About Breast Cancer
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 women in the United States. There are approximately 4,400 cases diagnosed each year in Indiana. Breast cancer is rare among males; however, because males 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. Potentially modifiable factors associated with increased breast cancer risk include weight gain after the age of 18, being overweight or obese (for postmenopausal breast cancer), use of menopausal hormone therapy (combined estrogen and progestin), physical inactivity, and alcohol consumption. Research also indicates that long-term, heavy smoking increases breast cancer risk, particularly among women who start smoking before their first pregnancy.
Additional risk factors include:
- Family history – Women who have had one or more first degree relatives who have been diagnosed with breast cancer have an increased risk. Additionally, breast cancer risk increases if a woman has a family member who carries the breast cancer susceptibility genes (BRCA) 1 or 2, which accounts for 5 to 10 percent of all female breast cancers. BRCA mutations also account for 5 to 20 percent of all male breast cancers, and 15 to 20 percent of familial breast cancers.
- Race – In Indiana, during 2008-2012, 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 at later stages.
- Reproductive factors – Women may have an increased risk if they have a long menstrual history (menstrual periods that start early and/or end later in life), have recently used oral contraceptives or Depo-Provera, have never had children, or had their first child after the age of 30.
- Certain medical findings – High breast tissue density, high bone mineral density, type 2 diabetes, certain benign breast conditions, and lobular carcinoma in situ can increase a woman’s risk in developing breast cancer. In addition, high dose radiation to the chest for cancer treatment increases risk.
Factors associated with a decreased risk of breast cancer include breastfeeding, regular moderate or vigorous physical activity, and maintaining a healthy body weight. Two medications – tamoxifen and raloxifene – have been approved to reduce breast cancer risk in women at high risk.
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:
- Clinical Breast Exams. The American Cancer Society recommends that women in their 20s and 30s have a clinical breast exam by a health care professional every three years. Asymptomatic women in their 40s should have yearly clinical breast exams.
- Screening Mammograms. The United States Preventive Services Task Force recommends a screening mammogram every two years for women aged 50 to 74, which help detect cancers before a lump can be felt. Women between the ages of 40 to 49, especially women with a family history of breast cancer, should discuss the risks and benefits of mammography with their health provider to determine if it is right for them.
According to the 2012 Indiana Behavioral Risk Factor Surveillance System, only 67.7 percent of women ages 40 and older had a mammogram during the past two years. Indiana currently ranks 44th in the nation for women who have had a mammogram. The Affordable Care Act requires preventive screening services to be included in most insurance policies. Often, these services are paid in full. Individuals should check with their individual insurance providers for specific plan information.
The five-year survival rate for localized breast cancer (cancer that has not spread to lymph nodes or other locations outside the breast) is 99 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.
- Breast Cancer Fact Sheet (2014)
- Indiana Cancer Facts and Figures 2012: Breast Cancer
- Breast Cancer Toolkit
Updated March 2015.