What every woman (of every age) needs to know
It's More Common Than You Think
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One in eight. That's the chance of a woman having invasive breast cancer some time during her life, making it the second most common cancer among women in the US, after skin cancer. While women over 50 constitute 65 to 70 percent of breast cancer cases, one in 200 women will be diagnosed before their 40th birthday, according to the American Cancer Society (ACS). And for these women, the prognosis is often much worse. Why? Because breast cancer in younger women is more likely due to an abnormal genetic component and more often occurs in both breasts.
The good news is that breast cancer death rates in all groups have steadily declined since 1990, likely as a result of earlier detection and advancements in treatments available.
It's Up to You to Know Your Risk
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"One of the most important things younger women can do is to know their family history," says Dr. Elizabeth Chabner Thompson, M.D., founder of Best Friends for Life (BFFL) Co., a company dedicated to improving the breast cancer patient experience. "Having a first-degree relative, like a mother or sister, get breast or ovarian cancer at a young age ups your risk. And any ovarian cancer incidents in your family especially ups your risk."
Since detailed medical history isn't exactly dinner-table conversation, it's up to you to ask questions, Dr. Thompson says. "Sometimes families will say 'she died of female cancer' so you need to ask: 'What did she die of, exactly? How old was she when she died?'"
This information is extremely important. "If you have a lot of cancer in your family, we can do a blood test to check for the BRCA genes (the "cancer gene" that runs in families)," Dr. Thompson says, adding that approximately 55-85 percent of women with the BRCA gene will go on to get breast or ovarian cancer.
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While the overall incidence of breast cancer is higher in white women, black women are more likely to die from it and to have secondary cancer. Black women are also three times more likely to develop an aggressive "triple negative tumor," compared to women of other racial backgrounds, say researchers from Boston University School of Medicine. A triple negative tumor is one of the most deadly types of breast cancer because it is resistant to most treatments.
Be Skeptical of New Science
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Despite media buzz about a March 2012 study that found breast self-exams to be ineffective, experts agree that mammography and self-exams are still one of the best ways to spot breast cancer and get prompt, proper treatment.
"What self-checks do is allow women to understand what's normal for them," says Dr. Debbie Saslow, Ph.D, director of breast and gynecologic cancer at the ACS. While performing a self-check might not always lead to early breast cancer detection, understanding what looks and feels normal to you will tip you off to when something is not right.
"The wisest thing is to know your body well. Don't be afraid to examine yourself; embarrassment is a dangerous barrier. Don't hesitate to talk to your doctor about any concerns," adds Dr. Stephen Marcus, cancer researcher and author of Complications of Cancer.
If you don't have a strong family history or find any irregularity in your breasts, Dr. Thompson echoes the ACS, advising that "most women should have a baseline mammogram at age 40 and then discuss with their doctor about the frequency of tests thereafter." She also suggests yearly clinical breast exams. "You should just make it part of your annual check-up because doctors are trained to find anomalies that you might not recognize yourself."
Not sure how to perform a self-check? Click here for our simple 3-step guide.
Diet and Exercise Matter More Than You Think
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Approximately one-third of all cancer deaths can be attributed to poor diet and inactivity, according to the ACS. The good news is that you don't have to be a total gym rat to reap the rewards of reduced cancer risk. A June 2012 study published in the journal Cancer found that even mild physical activity before or after menopause can reduce breast cancer risk. Women who exercised 10 to 19 hours per week experienced the greatest benefit with an approximate 30 percent risk reduction. Intensity level didn't matter—a brisk walk is just as worthwhile as a spinning class that leaves you drenched in sweat. Just be sure to keep your diet in check: Weight gain can eliminate the beneficial effects of exercise on breast cancer risk.
Be Choosy About Birth Control
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The bad news: Certain types of hormonal birth control can increase your risk for breast cancer. Progesterone-only contraceptives like the Depo-Provera shot double your risk when used for a year or longer, according to a study published in the April 2012 issue of Cancer Research. The good news: The increased risk dissipates within just a few months after quitting the shot.
The risk may extend to birth control pills too. While research on the subject isn't conclusive, experts say "those with a family history of breast cancer related to mutations in the BRCA genes should use caution before taking birth control pills."
If you're worried about your cancer risk, discuss your concerns with your doctor right away. "Make sure you're on the same page. If they say 'don't worry about that,' he or she may not be the right doctor for you," Dr. Thompson says.
There are also non-hormonal birth control options available like the Paraguard IUD, a T-shaped copper device placed in the opening of your cervix that prevents pregnancy by shedding copper ions which neutralize sperm. In fact, new guidelines from the American College of Obstetricians and Gynecologists (ACOG) suggest that IUDs and implants should be viewed as "first-line recommendations" for all women seeking to prevent pregnancy. Learn more about the latest birth control research here.
Where the Top Docs Are
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If you do find a lump or any irregularity, finding the right doctor with training and experience in treating early breast cancer is key, Dr. Marcus says. "Board certified radiologists or surgeons, especially those who have had extra training in the treatment of breast cancer, have special expertise in performing the tests, like the less invasive needle biopsies, that can effectively make the diagnosis and guide treatment."
To find the best doctor for you, Dr. Marcus recommends looking at nearby teaching hospitals and cancer centers, as they will usually have the most cutting-edge equipment and be on top of the most recent research.
Time Is On Your Side
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"Breast cancer is not usually an emergency. A lot of less experienced doctors will try to rush you into something, but it's about finding the right treatment, not the fastest treatment," Dr. Marcus says. And while it's important to make healthy choices, it's just as important to be gentle with yourself. "Once a cancer develops, it's no longer relevant how you got it. What's important is to be aware and make an action plan [for treatment]."
"If you find out you are high risk, it's not a death sentence," Dr. Thompson says. Things have dramatically improved over the past few decades. "We have surveillance and also surgical and medicinal options (chemoprevention) that can greatly reduce your risk."
She knows of what she speaks. "I had a prophylactic mastectomy (surgical removal of both breasts to prevent an occurrence of breast cancer before it starts) in 2006 because I have four generations of breast cancer in my family. And these are not your grandma's mastectomies! The surgery reduces your risk by 99 percent, and the options for reconstruction are incredible," she says. "You could see me in regular clothes or a swimsuit and never know. I wouldn't say this is the right decision for everyone but it absolutely was for me."
There's an App for That
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Keeping track of all the latest research, your family history, and lifestyle factors like alcohol use, smoking, weight gain, and exercise is enough to make some women leave their future to fate. Fortunately there's an app that can help. While Dr. Thompson still recommends seeing your doctor to discuss your risk, the Breast Cancer Risk Calculator app can help you track everything and determine your real risk.
Technology has improved more than just cancer detection and treatment—it's doing amazing things for patient care and support. My Breast Cancer Team is a new social networking site for women dealing with breast cancer. "We interviewed lots of people and asked them, 'What did you do after the diagnosis?'," says Eric Peacock, co-founder and CEO at MyHealthTeams. Their answer: "I went home and Googled it like never before." Next, they all had the same instinct—to find and connect with others dealing with the same disease, Peacock says.
Sites like this allow women to ask and answer questions, post photos, share emotional ups and downs, and offer "hugs," in addition to providing a forum to discuss and rate health care providers.