by Patrick J. Naples, M.D.

The combination of these two words strikes fear in most women.  Breast cancer is the number one health concern for women after the age of forty.   It is not, however, the number one health issue that affects women.  Lung cancer is the number one cause of cancer deaths in women, heart disease is the number one cause of all deaths, and osteoporosis is the number one disease that afflicts women.   If breast cancer is not the primary cause of death or even the primary illness that affects women, why is it so prominent a health concern?   Breast cancer is a very personal disease; it can alter a woman’s self image, confidence, and causes her to confront her own mortality.  It often strikes at a younger age than any of the other conditions mentioned above.  Breast cancer is the second leading cause of cancer deaths among women; it is the most frequently diagnosed cancer in women except for skin cancer.  A women’s life time risk for developing breast cancer is 1 in 8; the risk increases with age. The 10 year risk at age 40 is I in 69, 1 in 42 for women at age 50, and 1 in 29 at age 60. Over 250,000 women are diagnosed with invasive or noninvasive breast cancer each year; more than 40,000 women die of breast cancer yearly.  These are certainly very unsettling statistics but there is good news. There has been steady improvement in breast cancer survival over the past 2 decades. This improved survival rate has resulted from earlier detection and improved treatments.

From the early 1990’s there has been increased awareness, detection, and survival of breast cancer due to programs like the “Susan B. Komen Race for the Cure” and “Breast Cancer Awareness Month.” Recommendations for women to begin monthly self breast exams at age 30, annual or biennial screening mammograms at age 40, and annual mammograms at age 50.  Recently the United States Preventive Services Task Force (USPSTF), which is a government supported organization, made drastic changes in these screening recommendations. The USPSTF recommended that women with no genetic predisposition to breast cancer no longer do self breast exams, that screening mammograms not begin until age 50, only be performed every 2 years until age 75, and then discontinued after age 75. Five percent of breast cancers occur in women before the age of 40 and 20% occur before the age of 50. Why make such drastic changes in the recommendations for screening when the previous recommendations have produced such good results? They felt that self breast exams led to excessive anxiety and too many unnecessary tests.  Earlier mammogram screening required testing too many women in order to diagnose one woman with breast cancer; basically screening at an earlier age is not cost effective. Unfortunately this is the kind of analysis that we are going to see much more of in the future with national health care reform. The cost of tests and treatment will play an out of proportioned role in health care decisions.  Fortunately the outcry from the public and medical professionals about these changes has caused them to be retracted for now.

Currently the recommendations, therefore, are the same. Women should continue to do monthly self breast examinations; for women who are still menstruating this should be done on the last day or 2 of the menses. During the examination the woman should concentrate on the normal appearance and constituency of her breast. Once familiarity is achieved changes would more easily be recognized and an evaluation by your doctor would be important. Things to be on the lookout for during the self exams are lumps, dimpling in the skin, other changes in the skin appearance, or spontaneous nipple discharge. Screening mammograms should begin every 1 to 2 years at age 40 and yearly at age 50.  It is important to realize that mammograms are not 100% accurate; there are limitations to every test. If a change in the breast examination is noted either by you or your doctor it should continue to be followed even if the mammogram is negative. This may require alternative type testing, biopsy, or simply repeat examination by your doctor in a few months.

Every woman is at risk for breast cancer simply for the reason that she has breasts. The fact that there is no family history of breast cancer does not free a woman from the possibility. In my own family I have 2 sisters who had breast cancer. These are the first occurrences on either side of the family. Testing for genetic predisposition with testing for BRCA1 or BRCA2 genetic mutations is important if there is a history of breast cancer in close family members on either side of the family. This is a simple blood test. The risk for breast cancer increases with age, in women who went through early puberty or late menopause, women who had no children or who delayed childbirth until after age 30, and in obese women.

Breast cancer is a fairly common and worrisome disease but women are not defenseless.  By following screening recommendations, doing monthly self breast exams, and having yearly examinations by your physician earlier detection of breast cancer is possible.  Earlier detection improves survival and limits the extent of surgery necessary. Often breast preservation is possible thereby limiting self image concerns, discomfort related to surgery, and enables a return to a normal life style sooner. The risk for breast cancer can be reduced by maintaining normal body weight, eating a healthy balanced diet, exercising regularly, and limiting alcohol consumption and smoking.

Related posts:

1. Estrogen: The Misunderstood Hormone