There are a number of important facts we should all be aware of concerning breast cancer. I want to take this opportunity to clear up a few misconceptions and help women protect themselves from this disease.
Breast cancer is the most commonly diagnosed cancer, other than skin cancer, among American women, and the second-leading cause of cancer death (exceeded only by lung cancer). It is estimated that 235,000 women and men will be diagnosed with the disease in 2013 and about 40,000 will die. Approximately 2,200 of those diagnosed and 400 of those dying will be men.
The median age at diagnosis of a breast cancer patient is 61. Less than 20 percent are diagnosed before age 50. Indeed, age is the second strongest risk factor after female gender.
There has been progress in the fight against breast cancer. The age-adjusted death rate has decline 34 percent in the past 25 years. This means a woman of a given age is two-thirds as likely to die of breast cancer today compared to a woman of the same age 25 years ago.
Second, the reasons for the decline in mortality are, in order:
Improvements in treatment
Increased breast awareness
The Critical Need for Better Treatment
Many mistakenly believe mammography is the major reason for the decline. In the past, some advertisements and public health announcements have stressed mammography and not put enough emphasis on breast cancer awareness or on getting good treatment if diagnosed. Patterns of care studies show that we could save more lives by placing more emphasis on getting good treatment. Perhaps 20 percent of American women with treatable breast cancer get incomplete treatment. Less-than-optimal breast cancer treatment is the leading reason for racial and socioeconomic disparities in this disease.
In an effort to help women understand what is necessary to get good care, the American Cancer Society recently published the third edition of its book, Breast Cancer Journey, The Essential Guide to Treatment and Recovery. This guides newly diagnosed patients every step of the way through diagnosis and treatment.
Day-to-Day Awareness of Your Breasts and Breast Health
We should not underestimate the power of breast awareness. It is simply encouraging women to be aware of their bodies on a day-to-day basis while dressing or in the shower, and seeking evaluation of any change that they notice. The monthly breast self-examination is no longer advocated and has been replaced by breast awareness.
The Role of Mammograms
While it is not the leading reason for the decline in mortality, high-quality mammographic screening is important. All medical organizations stress the importance of regular mammography and clinical breast examination from age 50 onward. The American Cancer Society and several other organizations suggest annual screening start at age 40.
All medical organizations that issue screening guidelines also say that women should be informed of the limitations of mammography. It will find some lesions that turn out to be benign after an extensive and sometimes time-consuming evaluation. High-quality mammography will sometimes miss a cancer that we wish it had found. This information will allay some fears among those with a positive finding and help keep those who have had false positive findings continue to adhere to guidelines.
Genetic Testing for Breast Cancer
Recently, there has been increased interest in genetic testing for breast cancer risk.
About 1 percent of the population has a genetic alteration or mutation that puts them at higher risk for breast cancer. Mutations can be found in a number of genes (BRCA1, BRCA2, TP53, PTEN, CHEK2 and others). Approximately 5 percent of women with breast cancer have it due to a genetic mutation.
Approximately 15 percent of women diagnosed with a breast cancer have a family history of the disease. Most with a family history do not have a genetic mutation that increases risk.
More than 80 percent of women diagnosed with breast cancer do not have a family history of the disease.
The only people who should undergo genetic testing are those with an extensive family history of breast and other cancers, and then only after consultation with a qualified genetic counselor. Some have demanded and gotten testing for BRCA1 and BRCA2 when a brief conversation with a genetic counselor would have determined they should be tested for another gene or not tested at all.
Visit the American Cancer Society’s site for more information about breast cancer.