Breast Cancer Awareness  
Written by Rita-Marie Goudreau, CNM

Breast cancer is the most common cancer diagnosed in women in America. Early detection is your best protection and we at The Adler Center for Women’s Health feel that the education in this newsletter may help to save your life.  When breast cancer is detected early and treated promptly, suffering and ultimately the loss of life can be significantly reduced.  The words “Breast Cancer” can strike fear in your heart, but we want to educate and empower you so you won’t ignore the threat. Learn about your risks, do what you can to lower them and take advantage of screenings because early detection is still your best protection. 

What is breast cancer?

Breast Cancer is a disease that occurs when cells in the breast tissue become abnormal and divide without control or order. Cells normally divide in an orderly way to produce more cells only when they are needed. This process helps keep the body healthy. If cells divide when new cells are not needed, they form too much tissue.  This extra tissue, called a tumor, can be benign or malignant.

Benign tumors are not cancer

Eighty percent of all breast tumors are benign. They can usually be removed, and in most cases, they don’t come back. Most importantly, the cells in benign tumors do not invade other tissues and do not spread to other parts of the body. Benign breast tumors are not a threat to life.

Malignant tumors are cancer

The cancer cells grow and divide out of control, invading and damaging nearby tissues and organs. Cancer cells can also break away from the original tumor and enter the bloodstream or lymphatic system.   This is how breast cancer spreads and forms secondary tumors in other parts of the body. The spread of cancer is called metastasis.

How common is breast cancer in the United States?

Breast cancer is the most common cancer in women, aside from skin cancer. During 2004, an estimated 200,000 new cases of breast cancer are expected to occur among women in the United States. It is the second leading cause of cancer death, after lung cancer. An estimated 40,000 women are expected to die from breast cancer this year. About 1,300 new cases of breast cancer are expected in men in 2004.

What are the “risk factors”?

One woman in eight will develop breast cancer.  Certain factors can increase the odds that this woman will be you.  Even if none of the following apply to you, that does not mean you are immune.  Simply being a woman puts you at risk for breast cancer.  To predict when and in whom breast cancer will strike, we look for clues to signal which women may be more likely than others to develop the disease. These clues are called “risk factors” and below are a list of the most common. 

1. Age

The risk of breast cancer increases as a woman grows older. About 82 percent of breast cancers occur in women age 50 and older. The risk is especially high for women age 60 and older. Breast cancer is uncommon in women younger than age 35. There is some evidence to suggest young African-American women are at greater risk for breast cancer than young white women.

2. Personal History

Women who have had breast cancer and women with a history of breast disease (not cancer, but a condition that may predispose them to cancer) may develop it again.

3. Family History

The risk of getting breast cancer increases for a woman whose mother, sister, daughter, or two or more close relatives have had the disease.

4. Obesity

Obesity increases the risk of breast cancer in the postmenopausal women because of increased estrogen production in fat tissue.

5. The Breast Cancer Genes

Some individuals, both women and men, may be born with an “alteration” (or change) in one of two genes that are important for regulating breast cell growth. Individuals who inherit an alteration in these two genes are at an “inherited” higher risk for breast cancer. They may also pass this alteration on to their children. It is very rare – scientists estimate that only about 5-10 percent of all breast cancers are due to genetic changes. One out of two women with these changes is likely to develop breast cancer. Women with a family history of breast cancer are encouraged to speak to a genetics counselor to determine the pros and cons of genetic testing.

6. Having an early first period         

Women who begin menstruating before age 12 are at increased risk of developing breast cancer. The more menstrual cycles a woman has over her lifetime, the more likely she is to get the disease.

7. Having a first pregnancy after age 25 or 30

Although early pregnancies may help lower the chances of getting breast cancer, particularly before the age of 25, these same hormonal changes after age 35 may contribute to the incidence of breast cancer.

8. Having no children

Women who experience continuous menstrual cycles until menopause are at a higher-than average risk.

9. Use of Hormones

Estrogen is a hormone that naturally occurs in every woman. At the time menstruation begins, women start to produce larger amounts of estrogen and will continue to do so until they reach menopause. Estrogen appears to play a key role in breast cancer. Although estrogen doesn’t actually cause breast cancer, it may stimulate the growth of cancer cells.  This leads us to the discussion on Birth Control Pills (BCP) and Hormone Replacement Therapy (HRT). 

