About Breast Cancer
Breast cancer is a malignancy of the breast, usually involving the ductal or lobular tissues (the tissues involved in milk production). It is the 2nd most commonly diagnosed cancer in Michigan, and it is the most frequently diagnosed cancer among Michigan women.
Q. Why do some women get breast cancer and others do not?
A. Determining who will or will not get breast cancer is not an exact science. Although many risk factors may increase your chance of developing breast cancer, it is not yet known exactly how some of these risk factors can cause changes in DNA that result in normal breast cells becoming cancerous.
DNA is the chemical in each of our cells that makes up our genes — the instructions for how our cells function. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than how we look.
Some genes have instructions for controlling when our cells grow, divide and die. Certain genes that speed up cell division are called oncogenes. Others that slow down cell division, or cause cells to die at the right time, are called tumor suppressor genes. Cancers can be caused by DNA mutations (changes) that "turn on" oncogenes or "turn off" tumor suppressor genes.
Why Your Family History is Important
Knowing your family history of breast cancer is the first step in taking an active part in your health. The second step is talking to your health provider about your family history.
You can't change your family history, but it helps to be aware of it. If you and your health provider know that cancer tends to run in your family, you can watch more closely for the early signs of the disease. For example, if your mother was diagnosed with breast cancer before age 50, your doctor may want you to start having mammograms more often or at a younger age.
Q. So, if I have a family history of breast cancer, does that mean I am more at risk for getting the disease?
A. Most women are aware that a family history of breast cancer can increase your risk, but they also think that any type of cancer in the family makes you more at risk. This is not true.
Women with a family history of breast cancer make up only 5 percent to 7 percent of all women with breast cancer. There is a tendency among women, especially young women, to overestimate their risk of breast cancer and also to overestimate how much their risk can be reduced by screening mammograms.
Regular breast cancer screening (clinical breast exam and mammogram) will not reduce your risk of getting breast cancer. But, regular screening can possibly detect the disease at an early stage, when it is most treatable.
Q. What role do genes play in breast cancer?
A. Certain inherited DNA changes can increase the risk for developing cancer and are responsible for the cancers that run in some families. For example, the BRCA genes (BRCA1 and BRCA2) are tumor suppressor genes, and mutations in these genes can be inherited from parents. When they are mutated, they no longer suppress abnormal growth, and breast cancer is more likely to develop.
In the general population, 1 in 500 to 1 in 1,000 people have a mutation in the BRCA1 gene that increases their risk of developing cancer. In addition to breast cancer, BRCA1 mutations increase the risk of developing ovarian, prostate, and colon cancers. Men with an inherited mutation in the BRCA2 gene are at an increased risk of breast cancer.
Additional genes are likely associated with breast cancer risk. Many of these genes have not yet been identified or characterized, however.
Q. What if breast cancer does not run in my family? Do I still need to be worried about getting the disease?
A. Simply being a woman is the main risk factor for developing breast cancer. Although women have many more breast cells than men, the main reason they develop more breast cancer is because their breast cells are constantly exposed to the growth-promoting effects of the female hormones estrogen and progesterone.
Men can develop breast cancer, but this disease is about 100 times more common among women than men.
Understanding Your Risks for Developing Breast Cancer
A risk factor is anything that affects your chance of getting a disease. Different cancers have different risk factors.
Hardly a month goes by that we do not hear about something that will increase or decrease your risk for developing breast cancer. It is very difficult to know however, how much each factor changes your risk. Is each risk factor additive? Does the risk go up a few percentage points or by quite a lot? These can be difficult questions to answer.
But, risk factors don't tell us everything.
Having a risk factor, or even several, does not mean that you will get breast cancer. Most women who have one or more breast cancer risk factors never develop the disease, while many women with breast cancer have no apparent risk factors (other than being a woman and growing older).
Even when a woman with risk factors develops breast cancer, it is hard to know just how much these factors may have contributed to her cancer.
Q. What are the risk factors for breast cancer?
A. Simply being a woman is the main risk factor for developing breast cancer (although some men can also develop breast cancer). But, not all women develop breast cancer.
Some factors influence risk more than others, especially if you have a strong family history of breast cancer. Also, your risk for breast cancer can change over time, due to factors such as aging or lifestyle.
Q. How do I know if I am at high risk for developing cancer?
A. In general, a woman can be placed in the higher-risk category if she has either a single factor that greatly increases her risk or a combination of lesser factors that together increase risk.
Factors that can single-handedly increase a woman's breast cancer risk a great deal include:
Mutation in BRCA1 or BRCA2 genes
Very strong family history of breast cancer, such as mother and/or sister diagnosed at age 40 or younger
Personal history of breast cancer, LCIS, or atypical hyperplasia.
Radiation treatment to the chest area during childhood or young adulthood.
Q. What can I do to decrease my breast cancer risk?
A. There are four things you can do to help decrease your breast cancer risk:
Talk to your family to learn about your family health history.
Talk to your provider about your personal risk of breast cancer and what you can do to lower your risk.
If you DO NOT have breast cancer, ask your provider...
Are there steps I can take to lower my risk of breast cancer?
Are there ways to estimate my risk of breast cancer?
How accurate are these methods?
How do I determine if I have dense breasts?
If I do have dense breasts, how does that increase my risk?
What type of screening should I have?
Can you discuss the benefits of digital vs. standard mammograms in my case?
If you are at HIGH RISK of developing breast cancer, ask your provider...
I've been told I'm at higher risk of breast cancer. What should I do? Should I be taking tamoxifen? Do the benefits of tamoxifen outweigh the risks for me?
What about prophylactic mastectomy and increased screening? What screening tests are best for my level of risk? Can you discuss some of the options (such as MRI, digital mammograms) and when they would be recommended?
Given my medical history, how can I manage my menopausal symptoms? Are postmenopausal hormones a safe way to manage my menopausal symptoms?
What role does ductal lavage/ nipple aspiration cytology play in assessing breast cancer risk? Is there a breast center with expertise in this that can advise me about risk assessment and the appropriateness of ductal lavage for me?
Get screened
Ask your provider which screening tests are right for you if you are at a higher risk.
Have a mammogram every year starting at age 40 if you are at average risk.
Have a clinical breast exam at least every 3 years starting at age 20, and every year starting at age 40.
Getting regular screening tests is very important for women, regardless of their breast cancer risk. Early breast cancer usually does not cause pain and may exhibit no noticeable symptoms. As the cancer progresses, signs and symptoms can include:
a lump or thickening in or near the breast;
a change in the size or shape of the breast; nipple discharge, tenderness, or retraction (turning inward); and
skin irritation, dimpling, or scaliness.
These changes can also be caused by conditions other than breast cancer.
Women who are at a higher risk of developing breast cancer may need additional tests and closer watching by their providers
Know what is normal for you
See your health care provider right away if you notice any of these breast changes:
Lump, hard knot, or thickening
Swelling, warmth, redness, or darkening
Change in the size or shape of the breast
Dimpling or puckering of the skin
Itchy, scaly, or sore nipple or rash on the nipple
Pulling in of your nipple or other parts of your breast