Breast Cancer Toolkit

Breast cancer is an uncontrolled growth of breast cells. Breast cancer is the second leading cause of cancer death and, excluding skin cancers, the most frequently diagnosed cancer among U.S. females – with an estimated 232,670 new cases diagnosed nationwide during 2014. An estimated 4,400 Hoosiers are diagnosed with breast cancer each year. African American females are at increased risk for poor outcomes relating to breast cancer, in part, because they are more often diagnosed at a younger age, at a later stage of disease, and with more aggressive forms of breast cancer. 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.

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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 men, and that risk increases with age. Overall, in Indiana, the breast cancer incidence and mortality rates have decreased from 2003 to 2012.

According to the American Cancer Society, some potentially modifiable factors that may cause increased breast cancer risk include weight gain after age 18, being overweight or obese, the 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. In addition, the International Agency for Research on Cancer has concluded that there I s limited evidence that shift work, particularly at night, is associated with increased risk of breast cancer.

Some 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 BRCA 1 or 2 genes, which account for five to 10 percent of all female breast cancers, five 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 with more aggressive forms of breast cancer or at later stages.
  • Reproductive factors – Women with long menstrual history (menstrual periods that start early and/or end later in life), recent use of oral contraceptives or Depo-Provera, never having children, and having one’s first child after age 30 may increase risk.
  • 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.

Common Signs and Symptoms of Breast Cancer

Some common signs and symptoms of breast cancer 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

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.
  • Annual Screening Mammograms. The United States Preventive Services Task Force recommends biennial screening mammography 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.

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.

Resources

Additional and online resources: