Scope of the breast cancer problem

The American Cancer Society estimates that in the United States in 2000, over 175,000 women will be diagnosed with breast cancer and approximately 43,300 will die from this disease. In the United States, breast cancer is the most common cancer in women, and the second most common cancer killer in women (lung cancer is first). One woman out of eight will develop breast cancer sometime during her life, with the vast majority (77%) of these cases occurring in women over 50 years old.

It is important to note that many younger women vastly overestimate their risk of developing breast cancer, and believe that if they do get it, they will not survive. An encouraging fact for all women is that when breast cancer is detected early, when it is still confined to the breast and has not spread to the lymph nodes, the 5-year survival rate is 97%. Breast cancer is serious and it is real, but other diseases are often more common and more dangerous. Less than 4% of American women die of breast cancer, while about 30% die of heart disease.

Keep in mind that 70% of women with breast cancer have no identifiable risk factors, other than being female.

• Family History
  Women whose mothers, grandmothers or sisters have had breast cancer are two to three times more likely to develop breast cancer. However, 85% of women with breast cancer have no family history of the disease.
  
  
• First childbirth
  The risks are higher among women who have never had (and breastfed) a baby or whose first childbirth occurred after the age of thirty.
  
  
• Menstrual history
  Early first period (before age 11) and late menopause (after age 52) both increase risk.
  
  
  
• Diet
  High-fat, low-fiber diet increases risk. Risk also increases with higher weight.
  
  
• Age
  Risk increases with age. This disease is rare in women under the age of thirty. Women over fifty make up 77% of breast cancer cases.
  
  
• Alcohol
  Women who consume two to five alcoholic drinks a day have a higher risk of breast cancer than do non-drinkers.
  
  
• Genetic Alterations
  Specific alterations in certain genes, such as those in the breast cancer genes (BRCA1 or BRCA2), make women more susceptible to breast cancer.
  
  
• Hormone Replacement Therapy
  Recent evidence suggests that menopausal women who have long-term exposure (greater than 10 years) to hormone replacement therapy (HRT) may have a slightly increased risk of breast cancer.
  
  
• Socioeconomic Factors
  In the United States, white women from upper-socioeconomic classes living in urban areas are more at risk for breast cancer than other women, for reasons researchers do not yet understand.
  
  
• Environmental Factors
  Research has not yet proven whether there are breast cancer risk risks involved in a number of environmental exposures, including radiation, UV rays in sunlight, artificial sweeteners, pesticides and electromagnetic fields that surround electronic devices like microwave ovens and cell phones.

The Women's Cancer Network www.wcn.org has a cancer risk survey that you can take anonymously online. The survey covers breast, cervical, ovarian, and endometrial cancers. Be aware, though, that the survey was designed for heterosexual women and defines "sexual intercourse" and "sexual partners" as contacts with men.

Being a lesbian does not increase your risk for breast cancer, but having one or more of the risk factors below might. A lesbian or bisexual woman without these risk factors is at no greater risk than a heterosexual woman.

• Lesbians are less likely to seek routine health care because of the discomfort of coming out to health care providers and less access to health insurance. With fewer doctor visits, lesbian and bisexual women are less likely to have mammograms and professional breast exams. Studies also show that lesbian and bisexual women are less likely to perform breast self-exam regularly. For these reasons, lesbians and bisexual women may be less likely to have cancers detected at earlier, more treatable, stages.
  
  
• Lesbians are less likely to give birth by age 30 if at all, which increases risk.
  
  
• Some studies (see Note on Studies of Sexual Minority Health) indicate that lesbians may use alcohol more and have higher body weight, both of which may increase a woman's risk for breast cancer.

• Keep your diet low in fat.
• Keep your alcohol consumption light.
• Learn how to do breast self-exam and do it every month (click here for instructions).
• Have a health care provider examine your breasts every year and answer any questions you have.
• If you have no risk factors for breast cancer, get a baseline mammogram when you're 40. Then every 1-2 years after that -- assuming everything is fine -- until you are 50. After 50 get a mammogram every year.

Some women are concerned about the risks of mammograms. Click here to read about the mammogram question.

• Breast Self Exam
  
  • Account for 90% of all lump detection
  • Are easy and completely risk-free
  • Are performed by the person most knowledgeable about your unique breasts
  • Will pick up 40% of early cancers NOT seen on mammograms
  • Are free
  • Click here for instructions
    
    
• Mammograms
  
  • Can pick up some cancers years before they can be felt from the outside
  • Are recommended for women over the age of 40
  • Cannot replace the need for monthly breast self-exams
  • Will pick up 40% of early cancers otherwise unsuspected
  • Are known to miss at least 7-20% of cancers
  • Only 1 or 2 mammograms out of every 1,000 lead to a diagnosis of cancer. Approximately 10% of women will require additional mammography. Don't be alarmed if this happens to you. Only 8%-10% of those women will need a biopsy, and 80% of those biopsies will not be cancer.
  • Click here to read about the mammogram question.

• Health care provider exams
  
  • Are easy and risk-free
  • Are performed by people with expertise in the assessment of breasts (but are less familiar with your specific breasts than you are)
  • Can help you decide if you need to see a specialist or have a mammogram