At what age
should I start thinking about breast cancer?Although
80 percent of breast cancers occur in women older than age 50,
it is important for a young woman to examine her breasts so that
she will know what feels "normal" for finding changes
during breast self-exams later in life. Most breast cancers (70%)
are self-detected.
What
is a woman's risk of getting breast cancer?
Breast
cancer is the most common form of cancer (other than skin) in
American women and the second major cause of death after lung
cancer. One out of 8 women will develop breast cancer over the
course of a lifetime.
What
are the odds of getting and surviving breast cancer?
Many
survival and risks of incidence are correlated with the age of
the patient and the stage of the cancer when discovered. A report
from the National Cancer Institute (NCI) estimates that about
1 in 8 women in the United States will develop breast cancer during
her lifetime.
The present estimate is higher than the 1-in-9 figure reported
previously by the American Cancer Society (ACS), primarily due
to the inclusion of the oldest age groups in the new calculations.
The 1-in-9 estimate used a cutoff age of 85 years, but the new
1-in-8 figure (approximately 12.6 percent) includes all age groups
in 5-year intervals up to an open-ended interval of 95 years and
over. Each age interval is assigned a weight in the calculations
based on the proportion of the population living to that age.
The probability of developing breast cancer before age 85 remains
approximately 1 in 9.
Survival rates really depending on a combination of health status,
age, stage of the cancer and other factors. See your physician
for your own personal health assessment.
What
are the risk factors for developing breast cancer?
Risk
is increased with age, such that 80 percent of women with breast
cancer are over age 50. Women who have a history of breast cancer
in the family, who never have had children, who had a first child
after age 30, who began menstruation before age 12 or who complete
menopause after age 55 are also at increased risk of breast cancer.
Heavy alcohol consumption and obesity have also been shown to
increase the risk of breast cancer.
What
does it mean to have a genetic predisposition to breast cancer?
Genes
contain the hereditary information that is passed down from
parent to child. They serve as the blueprint for many features.
Everyone has two copies of a gene called BRCA1 in the cells
of their body, one inherited from their mother and one from
their father. In most people, both BRCA1 genes function normally.
But in some individuals, one copy carries a misspelling. This
change, or alteration, can occur at hundreds of different sites
along the BRCA1 gene. Some of these changes make a person more
at risk for developing breast or ovarian cancer, and may possibly
be associated with cancers of the colon and prostate.
In a recent research study, one particular alteration in BRCA1,
known as 185delAG, was found to occur more frequently in a group
of Jews of Eastern European descent (Ashkenazi Jews) than among
other ethnic groups in the study. Approximately 1 percent of
Ashkenazi individuals were found to carry this alteration in
this preliminary study. The National Cancer Institute and the
National Center for Human Genome Research will soon begin another
research study of the Ashkenazi Jewish population to determine
exactly how common this alteration is and how often this alteration
is related to the incidence of breast cancer and ovarian cancer.
What
we know and don't know about BRCA1 alterations:
Known: Most people who develop
breast cancer, including those in the Jewish population, have
normal BRCA1 genes. In fact, only about 5-10 percent of all
breast cancer cases appear to be inherited and not all of these
are related to BRCA1. BUT, Although certain to be fairly low,
the exact percentage of inherited breast and ovarian cancers
in the Jewish population is not known.
Known: Women with a strong family history of breast and/or
ovarian cancer who have inherited an alteration in BRCA1 have
a substantial risk of developing breast and/or ovarian cancer.
This often occurs at an unusually early age, for instance, before
menopause. BUT, The cancer risks for an individual without a
strong family history who is found to carry the 185delAG alteration
is not known. There are other factors such as lifestyle, hormonal
factors, environmental influences, and other inherited traits
that affect cancer risks. As testing for alterations in the
BRCA1 gene becomes available to researchers, the interaction
of these factors can be studied.
Known: Not all women who carry the BRCA1 alteration will
develop breast or ovarian cancer BUT, the alteration is not
the single cause of disease, only a contributing factor. There
must be other factors, yet unknown, that affect the development
of cancer in addition to having an altered BRCA1 gene. Therefore,
people who carry the altered gene are said to have a susceptibility
to breast and ovarian cancer.
Known: If a woman tests negative for an alteration in
BRCA1, she may still get breast cancer. On average, a woman
has a one in eight lifetime risk of developing breast cancer.
BUT, All the genes that may increase a woman's risk of breast
and ovarian cancer have not been identified and, therefore,
cannot be tested for.
What
are some factors in breast cancer treatment and recovery?
Your
chance of recovery (prognosis) and choice of treatment depend
on the stage of your cancer (the size of the tumor and whether
it is just in the breast or has spread to other places in the
body), the type of breast cancer, certain characteristics of
the cancer cells, and whether the cancer is found in your other
breast. Your age, weight, menopausal status (whether or not
you still have menstrual periods), and general health can also
affect your prognosis and choice of treatment.
Breast
Cancer and the Women's Health Initiative. Because
of the Women's Health Initiative (WHI), many women have taken
themselves off of the Hormone Replacement Therapy (HRT). The
results have been remarkable - dramatic;
2.5 % drop in breast cancer cases in 2002, and 7% drop in 2003
- overall a 15% drop. This is the first drop since 1945. These
percentages equate to between 14,000 and 30,000 women each year
who will not get breast cancer.
References:
American Cancer Society, the National Cancer Institute, the
Centers for Disease Control and the Journal of Clinical Oncology.
There
were 2 large French studies done which followed women for 9
to 20 years who were taking estradiol and oral progesterone
and found no increase risk of breast cancer and one showed a
slight decrease of breast cancer.
References:
1. de Lingnieres et al, Climacteric, 2002
2. Fournier A, et al, Int J. Cancer, 114-2005
Main
points of authors on paper regarding Breast Cancer
1.
It's the synthetic progestins that contribute to causing breast
cancer-not progesterone.
2. Even one full-term pregnancy is remarkably protective against
breast cancer.
3. Women with the highest progesterone levels, and the highest
progesterone/estradiol levels during pregnancy, have the lowest
risk of breast cancer.
4. It's the estrogen, not progesterone, that stimulates proliferation
of breast cells.
5. Menstruating women who have the lowest mid-cycle progesterone
levels, have the highest risk of breast cancer.
6. "It is probable that the increase in Breast Cancer risk
found in other studies with HRT is related to the fact that
synthetic progestins, rather than progesterone, were used"
- French Study.
7. Insulin resistance, hyperinsulinemia and high blood glucose
are associated with an increased risk of breast cancer.
Reference:
"Pregnancy, progesterone and progestins in relation to
breast cancer risk", by Carlo Campagnoli.
