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If detected early, breast cancer can often be treated effectively with surgery that preserves the breast. Five-year survival after treatment for localized breast cancer is 96.3%. (Source: National Cancer Institute)

Current factors known to contribute to overall breast cancer risk are mostly uncontrollable, including age, personal and family breast cancer history, certain genetic factors, first menstrual period before age 12, menopause after 55, breast density, and race. A few factors that can be controlled that have been shown to increase breast cancer risk include obesity, alcohol consumption, and lack of physical activity.

For women who have a high risk of breast cancer, there are some drugs that may help reduce their risk of breast cancer, but they have significant side effects. The idea of a drug to reduce risk sounds exciting. But remember these are drugs with significant side effects that will be given to healthy women and there is no evidence they would prevent cancer from developing.

It is important to keep in mind that most women who have known risk factors do not get breast cancer. Except for growing older and certain genetic factors, most women with breast cancer have no clear risk factors. We currently can’t tell any individual woman, “Do this or take this and you won’t get breast cancer.”

The American Institute for Cancer Research (AICR) recommends nine diet and lifestyle guidelines.

• Don't smoke

• Maintain a maximum body mass index of 25 and limit weight gain to no more than 11 pounds after age 18

• Engage in daily moderate and weekly vigorous physical activity

• Eat five or more servings of vegetables and fruits each day

• Eat seven or more portions of complex carbohydrates such as whole grains and cereals each day and limit processed foods and refined sugar.

• Limit alcoholic drinks to one drink a day for women

• Limit red meat to about three ounces daily

• Limit intake of fatty foods, particularly those of animal origin

• Limit intake of salted foods and use of salt in cooking

A high-risk woman who has a strong family history of breast cancer may wish to consult a genetic counselor about testing for breast cancer genes, and surgical and chemopreventative measures.

• An abnormality that shows up on a mammogram before physical symptoms develop.

• A lump in the breast.

• A thickening, swelling, distortion or tenderness in the breast.

• Skin irritation or dimpling in the breast.

• Nipple pain, scaliness or retraction.

Note: breast pain is very commonly due to benign conditions and is not usually the first symptom of breast cancer. (Source: National Cancer Institute)

Women should follow these 3 steps to good breast health:

• Perform monthly breast self-exams, starting at age 20.

• Have a clinical breast exam at least every 3 years (annually after 40).

• Have annual screening mammograms beginning at age 40, earlier if you have a family history of breast cancer or other concerns about your personal risk.

(Source: American Cancer Society)

It is estimated that in 2022, 2,710 cases of breast cancer were diagnosed in men and approximately 530 died from metastatic disease. On average, 1 in 726 men will be diagnosed in his lifetime.

Stand in front of a mirror with your hands first overhead and then on your hips. Move your body slowly so you see every part of your breasts, including underneath, to notice if any changes have occurred.

Next, put one hand behind your head and three fingers on each breast, one at a time, to feel for any change.

Move your fingers in small circles upward, with different levels of pressure. Choose easy, medium and then hard while walking your fingers from one area until the next. Be sure to feel the entire breast and under each armpit. Finishing by squeezing the nipple. If there is discharge or pain, contact your physician.

Different women have different breast cancer types with unique disease characteristics including:

• the stage

• the size and grade of the tumor

• if there is lymph node involvement [nodal status]

• hormone receptor-positive or negative

• HER2/neu positive or negative

We also know that there are inherited gene mutations that affect breast cancer, such as BRCA 1 and BRCA2 mutations.

Breast cancer treatments have evolved over the years with the development of a range of chemotherapy drugs and therapies that target specific types of known breast cancers. About 15 to 20% of women with breast cancer are found to overexpress a protein called HER2. Nearly four out of five women with breast cancer have hormone receptor (HR) positive cancer, also called estrogen receptor (ER) and/or progesterone receptor (PR) positive. Hormonal therapies may keep these types of cancers from growing, increasing survival and reducing recurrence.

Triple-negative breast cancer is another subtype of breast cancer (called triple-negative because it lacks the receptors for estrogen and progesterone and has normal levels of HER2).

It is important to recognize that just like any other diagnosis, knowing the specific kind of breast cancer one has is important to finding the best treatment.

American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.

Stage 0

Stage 0 describes non-invasive breast cancers and is also called ductal carcinoma in situ (DCIS). In DCIS, cancer cells are still within a duct and have not invaded deeper into the surrounding fatty breast tissue. Paget disease (a cancer of the nipple that is very rare in men) is also stage 0 if there is no underlying tumor mass. There is no evidence of cancer cells invading the tissue.

Stage I

Stage I describes a tumor that is 2 cm or less and has not spread to the lymph nodes, or — if it has spread there — the cancer in the lymph nodes is microscopic (less than 2 mm in size).

Stage II

Stage II describes a tumor that is between 2 and 5 cm or has spread to a few lymph nodes in the armpit and is is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which: No tumor can be found in the breast, but cancer cells are found in the lymph nodes. The tumor measures 2 centimeters or less and has spread to the lymph nodes. The tumor is from 2 centimeters to 5 centimeters and has not spread to the lymph nodes.

Stage IIB describes invasive breast cancer in which: The tumor is from 2 centimeters to 5 centimeters and has spread to the lymph nodes. The tumor is larger than 5 centimeters but has not spread to the lymph nodes.

Stage III 

Stage IIIA describes invasive breast cancer in which no tumor is found in the breast, but cancer is found in lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. The tumor is 5 centimeters or smaller and has spread to lymph nodes that are clumped together or sticking to other structures. The tumor is larger than 5 centimeters and has spread to lymph nodes that are clumped together or sticking to other structures.

