Breast cancer risks and recommendations

Breast cancer remains the most common cancer among women, with about one in nine American women expected to experience a diagnosis of breast cancer in her lifetime. For 1996, the American Cancer Society estimates that 184,300 women will be diagnosed with breast cancer in the United States.

As a cause of cancer mortality among females, breast cancer is second only to lung cancer. Overall, the mortality rates from breast cancer have changed little over the past 50 years.

Despite these sobering statistics, extraordinary advances have been made in understanding the possible underlying causes of and in exploring new treatment options for breast cancer. In 1994, three groups identified a gene thought to be involved in about 5 percent of cases of inherited breast cancer, termed the "BRCA1" gene. Breast cancer has been known to be diagnosed in individuals with no family history (spontaneous), or to run in families (familial), as well as to be inherited from parents passing on the genetic changes to their children (hereditary). The BRCA1 gene can be carried by both males and females and also has been associated with an increased risk of ovarian cancer as well as possibly other cancers, such as cancer of the colon. Another breast cancer susceptibility gene, called "BRCA2," was subsequently identified and also increases the individual's chances of developing breast cancer over the course of a lifetime. The BRCA1 gene may be found in women with a personal history of breast cancer diagnosed at an early age (before age 50), or with a strong family history of breast and/or ovarian cancer, often spanning several generations, and has been possibly associated with certain ethnic groups. Tests for both BRCA1 and BRCA2 are under development, and commercial availability for the BRCA1 test may soon be a reality for individuals with personal or family histories that might indicate a hereditary basis for breast cancer.

While knowledge of genetic mutations may be extremely useful in eventually understanding the etiology of breast cancer, customizing screening plans and even designing therapeutic interventions, the most important risk factor in breast cancer diagnosis is still a woman's age. All women over the age of 50 are at risk for breast cancer regardless of prior family history.

While various risk factors, including diet, obesity, alcohol consumption, exercise, use of oral contraceptives and other hormonal agents, and fat intake have been analyzed for possible correlation with breast cancer risk, age remains the most important. As such, women between the ages of 40-50 are recommended to have screening mammograms performed every one to two years or based on their physician's advice, and women over age 50 should have a mammogram annually. In addition, women should have a clinical breast exam performed by a health care provider every year. These interventions are aimed at diagnosing breast cancer at an early stage, when it is most curable.

Breast cancer has had widespread media attention over the past decade and is a frequent subject of women's publications and forums. The focus of October as "Breast Cancer Awareness Month" was an opportunity to highlight known risks, recommendations for early detection and advances in breast cancer research. Accurate information about breast cancer and what women themselves can do to reduce their risk or increase their chances of survival if a diagnosis is made is essential in order to reduce the mortality rates as well as the personal and family impact from this common and often devastating disease.

Theresa W. Gillespie is the director of Clinical Research and Education and associate director of the Winship Cancer Center.

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