Over 25 years ago, the National Breast Cancer Awareness Coalition (NBAC) was established as a collaboration between the American Cancer Society and a pharmaceutical company now known as AstraZeneca. These two entities are the driving force behind National Breast Cancer Awareness Month: 31 days filled with pink ribbons, monuments illuminated in pink , and, most importantly, information on the current state of breast cancer diagnosis and treatment.
In their lifetimes, women now have a one in eight chance of being diagnosed with breast cancer. The median age for this diagnosis is 61—this means that half of women are diagnosed before that age and the other half after. In the 1970s, that rate was more like 1 in 11. Diagnoses have risen for several reasons: better early detection through screening, rising prevalence of obesity (a major risk factor), changing reproductive patterns (women having fewer children and having them later in life), and an impact from widespread post-menopausal use of standard hormone replacement therapy (HRT) using estrogens and progestin drugs.
At Ageology, one of the therapies we often recommend in our integrative metabolic medical programs involves hormones—but not the kind linked with increased risk of breast cancer. I’ll come back to this topic in a later post, as it is controversial and a little complicated.
First, a few startling breast cancer facts and figures from the American Cancer Society’s 2013 report, Breast Cancer Facts and Treatment:
- In 2013, an estimated 232,340 new cases of invasive breast cancer will be diagnosed in American women.
- An additional 64,640 cases of breast cancer in situ—precancerous cells that haven’t turned cancerous yet, or that haven’t moved from within breast ducts out into surrounding tissues—are also forecast.
- In 2013, approximately 39,620 American women are expected to die from breast cancer. This cancer kills more American women than lung cancer, and it is the second most common cancer in women in the United States (second only to skin cancer).
Now, for some good news:
- Death rates from breast cancer fell by 34% between 1990 and 2010, with the fastest decreases in women under the age of 50.
- Over 2.9 million American women who have been diagnosed with breast cancer were alive as of January 1, 2012.
- Mammography screening is believed to reduce risk of dying from breast cancer by between 15 and 30%. Modern digital mammography exposes the breasts to much less radiation than earlier iterations of this test, and the science behind targeted therapies has yielded much better cure rates than were possible even a decade ago.
The good news about breast cancer survival rates is tempered somewhat by a wide disparity in the decrease in death rate between African-American women and white women. Five-year breast cancer survival in white women is 92%, but only 75% in African-American women. Death rates are also significantly higher in women lower on the socioeconomic spectrum than those at higher income levels.
Men get breast cancer too, but their rates are much lower than those of women: only 1.2 in every 100,000 men will develop this disease. The third week of October has been designated Male Breast Cancer Week to help remind men and the women that they should have any breast abnormality checked out by a physician.
Raising breast cancer awareness is, in large part, about reminding people what they can do to prevent the disease—informing them about how they can control whatever risk factors they can. Unfortunately, most of the risk factors at play aren’t under our control.
Being female, over 50 (most cases impact women 50 and older), having a family history of the disease, having had an early menarche (start of menstrual periods), or having had a late menopause (after age 55) are all out of a woman’s control. Although having children before the age of 30, having more term pregnancies, and breastfeeding for at least one year will reduce risk, women don’t generally make their reproductive choices based on their impact on breast cancer risk.
So that leaves only a few controllable risk factors: obesity, smoking, excessive alcohol consumption, and use of standard estrogen plus progestin hormone replacement therapy like Prempro. Although there is some evidence that a nutrient-rich diet full of fresh vegetables will help reduce risk of many cancers, there isn’t enough to make a strong connection to breast cancer prevention, aside from the positive impact a diet like this will have on body weight. Use of oral contraceptives also increases breast cancer and cervical cancer risks in young women. Risk returns to baseline 10 years after use stops. To play it extra-safe, opt for non-hormonal birth control if possible.
Since we can’t always prevent breast cancer, early detection is key. The sooner breast cancer is detected, the more likely a complete cure. The downside of aggressive early detection and treatment is the risk of either false positives (unnecessary biopsies aren’t much fun), which are more likely than most people know, or of overtreatment of something that would ultimately never have posed significant risk. Right now, the state of current research has not enabled us to identify which early-stage cancers should be treated and which can be left alone. Until that time comes—and it will probably come in the next 10 years—we generally advise treatment in all cases.
It’s also important to know your risks. Women with first-degree relatives with breast cancer; who have dense or fibrocystic breasts; or who have multiple female relatives who have had ovarian and/or breast cancer are very high-risk. The latter group may carry the BRCA1 or BRCA2 genes, which are rare but confer an enormous lifetime risk of breast and ovarian cancer. This group was made famous by Angelina Jolie’s decision to undergo prophylactic mastectomy to avoid breast cancer. If you aren’t sure how to gauge your risk, have that conversation with your doctor so you can know where you stand, how vigilant you should be, how often you should have a mammogram, and whether you’re a candidate for breast MRI screening to look more carefully for possible cancer.
Know your breasts, too. Look at them in the mirror and learn from your doctor how to do a self-exam. Be wary of any changes that crop up in the look or feel of your breasts, especially hard lumps in the breast tissue or under the arms.
The American Cancer Society and the Mayo Clinic recommend yearly mammography for all women aged 40 and older. This guideline is based on studies that show a 29% decrease in breast cancer deaths in women who get yearly mammograms. Other organizations have less demanding guidelines: the US Preventative Services Task Force recommends starting screenings at age 50 and repeated every two years—probably a fine alternative for women at lower risk.
Photo credit: sheknows.com