Stage IIIB describes invasive breast cancer in which the tumor may be any size and has spread to the chest wall and/or skin of the breast. The tumor may have spread to lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.

Stage IIIC describes invasive breast cancer in which there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast. The cancer has spread to lymph nodes above or below the collarbone. The cancer may have spread to lymph nodes or to lymph nodes near the breastbone.
 

Stage IV

Stage IV describes invasive breast cancer in which the cancer has spread to other organs of — usually the lungs, liver, bone, or brain.

Several mutations are thought to be necessary over a span of a number of years before the cell is in the mode of uncontrolled growth of abnormal cells we call cancer. It is hard to believe, but at the time of diagnosis, most women have probably had their breast cancer for five to eight years. The rate of division and rapidity of growth varies and unchecked, breast cancer can eventually form a mass (tumor) and spread to other parts of the body via the blood and lymph system.

In most cases, doctors cannot explain why a woman develops breast cancer. Studies show that most women who develop breast cancer have none of the risk factors listed below, other than the risk that comes with growing older. The median age of diagnosis at 62 years of age.

Also, most women with known risk factors do not get breast cancer. Scientists are conducting research into the causes of breast cancer to learn more about risk factors and ways of preventing this disease.

It is normal to feel a treatment decision must be made right away but taking time to decide on an appropriate course of action may be time very well spent. Second opinions can be very helpful as no two breast cancers are not the same and cannot be treated as such. Breast cancer is a complex disease with many variants needing different treatments.

The incidence rate of breast cancer for African American women is about 127 per 100,000 women compared to about 132 per 100,000 for white women. The mortality rate of breast cancer for African American women is about 28 per 100,000 women compared to 20 per 100,000 white women. Although the incidence rates are similar, the mortality rate among African American women is 40% higher than among white women. (Among Hispanic women, the incidence rate is 94 per 100,000 women and the mortality rate is 14 per 100,000 women. Among American Indian or Alaskan Natives, the incidence rate is about 95 per 100,000 women and the mortality rate is 15 per 100,000 women.)

The reasons for the disparity in mortality are complex and include access to care. Another reason for the difference in mortality among African American women may be that young African American women are disproportionately affected by triple-negative breast cancer. About 21% of breast cancers in African American women are triple-negative which is approximately double the proportion of this subtype in other racial/ethnic groups. There is no targeted treatment for this subtype.

Siegel, RL, Miller, KD, Fuchs, H, Jemal, A.  Cancer Statistics, 2021. CA Cancer J Clin.  2021: 71: 7‐33.

https://doi.org/10.3322/caac.21654

American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.

It may seem logical that if breast cancer is found, removing the entire breast is more likely to be a lifesaving treatment. But in cancer treatment, more is often NOT better. Multiple randomized trials, now with long-term follow-up, have demonstrated that survival after lumpectomy (i.e., breast conservation surgery) combined with breast radiotherapy is equivalent to mastectomy for treating most early-stage breast cancers. Once you know the pros and cons of each treatment for your type of breast cancer and your situation, the choice is often a personal one. If a doctor recommends one instead of the other, ask why and educate yourself on the evidence.

Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227-32.

Children can inherit an altered breast cancer susceptibility gene from either their mother or father. Most women—about 80%—who get breast cancer do not have a sister or mother who has breast cancer. While all breast cancer is genetic in origin, most of it is not inherited. (Source: The Breast Cancer Survival Manual by Dr. John Link, American Cancer Society)

• A man's lifetime risk is 1 in 726

• Men of color have a 52% higher risk rate for breast cancer over white men

• The mortality rate for men with breast cancer is 19% higher than for women

• Men with a BRCA1 mutation a 1-1.2% lifetime risk of breast cancer

• Men with a BRCA2 mutation have a 7-8% lifetime risk of breast cancer

• Up to 40% of breast cancers in men may be related to a BRCA2 mutation

The Breast Imaging Reporting and Data System or BI-RADS sorts mammogram results (and sometimes ultrasound or MRI) into seven categories numbered 0 through 6. This system allows for uniformity among clinicians when describing mammogram finding, simplifying communication about test results and follow up.

What do the BI-RADS categories mean?

0 – Incomplete. Additional imagining may be required.

1 – Negative. This is a normal test result.

2 – Benign. This is also a negative test but may indicate calcifications, masses, lymph nodes or a change since last imaging was done.

3 – Likely benign but follow up is recommended to be sure no further changes occur.

4 – Suspicious abnormality for which a biopsy is recommended.

5 – Highly suggestive of malignancy. Biopsies are strongly recommended.

6 – Biopsy-proven malignancy.

Your mammogram report will include an assessment of your breast density, a description of how much fibrous and glandular tissue there is as compared to fatty tissue. Breast density can impact the effectiveness of mammography as a form of screening as it can be to see abnormal areas. MRI or ultrasound are often suggested in addition to mammography. High breast density also slightly raises your breast cancer risk so it is important to know your breast density score.

A breast density score is a letter grade from A to D:

• A: Least dense: breast is almost entirely fatty tissue

• B: Scattered areas of dense fibrous and glandular tissue

• C: Heterogeneously dense with an almost equal mix of fatty and dense tissue

• D: Mostly dense tissue (extremely dense) 

New laws require healthcare providers to inform women of their breast density score after a mammogram. Dense breast tissue can make it harder to detect cancer on a mammogram and is also linked to a higher risk of breast cancer. With this information, women can now advocate for additional screening options, such as MRIs and ultrasounds, which can be more effective in detecting cancer in dense breast tissue. These laws also strengthen the ability to demand insurance coverage for supplemental screenings, ensuring that women at higher risk receive the thorough and potentially life-saving care they need. If you have dense breasts, talk to your doctor about additional screening options and check with your insurance provider about coverage under these new regulations.