Breast cancer is the most commonly diagnosed cancer in women after skin cancer. It is also the second leading cause of cancer death for women after lung cancer. To put it in numbers: 1 in 8 women in the U.S. will develop invasive breast cancer in their lifetime. In 2021, this means that it is estimated that 281,550 women will develop invasive breast cancer and an additional 49,290 will be diagnosed with ductal carcinoma in situ. Although men are at much lower risk, there will be an estimated 2,650 cases diagnosed in men as well.
These numbers are sobering, and there is concern that with preventive health care being delayed due to the pandemic, diagnoses will be made at a more advanced stage which will likely increase the mortality. About 43,600 women in the U.S. are expected to die from breast cancer in 2021. As we know the best screening tool for breast cancer is a mammogram. There are a number of guidelines addressing the optimal timing and frequency of mammography but the general consensus is that screening with mammography should start between age 40-50 and should be done every 1-2 years. 3D mammogram is a newer technique becoming more widely available and will likely be the gold standard in the future.
Additional imaging modalities include ultrasound and MRI. Ultrasound is generally used when there is a palpable lump or abnormality on the mammogram. MRI is reserved for women at particularly high risk who are advised to start screening at a younger age. Although most physicians still recommend self-breast exams as well as clinical breast exams, those have not been shown to be particularly sensitive or specific for breast cancer detection.
The staging of breast cancer is based on imaging and biopsy, and the treatment plan is dependent on those. Treatments can include surgery- either removing the cancer or the entire breast, radiation, chemotherapy and hormone therapy.
As with most diseases, some risk factors for breast cancer are in our control and some are not. Besides being female, some of the other risk factors that are pre-determined are age, family history, genetics, race, and breast density. Most breast cancers are found in women greater than age 55. If you have a first degree relative (meaning mother, sister or daughter) with breast cancer, your risk is twice that of the general population. The BRCA1 and BRCA2 mutations are some of the known mutations that put a person at increased risk. With that being said, it is significant that 85% of breast cancers occur in women with no family history.
Factors that are at least partially under our control include: alcohol use, weight, sedentary lifestyle, reproductive history, and use of hormonal birth control and hormone replacement therapy. Women who drink one alcohol beverage daily have up to a 10% increased risk for breast cancer compared to non-drinkers. Most of the other risk factors are related to estrogen exposure. So anything that increases estrogen exposure can increase breast cancer risk. This includes being over-weight, delaying child-birth till after age 30 or not having any children, or taking hormonal medicines. Breast-feeding and having multiple children, on the other hand, tend to be protective against breast cancer.
Because of the wide range of risk factors, evaluation and treatment for breast cancer, it is important that you discuss your particular situation with your physician. Screening mammogram is available at Essentia Health in Sandstone and Moose Lake as well as at Gateway Clinic in Moose Lake. Additionally, diagnostic mammogram and ultrasound are available at Gateway Clinic in Moose Lake.
For additional information:
American Cancer Society: www.cancer.org
National Cancer Institute: www.cancer.gov
Dr. Bridget Dewey is an Internal medicine/Pediatrics doctor at Gateway Family Health Clinic.