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.
Return
to the November 4, 1996 contents page