Each of your breasts contains 15 to 20 lobes of glandular tissue,
arranged like the petals of a daisy. The lobes are further divided into
smaller lobules that produce milk during pregnancy and breast-feeding.
Small ducts conduct the milk to a reservoir that lies just beneath your
nipple. Supporting this network is a deeper layer of connective tissue
The spaces between the lobes and ducts are filled with fat, which
makes up about 80 to 85 percent of your breast during your reproductive
years. Your breasts also contain vessels that transport lymph - a
colorless fluid that carries waste products and cells of the immune
system - to lymph nodes located primarily under your arm (axillary
nodes) but also above your collarbone and in your chest. These nodes are
collections of immune system cells that filter harmful bacteria and play
a key role in fighting infection.
Cancer affects your cells, the basic units of life. Normally, cells
grow and divide in an orderly way. But sometimes this growth gets out of
control - cells continue dividing even when new cells aren't needed.
These extra cells may form a mass of tissue called a tumor.
Tumors may be either noncancerous (benign) or cancerous (malignant).
Cells from malignant tumors can invade and damage nearby tissues and
organs. They may also travel through your bloodstream or lymph system to
other parts of your body.
In most cases, it isn't clear what triggers abnormal cell growth in
breast tissue. It is known that between 5 percent and 10 percent of
breast cancers are inherited. Defects in one of two genes, breast cancer
gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), put you at greater risk
of developing the disease. In fact, women who have mutations in these
genes have a much higher chance of developing breast cancer and a higher
chance of developing
ovarian cancer. Both men and women can inherit
these genes from either parent.
Although the discovery of these genes is important, it's only the
first step. Breast cancer is a complex disease that eventually may prove
to have a number of causes.
The American Cancer Society estimates that 75 percent of
cancer cases occur in women with no known risk factors. At the same
time, having one or even several risk factors doesn't mean you'll
develop the disease. The following factors may increase your risk of
- Sex. Being a woman is your greatest
risk factor. Although men can develop breast cancer, it's 100 times
more common in women.
- Age. Your chances of developing
breast cancer increase as you get older. The disease rarely affects
women under 25 years of age, whereas close to 80 percent of breast
cancers occur in women over age 50. At age 40, you have a one in 252
chance of developing breast cancer. By age 85, your chance is one in
- A personal history of breast cancer.
If you've had breast cancer in one breast, you have an increased
risk of developing cancer in the other breast.
- Family history. Women who have a
mother or sister with breast cancer have a greater chance of
developing breast cancer themselves. In general, the more relatives
you have with breast cancer who were premenopausal at the time of
diagnosis, the higher your own risk. If you have one close relative
with breast cancer, your risk is doubled. If you have two or more
relatives, your risk increases even more.
- Genetic predisposition. Between 5
percent and 10 percent of breast cancers are inherited. Defects in
one of several genes, especially BRCA1 or BRCA2, put you at greater
risk of developing the disease. Usually these genes help prevent
cancer by making proteins that keep cells from growing abnormally.
But if they have a mutation, the genes aren't as effective at
protecting you from cancer. Women who are of Ashkenazi (Eastern and
Central European Jewish) ancestry are especially at risk.
- Excess weight. The relationship
between excess weight and breast cancer is complex. In general,
weighing more than is healthy for your age and height increases your
risk if you've gained the weight as an adult and especially after
menopause. The risk is even greater if you have more body fat in the
upper part of your body. Although women usually have more fat in
their thighs and buttocks, they tend to gain weight in their
abdomens starting in their 30s, which can increase their risk.
- Exposure to estrogen. The longer
you're exposed to estrogen, the greater your breast cancer risk. In
general, if you have a late
menopause (after age 55) or you began
menstruating before age 12, you have a higher risk of developing
breast cancer. The same is true for women who never had children, or
whose first pregnancy occurred when they were age 35 or older.
- Race. Caucasian women are more likely
to develop breast cancer than are black or Hispanic women. Black
women, however, are more likely to die of the disease because they
tend to be diagnosed at a later stage than are white women. But
socioeconomic factors, rather than race, may account for the
difference in mortality. A study of more than 5,000 Detroit-area
women published in the Journal of the National Cancer Institute
found that women of all races with incomes below the poverty level
were more likely to be diagnosed with late-stage breast cancer and
three times more likely to die of the disease than were women with
higher incomes. The study's authors concluded that low-income women
weren't receiving the routine medical care that would allow breast
cancer to be discovered earlier.
