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The female breast consists of milk-producing glands (the lobes and smaller lobules), ducts that conduct milk to the nipple, connective tissues, blood vessels, and lymph vessels that conduct lymph to lymph nodes in the axilla (armpit). Breast cancer occurs when breast cells do not die when they would under normal circumstances or when breast cells reproduce more rapidly than normal, forming a tumor. Breast tumors can develop in any of the breast tissues but are most common in the cells lining the ducts. Not all breast tumors are malignant (cancerous).
Breast cancer is the second leading cause of cancer death and, excluding skin cancers, the most frequently diagnosed cancer among U.S. women – affecting one in eight women. An estimated 4,400 Hoosiers were diagnosed, and 889 lives were lost as a result of breast cancer, during 2011. Beginning at the age of 50, screening mammograms are recommended yearly for women. Breast cancer is rare among men; however, because men are prone to ignoring warning signs, they are often diagnosed at later stages and have poorer prognoses.
Who gets Breast Cancer Most Often?
Sex and age are the two greatest risk factors for developing breast cancer. Women have a much greater risk of developing breast cancer than do men, and that risk increases with age. Overall, in Indiana, the breast cancer incidence and mortality rates have decreased from 2002 to 2011.
Some additional risk factors include:
Genetics. Women who have two or more first degree relatives who have been diagnosed with breast cancer before the onset of menopause have increased risk. Additionally, breast cancer risk increases if a woman has a family member who carries the BRCA 1 or 2 genes, which account for five to 10 percent of breast cancer cases. Race. In Indiana, during 2007-2011, the breast cancer incidence rates for African-American and white women were similar, but the mortality rate for African-American women was 39 percent higher than for whites. This increased risk can partially be attributed to African-American women being diagnosed with more aggressive forms of breast cancer or at later stages. Estrogen. Women who started menstruation before age 12 or menopause after age 55 might be at increased risk as a result of a higher lifetime exposure to estrogen. Pregnancy and breast feeding history. There are studies that show that women who have not had children, had their first child after age 30, or have not breastfed might have an increased risk of developing breast cancer. History of hormone replacement therapy (HRT). Using HRT can increase a woman's risk of developing and dying from breast cancer. This risk can be increased after just two years of using HRT. Women should talk with their doctor about the risks and benefits of using HRT. Certain medical findings. High breast tissue density, high bone mineral density, and biopsy-confirmed hyperplasia (an overgrowth of the cells that line the ducts or the lobules) increase women's risk for developing breast cancer. Alcohol intake. Having two or more alcoholic drinks a day increase female breast cancer risk by 21 percent. Weight and exercise. Gaining weight after age 18 and being overweight, especially post menopause, can increase your risk of developing breast cancer. The more body fat a woman has the higher her estrogen levels typically are, increasing her risk of developing breast cancer. According to the 2008 Physical Activity Guidelines for Americans, adults should perform 150 minutes of moderate-intensity aerobic activity (i.e., brisk walking) every week and muscle-strengthening activities on two or more days a week that work all major muscle groups (i.e., legs, hips, back, abdomen, chest, shoulders, and arms).
The early stages of breast cancer typically show no symptoms. However, as the cancer progresses, some symptoms may be noticed. These can include
Lumps, hard knots, or thickening Swelling, warmth, redness, or darkening Pulling in of the nipple or other parts of the breast Change in size or shape Nipple discharge that starts suddenly Dimpling or puckering of the skin Itchy, scaly sore, or rash on the nipple New pain in one spot that doesn’t go away
Early detection is critical for breast cancer. Women should have frequent conversations with their health care provider about their risks for breast cancer and how often they should be screened. In general, women should follow these recommendations:
Breast Self Awareness. Women in their 20s should be aware of the normal look and feel of their breasts, so that they can identify potentially dangerous changes. Clinical Breast Exams. Women in their 20s and 30s should have a clinical breast exam by a health care professional every three years. Women in their 40s should have yearly clinical breast exams. Annual Screening Mammograms. Women, beginning at the age of 50, should have yearly screening mammograms, which help detect cancers before a lump can be felt. Women with increased risk for breast cancer should begin talking to their doctor about the risks and benefits of mammography beginning at age 40.
The five-year survival rate for localized breast cancer (cancer that has not spread to lymph nodes or other locations outside the breast) is 98 percent. It is important to educate both men and women about the importance of early detection, and encourage them to have critical conversations about appropriate screenings with their healthcare provider.
Updated February 2014.