The pink ribbon symbolizes the great fight against breast cancer. But, how much do you honestly know about it? For American women, breast cancer is the second most common cause of cancer death (following lung cancer)¹. The causes are unknown; there is no prevention or cure.With over 2 million women afflicted with breast cancer, it's time to learn the critical facts about how you can reduce your risk.²

If you are a woman, you are at risk for breast cancer. That's all it takes. Caucasian women are more likely to get breast cancer than any other racial or ethnic group.African American women are more likely to die from breast cancer than white women.The median age at death for Caucasian breast cancer patients is 70 years; for African-American breast cancer patients, its 61 years.³

The older a woman is, the more likely she is to get breast cancer. Breast cancer is the leading cause of death in women between the ages of 40 and 55. One woman in eight who lives to age 85 will develop breast cancer during her lifetime.⁴

Over 2 million breast cancer survivors are alive in America today.Of those women diagnosed with breast cancer 5 years ago, 88% of them are still alive. Of those diagnosed 10 years ago, 80% are still alive; of those diagnosed 20 years ago, 63% are still alive.⁵ Since we do not know the causes of breast cancer, we cannot prevent it. But we can lower our chances by considering our risk factors and knowing what the numbers mean. Reducing the number of risks should be part of an early detection plan.

0.1. Risk Factors and Prevention

A risk factor is anything that increases your chance of getting a disease. But, having a risk factor does not necessarily mean you are going to get the disease. Most women have no known risk factors except being a woman and getting older. Just because other family members had breast cancer doesn’t mean their disease was inherited. About 5 to 10 percent of all breast cancers occur because of inherited mutations.

Some risk factors are beyond your control. A woman cannot change the fact that breast cancer runs in her family. She can't change her race (Caucasian women are at a slightly higher risk) or stop herself from getting older (77% of breast cancer cases occur in women over age 50). Some factors you can't necessarily control include:

• Gender- breast cancer is about 100 times more common among women than men
• Aging- risk increases as you get older. About 17% of invasive breast cancer diagnoses are among women in their 40s while about 78% of women with invasive breast cancer are age 50 or older when diagnosed
• Genetic risk factors- About 5%-10% of breast cancer cases are hereditary as a result of genetic mutations (BRCA1 and BRCA2 genes)
• Personal history of breast cancer- A woman with cancer in one breast is 3 to 4 times more likely of developing a new cancer in the other breast or in another part of the same breast
• Race- Caucasian women are slightly more likely to develop breast cancer than African American women. African-American women are more likely to die of breast cancer than White women. Asian, Hispanic and Native American women have a lower risk of developing and dying from breast cancer
• Abnormal breast biopsy- Some types of benign breast conditions are more closely linked to breast cancer risk than others (ductal hyperplasia, complex fibroadenoma, sclerosing adenosis, papillomas or papillomatosis, radial scar)
• Previous chest radiation- Women who have undergone radiation therapy in the chest area as a treatment for another cancer are at a significantly increased risk
• Menstrual periods- women who started menstruating before the age of 12 or who went through menopause after age 55 have slightly higher risks

You can control certain risk factors by making through personal lifestyle choices. Recognize the risks that you can control including:

• Having children- women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk.Having multiple pregnancies and becoming pregnant at an early age reduces risk.
• Oral contraceptive use- Studies have suggested that women who use birth control pills have a slightly greater risk of breast cancer than women who have never used them.The decision to use oral contraceptives should be made by you and your physician after weighing the possible risks and benefits.
• Postmenopausal hormone therapy-Long-term use of postmenopausal hormone therapy (in particular estrogen and progesterone combined) increases risk of breast cancer. The decision to use hormone therapy should be made by you and your physician after weighing the possible risks and benefits.
• Breast feeding and pregnancy- Some studies suggest that breast-feeding may slightly lower breast cancer risk (especially if breast-feeding is continued for 1.5 to 2 years).
• Alcohol- Breast cancer risk increases with the amount of alcohol consumed. Women who consume one alcoholic drink a day have a very small increase in risk compared to nondrinkers. Those who have 2 to 5 drinks daily have about 1 ½ times the risk of women who don’t drink.
• High fat diets- Being overweight has been found to be a breast cancer risk, especially for women after menopause.

• Physical activity- In one study from the Women’s Health Initiative (WHI) as little as 1.25 to 2.5 hours per week of brisk walking reduced a woman’s risk by 18%. Walking 10 hours a week reduced the risk a little more.

