for only 1-3% of breast cancers. It often begins with swelling or reddening of the breast rather than a lump. IBC can grow very quickly, symptoms my worsen in a single day so it’s very important to recognize the signs of this disease and seek prompt attention.

Tumor Characteristic

 

Some breast cancers are aggressive, while others grow slowly over longer periods of time. Sometimes breast cancers have hormone receptors, which are protein molecules in the cells that bind to estrogen and progesterone and act like on-off switches for tumor growth. Cancers with hormone receptors are referred to as estrogen receptor positive (ER+) or progesterone receptor positive (PR+). These types of receptors respond well to antihormone treatments that reduce the amount of these hormones in the body which will block the tumor ability to feed off them. Tumors without estrogen or progesterone receptors are called receptor negative (ER- and PR-). These type of tumors don’t respond as well to antihormone therapies. Many breast cancers make too much HER2/neu, which is a protein that promotes the growth of cancer cells. Approx 15% of breast cancers are triple-negative.

 

Summary

 

Most breast cancers are not hereditary and a large percentage of cases are sporadic with no known cause/link.

  • 5-10% hereditary (passed from father or mother)
  • 15-30% occur within a family
  • 60-80% sporadic

 

The American Cancer Society estimates in Maryland, 4,760 women will be diagnosed with breast cancer, 800 women will die from the disease in 2013. We all need to be as proactive as we can in reducing our individual risk. If you are average risk and fall into the 1 in 8 category, your risk is still worth thinking about given the estimated number of cases in Maryland. If you are at a higher risk there are steps you can take to be proactive and ways to reduce your odds. Researchers are just beginning to scratch the surface related to environmental factors and food choices that may increase individual risk. Learn ways to be proactive and live healthy here. Start asking questions and really understand the statistics related to breast cancer.

 

The American Cancer Society released the estimated number of new cases and deaths in the US for 2013.

  • New cases
    • Women 232,340, 4,760 in Maryland
    • Men 2,240
  • Deaths

    • Women 39,620, 800 in Maryland
    • Men 410

 

Unless otherwise cited statistics and other information were provided by A Johns Hopkins Press Health Book – Confronting Hereditary Breast and Ovarian Cancer, identify your risk, understand your options, change your destiny – published 2012.

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