Birth Control Pills - According to many studies, using BCP does not increase your overall lifetime risk of breast cancer.  Current or former use of oral contraceptives among women ages 35 to 64 did not significantly increase the risk of breast cancer. The findings were similar for white and black women. Don’t forget, that BCP also have many health benefits, like decreasing your risk of anemia, ovarian cancer, uterine cancer and preventing pregnancy.

Hormone Replacement Therapy - In the premenopausal/menopausal period studies have shown a very slight increase in the risk of breast cancer in women taking replacement hormones, while other studies have found no increased risk.  Based on the Women’s Health Initiative Study (2002), women do appear to have an increased risk of breast cancer while they are on HRT and a short time thereafter, compared to those who have never used postmenopausal HRT.  However, the latest research from the American Cancer Society yielded some surprising results.  A recently completed study suggests that women who use HRT are less likely to die from breast cancer than nonusers.  This may be due to the fact that women on HRT are seeing their Doctor or Nurse-midwife yearly for their annual exam, they are getting routine mammograms and are performing breast self exams more routinely, therefore suspicious “lumps” are being detected sooner.

How can I reduce my risks of developing Breast Cancer?

Common to all women are daily lifestyle decisions that may affect breast cancer risk.  These day-to-day choices involve factors such as poor diet, insufficient physical activity, alcohol use, and smoking. Besides possibly reducing breast cancer risk, lifestyle improvements represent smart steps for a healthier life, since they can help prevent heart disease, diabetes, and many other chronic, life-threatening conditions.

1. Decrease your daily fat intake

Eat leaner meats and limit red meat. Reducing your fat intake helps prevent other health problems, such as heart disease and stroke, and may reduce your chance of developing breast and colon cancers.

2. Increase fiber in your diet

Fiber is found in whole grains, vegetables and fruits. This type of diet is beneficial for your heart and can help prevent other cancers, such as colon cancer.

3. Eat fresh fruits and vegetables

In addition to their fiber content, fruits and vegetables have antioxidant properties and micronutrients that may help prevent some cancers.

4. Limit alcohol

Evidence suggests that a small increase in risk exists for women who average two or more drinks per day (beer, wine, and distilled liquor).

5. Stay active

The U.S. Surgeon General recently reported that you can help prevent many health problems by engaging in a moderate amount of physical activity (such as taking a brisk, 30-minute walk) on most days of the week. Strive to maintain the body weight recommended by a health professional, since excess fat may stimulate estrogen production.

6. Don’t smoke

Although smoking doesn’t cause breast cancer, it can increase the chance of blood clots, heart disease, and other cancers that may spread to the breast.

What kinds of tests can be done to detect breast cancer?

Early detection is critical and there are two equally important things you can do to detect breast cancer in the early stages, when treatment is easier and more effective- Breast exams and Mammograms.

Breast exams

Breast self-examination (BSE) may alert women to any changes in her breasts. The value of BSE is that it helps a woman become familiar with how her breasts normally feel and to notice any changes.  It is also very important that you see a health care provider yearly. Your Doctor or Nurse-Midwife should examine your breasts, called clinical breast examination (CBE) as part of  routine health care to search for any abnormalities that you may have missed during your own breast self exams.

Mammograms

Mammography is a low dose x-ray used to image the breast tissue.  Mammography detects 90-95% of all breast cancers and can find tumors 1-2 years before they can be felt. For most women, high-quality mammography screening should begin at the age of 40. As risk factors vary in everyone, each woman and her Doctor or Nurse-midwife should discuss the plan that’s right for her. Most organizations recommend screening every one to two years. Screening should continue throughout a woman’s lifetime.  At The Adler Center for Women’s Health we will develop a personalized plan for your mammogram screening needs based on your history, risk factors, and annual breast exam.

In conclusion, I want to emphasize that we still don’t know how to prevent breast cancer, so we have to find it early and treat it.  It’s very scary to find a lump, but not looking will not make it go away.  If you do find a lump -  don’t panic.  Don’t let the fear of treatment prevent you from looking either.  If you have any questions or think you should make an appointment for an exam, please feel free to call our office.    

Rita-Marie Goudreau, CNM