• 0.2. Screening and Prevention

  Detecting breast cancer early increases a woman's chances of survival. Screening does not necessarily mean your health care provider suspects you have breast cancer. Health care providers usually recommend the following tests for breast cancer when you don't have any symptoms:

  • Screening Mammogram- an x-ray of the breast.
  • Magnetic Resonate Imaging- As of March 2007, the American Cancer Society has posted new guidelines recommending women who are at a “high risk” for breast cancer receive a yearly MRI screening in addition to a mammogram.
  • Clinical Breast Exam- physical exam of your breasts by a medical professional
  • Breast Self-Exam- physical exam of your breasts by yourself. Learn the normal look and feel of your breasts. Check for changes every month just as your period is ending. If you no longer have periods, do them the same day each month. Some lumpiness can be normal. If you feel any change or a new lump, ask your doctor to examine the area. See the American Cancer Society for a guide to a breast self-exam.

The American Cancer Society recommends the new following guidelines for early detection:

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
• Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.
• Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

0.3. Symptoms of Breast Cancer

Mammograms can detect cancers found before they cause any symptoms. But, the most common symptom of breast cancer is a new lump or mass. It may be painless, hard or soft, rounded or with uneven edges. It’s important to have any irregularity checked by your health care provider. The American Cancer Society also recognizes these important signs of breast cancer:

• swelling of part of the breast
• skin irritation or dimpling
• nipple pain or the nipple turning inward
• redness or scaliness of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump in the underarm area

If you suspect you might have breast cancer, you will need to undergo other diagnostic tests to detect the extent of the cancer and if it is spreading. These tests may include some of the following:

• Diagnostic Mammograms
• Breast Ultrasound
• Ductogram (also called a galactogram)
• MRI
• Biopsy
• Chest x-ray
• Bone scan
• CT scan (computed tomography)
• PET scan (positron emission tomography)

The Tamoxifen and Rafloxifene Story

Up until menopause, ovaries produce the hormone estrogen. After menopause, the body's fat tissue is converted into estrogen. Estrogen promotes the growth of about two thirds of breast cancers (called hormone receptor positive cancers). Because of this, many women who are treated for breast cancer need to block the effects of estrogen or lower the levels.

Tamoxifen is FDA approved to prevent and treat breast cancer. Taking the drug for 5 years reduces the chances of the cancer coming back by about 50% for women with early breast cancer. Tamoxifen is also taken by women at high risk to prevent breast cancer. In postmenopausal women, tamoxifen is also likely to maintain bone mineral density. In premenopausal women, it is likely to induce bone loss because its major effect is blocking estrogen.

Tamoxifen is associated with the following side effects:

• An increased risk of developing endometrial cancer (cancer to the lining of the uterus)
• An increase the risk of uterine sarcoma (a rare cancer of the connective tissue of the uterus)
• Blood clots
• Weight gain
• Hot flashes
• Vaginal discharge
• Mood swings
• Early cataracts may occur

Raloxifene is similar to Tamoxifen in that it stops breast cells from being affected by estrogen. Currently, the FDA has approved raloxifene only for the prevention of osteoporosis in post-menopausal women. Raloxifene has not been studied as long as tamoxifen so information on the drug is still limited.

The STAR (Study of Tamoxifen and Raloxifene) clinical trial revealed both drugs reduced the risk of invasive breast cancer by about the same extent.This trial included more than 19,000 post-menopausal women who were at an increased risk of breast cancer. They were assigned to take either tamoxifen or raloxifene each day for 5 years. One hundred sixty-three breast cancers were found in the tamoxifen group and 168 cases in the raloxifene group.

Raloxifene seems to reduce the risk of invasive breast cancer to the same extent as tamoxifen although it may not reduce the risk of non-invasive cancers to the same degree.Raloxifene may have fewer side effects than tamoxifen but it is not without risks.

Possible side effects of taking raloxifene include:

• Blood clots
• Uterine cancers
• Hot flashes
• Vaginal dryness or irritation
• Leg cramps
• Flu-like symptoms
• Edema (swelling in the hands or feet)

For information on Breast Self-Exams, visit the American Cancer Society.

Learn more about Mammograms

References
¹American Cancer Society, Breast Cancer Facts & Figures 2005-2006.

²Ries LAG, et al. SEER Cancer Statistics Review, 1975-2003. Retrieved June 2006 from the National Cancer Institute website http://seer.cancer.gov/csr/1975_2003/
Based on November 2005 SEER data submission, posted to the SEER web site 2006. On January 1, 2003, there were approximately 2,356,795 women alive who had a history of breast cancer.

³NCI SEER CSR 1975-2003; Breast Cancer, Table I-13. Retrieved March 2007 from the National Cancer Institute Website http://seer.cancer.gov/csr/1975_2003/sections.html 

⁴National Breast Cancer Institute. Retrieved March 2007 from National Breast Cancer Institute website http://www.nationalbreastcancer.org/early_detection/index.html

⁵American Cancer Society, Breast Cancer Facts & Figures 2005-2006. Retrieved 30 March 2007 from http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=5