Breast Cancer Awareness Month

There are several risk factors for breast cancer, as identified by the American Cancer Society (ACS). Some of these 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 doesn't mean you'll go on to develop breast cancer. Likewise, a lack of risk factors doesn't mean you 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 are female gender, aging, genetics, and race and ethnicity (white women are at slightly higher risk) according to the ACS. A greater number of menstrual cycles, previous chest radiation, and exposure to the drug diethylstilbestrol (DES) also puts women at a slightly higher risk.

Other risk factors can often be controlled. Pregnancy and childbirth are some of these factors. According to the National Cancer Institute (NCI), having more than one child provides increased protection with each successive birth.

Women who breastfeed also reduce their risk of breast cancer, the NCI explains. The longer the total length of time spent breastfeeding during the child-rearing years, the greater the protection.

Oral contraceptives, according to the ACS, slightly increase risk. Though once a woman is off contraceptives for 10 years, that risk is no longer present.

Hormone therapy for menopausal women can also increase risk. The ACS says estrogen alone is not a concern. For certain women, it can even slightly reduce the risk. But estrogen combined with progestin can increase risk.

Another risk factor is alcohol. Having one daily drink increases the risk only slightly, while the greater the consumption, the higher the risk. More than 5 drinks daily increase the risk for other cancers as well.

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

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

Several factors that previously have been claimed to increase risk factors are now disproven or deemed highly improbable, according to ACS and Memorial Sloan Kettering. These include antiperspirants, bras, abortion or miscarriage, dense breasts, fibrocystic disease, 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 require further research to determine if there's any relationship.

Early detection and screenings

Screenings are an essential means for detecting breast cancer, hopefully in its early stages.

Until more recently, women were encouraged to do a monthly self-examination. But a major study reported in The Journal of the National Cancer Institute in 2002, concluded self-examination has played no role in improving cancer detection. It also found the extensive teaching of self-examination leads to an increased rate of benign breast biopsies.

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. Then at age 40, clinical exams should be done annually. Women with higher risk factors should have exams more often and consult with their doctor for the recommended frequency.

Mammography, one of the most crucial tools in early detection for decades, first started in the 1960s. It's now known there are at least four types and subtypes of breast cancer. Mammography often doesn't detect the more lethal types until they're in the later stages. Add to this, mammograms result in significant overdiagnosis leading to unnecessary treatment. This comes with its own risks.

Various studies reveal mammography screening seems to have very limited usefulness among women under 40.  It’s moderately effective for detection in women ages 40-49 and is most useful for those in the 50-69 age group.

The results of recent studies have, therefore, revealed several needs. First, more research is needed to better answer questions about the approach to both detection and treatment. Additionally, better screening techniques should be developed for detecting the more deadly forms of breast cancer.

The latest cancer screening guideline by the ACS (2015) recommends women with average risk should begin regular mammography screenings at age 45. Then they should be annually screened until they reach 54. After that, they should transition to every two years, as long as they're in good health with a life expectancy of at least 10 years.

OCTOBER IS BREAST CANCER AWARENESS MONTH

LOOKING FOR SYMPTOMS?

There are several signs to watch for that might be indicative of breast cancer, although most of these symptoms could be caused by something else such as caffeine, menstrual periods, infection, or other illness or factors. If you notice any of these symptoms, see your health care provider to rule out breast cancer. Symptoms to watch for, say ACS and other breast cancer organizations, 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
• Nipple discharge that occurs without squeezing the nipple
• Nipple discharge that occurs in only one breast
• Thickening, a lump or hard knot inside the breast or in the underarm area
• Breast swelling, warmth, or redness
• 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