Breast Cancer Risks, Symptoms, and New Revelations on Early Detection

There can be life after breast cancer. The prerequisite is early detection.” – Ann Jillian

Twelve percent of women today will develop invasive breast cancer, and more than 40,000 will die from it this year alone, reports Breastcancer.org. That’s why a refresher course on early detection and keeping up to date on latest studies is so important and the reason for Breast Cancer Awareness Month (October).

Risk Factors
There are several risk factors for breast cancer, as identified by the American Cancer Society. Some of these factors are unchangeable but should be taken into account in developing a screening plan. Other risk factors are lifestyle related. Therefore, women, especially those already at higher risk, should consider those factors she can control.

Still, the simple presence of risk factors does not mean a woman will go on to develop breast cancer. Likewise, lack of risk factors doesn’t mean a woman won’t develop the disease. For this reason, all women should be aware of the risks and symptoms and what screening does and doesn’t do.

Some factors that are unchangeable and increase risk, according to the ACS, are female gender, aging, genetics, race and ethnicity (white women are at slightly higher risk), dense breast tissue, a benign breast condition such as fibrosis or others, greater number of menstrual cycles, previous chest radiation, and exposure to the drug diethylstilbestrol.

Other risk factors, however, can often be controlled. Pregnancy and childbirth affect risk. But it isn’t all one way or the other. According to the Susan G. Komen Foundation, having more than one child provides increased protection with each successive birth. Women who have never had a child have a slight increased risk over those who have had more than one child.

Yet, women who give birth to only one child at the age of 35 or older will have a slightly increased risk over those who had no children.

Women who breastfeed reduce their risk of breast cancer, as SGKF explains. And the greater the total length of time spent breastfeeding during childrearing years, the greater the protection.
Oral contraceptives, according to the ACS, slightly increase risk. But once a woman has been off contraceptives for a period of 10 years, that risk is no longer present.

Hormone therapy for menopausal women may also increase the risk for those women with a uterus. Because estrogen alone can increase risk of uterine cancer, progesterone is typically prescribed along with estrogen. This may then increase breast cancer risk. Women without a uterus are prescribed estrogen alone, and therefore are not at increased risk, says ACS.

Alcohol is a risk factor. Having one drink daily increases risk only slightly, while the greater the consumption, the greater the risk. More than five drinks daily increases risk for other cancers as well.

Breastcancer.org says smoking also slightly increases risk for breast cancer. After menopause, being overweight or obese increases risk as well, says the ACS. But as the organization explains, the risk of breast cancer related to weight is complex, and those who were overweight as a child may not be affected. The distribution of excess body fat may also play a role, and waist-area fat may be more significant in increasing risk than fat in other parts of the body, such hips and thighs.

Exercise, however, has been shown to decrease risk, according to a study by the Women’s Health Initiative, which found just 1.25 to 2.5 hours of brisk walking each week can reduce risk by 18 percent.

Several factors that have previously been claimed to increase risk factors have now been disproven or deemed highly improbable, according to ACS. These include antiperspirants, bras, abortion or miscarriage, and breast implants.

Factors that remain unclear because studies have produced conflicting results include diet and vitamins, environmental chemicals, tobacco smoke, and night work. These factors will require further study to determine if there is any relationship.

Symptoms
There are several signs to watch for that could be indicative of breast cancer, though most of these symptoms could also be caused by something other than breast cancer such as caffeine, menstrual periods, infection, or other illness or factors. If you do notice any of these symptoms, you should see your healthcare provider to rule out breast cancer. Symptoms to watch for, says SGKF, include:

• A new lump or breast change that feels different from the rest of your breast

• A new lump or breast change that feels different from your other breast

• You feel something different that you’ve not previously felt

• Nipple discharge that occurs without squeezing the nipple

• Nipple discharge that occurs in only one breast

• Bloody or clear discharge, rather than milky

• Thickening, a lump or hard knot inside the breast or in underarm area

• Breast swelling, warmth, or redness

• Change in breast shape or size

• Breast skin dimpling or puckering

• A sore or rash on the nipple, particularly scaly or itchy

• Your nipple or other parts of your breast pulling inward

• Sudden nipple discharge

• Pain in one spot that doesn’t go away

Early Detection and Screenings
Screenings are an important means for detecting breast cancer, ideally in its early stages.
Women have long been encouraged to do a monthly self-examination. But a major study reported in The Journal of the National Cancer Institute in 2002 concluded breast self-examinations have played no role in improving cancer detection. Today, there is much controversy over the importance of a BSE for detecting cancer.

Clinical breast exams, however, are still recommended. For women with average risk factors, these should be done every one to three years starting at age 20. At age 40, clinical exams should be done annually. Women with greater risk factors should have exams more often and consult with their doctor for the recommended frequency.

Mammography, believed to be one of the most crucial tools in early detection for decades, first started in the 1960s. Early trials found mammography reduced breast cancer death rates by 25 percent.

But Peggy Orenstein points out in her 2013 New York Times article, “The Feel-Good War on Breast Cancer,” such statistics have overstated mammography’s role in the reduction of breast cancer death rates. This is because increased use of mammograms occurred along with much-improved treatments, and medical experts believe treatments have likely played the greater role in reducing deaths.

For this reason, mammograms have come under fire over the past couple of years as more studies have revealed the debatable usefulness of this screening technique, at least for younger women. This is because breast cancer and detection is more complex than it was once understood to be.

It is now known there are at least four types and subtypes of breast cancer. Mammography often does not detect the more lethal types until they are in the later stages. Add to this that mammograms result in significant over-diagnosis, leading to unnecessary treatment, which comes with its own risks.

“Ductal carcinoma in-situ is also referred to as noninvasive, or Stage 0, breast cancer. It is primarily diagnosed by screening mammogram, as it often does not form a palpable lump,” Dr. Deanna Attai, president of the American Society of Breast Surgeons, said.

“DCIS accounts for approximately 20 percent of mammographically detected breast cancers. As screening mammography has become more prevalent, the rate of DCIS detection has increased.”
Some medical experts say DCIS is really not a form of cancer at all, and referring to it as such results in overly aggressive treatment. The likelihood of low-grade DCIS developing into invasive breast cancer is only 16 percent, said Attai, while high-grade DCIS has a 60 percent chance of developing into invasive breast cancer over 10 years.

The problem, however, is there is currently no way to determine which cases of DCIS will ultimately develop into breast cancer. This creates a major dilemma.

Still, what is known is that among women in the United States, breast cancer is the second leading cause of cancer deaths. Though various studies reveal mammography screening seems to have very limited usefulness among women under 40, it is nonetheless moderately effective for detection in women ages 40-49, and is most effective for those in the 50-69 age group.

There is no one-size-fits-all plan that works best. Therefore, mammography screening for breast cancer should be based on informed decisions and individualized plans that take into account a woman’s age, risk factors, and both the advantages and disadvantages of mammograms for each woman’s unique situation. BW