- Hormone replacement therapy (HRT). In
July 2002, a study sponsored by the National Institutes of Health (NIH)
was halted as researchers reported that HRT, once considered
standard treatment for menopausal symptoms, actually posed more
health benefits than risks. Among those was a slightly higher risk
of breast cancer for women taking the particular combination of HRT
- estrogen plus progestin - used in the study. In addition,
combination hormone therapy can make malignant tumors harder to
detect on mammograms, leading to cancers that are diagnosed at more
advanced stages, when they're harder to treat. Because combination
HRT can result in serious side effects and health risks, work with
your doctor to evaluate the options and decide what's best for you.
- Birth control pills. Because of the
recent information on HRT, many younger women are concerned about
the relationship between birth control pills and breast cancer.
Unfortunately, there's no clear answer. A large study of women
between the ages of 35 and 64 published in June 2002 in the New
England Journal of Medicine concluded that current or former use
of oral contraceptives didn't increase the risk of breast cancer.
But the American Cancer Society says that women currently using the
pill may have a slightly increased risk, whereas women who stopped
using oral contraceptives 10 years ago probably don't have such a
risk. For the latest information on the pill and breast cancer, talk
to your doctor.
- Smoking. A study
published in April 2001 found that
smoking significantly increases
the risk of breast cancer in women with a strong family history of
breast and ovarian cancers.
- Exposure to certain carcinogens. Polycyclic aromatic
hydrocarbons (PAHs) are chemicals found mainly in cigarette smoke
and charred red meat. Studies have shown that exposure to these
chemicals can significantly increase your chances of developing
breast cancer. Exposure to certain pesticides also may increase your
risk, but more research needs to be done to establish a clear link.
- Excessive use of
alcohol. Women who consume more than one
alcoholic drink a day have a 20 percent greater risk of breast
cancer than do women who don't drink. The National Cancer Institute
recommends limiting alcohol intake to no more than one drink daily.
- Unusual sleep patterns. You may have an increased risk of
breast cancer if you work the graveyard shift or are up often during
the night. The risk seems to be greatest if you don't sleep between
1 a.m. and 2 a.m., when levels of
melatonin - a sleep-regulating
hormone - are highest. Women who reported missing sleep during this
period at least three nights a week had a 40 percent increased risk
of developing breast cancer. Women who worked nights fared worse,
with a 60 percent increased risk. Researchers speculate that
suppression of melatonin by exposure to light may increase the
release of estrogen by the ovaries.
When to seek medical advice
Although most breast changes aren't cancerous, it's important to have
them evaluated promptly. If a problem exists, you can have it identified
and treated as soon as possible. See your doctor if you discover a lump
or any of the other warning signs of breast cancer. And if you've been
treated for breast cancer, report any new signs or symptoms immediately.
These include a new lump in your breast or an ache or pain - especially
in a bone - that doesn't go away after three weeks. In addition, talk to
your doctor about developing a breast-screening program that's right for
Screening and diagnosis
Screening - looking for evidence of disease before symptoms appear -
is the key to finding breast cancer in its early, treatable stages.
Depending on your age and risk factors, screening may include breast
self-examination, examination by your nurse or doctor (clinical breast
exam), mammograms (mammography) or other tests.
For years, women have been advised to examine their breasts on a
monthly basis starting around age 20. The hope was that by becoming
proficient at breast self-examination and familiar with the usual
appearance and feel of their breasts, women would be able to detect
early signs of cancer.
But some studies have shown that teaching women to perform breast
self-exams may not accomplish this goal. A large, randomized clinical
study in Shanghai, China, for example, concluded that breast self-exams
don't actually reduce the number of deaths from breast cancer. In
addition, the study found that women who perform regular breast
self-exams may be more likely to undergo unnecessary biopsies after
finding breast lumps. This was one of the primary reasons that in May
2003 the American Cancer Society changed its recommendations on breast
self-examination, stating that the procedure should be considered an
option, rather than a requirement, for most women.
The new guidelines emphasize breast health awareness instead of a
strict series of monthly self-exams. Although the guidelines don't say
you shouldn't perform the exams, the importance of self-exams has been
replaced by a general need to become more familiar with your breasts. If
you'd like to continue performing breast self-exams, ask your doctor to
review your technique.
To check for breast changes, do a self-exam once a month. Use your eyes
and hands to search for lumps, thickened areas, swelling and skin
changes. Move your fingertips in a circular motion, going .
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