Breast Cancer: Frequently Asked Questions
Q: Who is most likely to get breast cancer?
A: Breast cancer occurs most often in women over 40 and the risk increases with age. There are many things that may increase a woman's risk of breast cancer. They are called risk factors. Some of them cannot be controlled, and others are lifestyle choices that can be controlled. Some things may cause large increases in risk and some may result in small increases in risk.
Risk factors that cannot be controlled include having a breast cancer gene and having a long, uninterrupted menstrual history. Families who have a breast cancer gene tend to have several members with breast cancer and it is often diagnosed before menopause. These families may also have cancers of the endometrium, ovary, or colon. A long, uninterrupted menstrual history includes menstruation that begins at an early age, menopause starting at a late age, not having children, or first pregnancy at late age.
Controlling modifiable risk factors include reducing or eliminating the use of postmenopausal estrogen, decreasing alcohol use to no more than one drink a day, addressing postmenopausal obesity, being physically active, and stopping smoking. The role of diet as a breast cancer risk factor is unclear at this time. Lifestyle risk factors may be of the most importance to women already at high risk due to family history and breast cancer gene presence.
Q: Can breast cancer be prevented?
A: There is no sure way to prevent breast cancer. All women can consider the lifestyle risk factors as they make their choices. The answers are not all in on this subject and women need to stay informed as new research is published. For women who are at higher-than-average risk, tamoxifen and raloxifene have been approved in the United States to help reduce their risk of developing breast cancer. These hormonal treatments have side effects and risks, so the decision to use one of them for prevention should be made in careful consultation with a breast cancer specialist. For women at extremely high risk of breast cancer, preventive mastectomy (surgery to remove the breasts) may be considered. While many breast cancers cannot be prevented, early detection and prompt treatment can save lives when breast cancer occurs.
Q: Is breast cancer inherited?
A: All cancers involve changes in a person's genes. Usually, several changes are required before a cancer develops. If a person inherits a genetic mutation (change or defect), from a parent, that person has a higher risk for developing cancer. It is currently believed that less than 10% of breast cancers involve an inherited genetic mutation. Most happen because of genetic mutations that occur during the person's lifetime. If a woman's mother, grandmother, aunts, or sisters developed breast cancer before menopause, she may have a greater chance of getting breast cancer than a woman with no family history. The same gene may increase risk for ovarian, prostate, and pancreatic cancers. Genetic testing may help determine if a woman has inherited a breast cancer gene.
Q: How often should I have a mammogram?
A: Experts have different recommendations for mammography. Currently, the U.S. Preventive Services Task Force recommends screening every 2 years for women ages 50 to 74, with the choice to start getting mammograms every 2 years starting at age 40. The American Cancer Society (ACS) recommends yearly screening for women ages 45 to 54, then a choice of screening every 2 years or every year for women age 55 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them.
Q: Does it hurt to have a mammogram?
A: A mammogram may be slightly uncomfortable, but it shouldn't hurt. In order to get a clear picture, the breast is compressed between two flat plates. It lasts only a few seconds. It is a good idea to schedule a mammogram after your menstrual period when your breasts are less likely to be tender.
Q: Does breastfeeding either cause or prevent breast cancer?
A: Some studies have found that breastfeeding may reduce the risk of breast cancer. The benefit appears to be related to how long the woman breastfeeds. This is a difficult thing to study in the U.S., but 1½ years of breastfeeding seems to be needed to impact risk.
Q: Can injuries to the breast cause breast cancer?
A: Injuries to the breasts do not cause breast cancer to develop. Often injuries lead to the discovery of a tumor because it causes women to pay more attention to their breasts, but bumps and bruises do not cause tumors to appear.
Q: What is preventive mastectomy?
A: Preventive or prophylactic mastectomy is the removal of one or both breasts to reduce the risk of getting breast cancer. Some women who have a very high risk of breast cancer choose this option. However, some women who have had this surgery have regretted it afterward. This irreversible decision should be made carefully, following extensive consultation with a breast cancer expert and genetic counselor about risk, benefits, and other alternatives.
Women who consider prophylactic mastectomy are often also advised about prophylactic oophorectomy—removal of the ovaries. This is considered because women with genes for breast cancer risk may also be at high risk for ovarian cancer. Removing the ovaries in premenopausal women may decrease breast cancer risk, as well.
Q: Can breast cancer be cured?
A: Most women diagnosed with breast cancer in the early stages are alive after 5 years. Many women with breast cancer will be successfully treated and never experience breast cancer again. However, all women who have had breast cancer are at risk for recurrence (it comes back after treatment) or for a second primary breast cancer and thus regular checkups and mammograms are essential. At this time, there is no cure for women whose breast cancer has spread to other parts of the body. Still, many of these women can live for many years, undergoing treatment for breast cancer as a chronic illness.
Q: Can my doctor tell if I have cancer without doing a biopsy?
A: A biopsy is the only way to be sure if a breast change or lump is cancer or not. By feeling the lump, it is possible for the doctor to determine if the lump is suspicious, but not if it is cancer.
Q: Why is chemotherapy such a long treatment?
A: Cancer cells divide quickly but they also take "rests" between divisions, just like normal cells do. During these resting periods, the cancer cells are relatively safe from chemotherapy drugs, which only attack tumor cells that are growing or dividing. Chemotherapy is administered over a period of months to reduce the chance that resting cells will be left behind and cause a recurrence.
Q: Where is the best place for me to receive treatment?
A: There are many factors to consider in deciding where to receive treatment. Ideally, a woman with breast cancer is treated by a team of doctors that specialize in breast cancer treatment. That team is supported by other health care professionals, such as oncology nurses, social workers, physical therapists, nutritionists, and others who collaborate to meet the needs of the patient. This helps to ensure that all options are considered and the best treatment plan for that woman is developed and provided.
Often, these resources may not be available close to the woman's home. In that case, decisions must be made that balance the health care needs with other parts of the woman's life. If possible, she should consider going to a multidisciplinary breast program at a major cancer center if she has a new breast cancer diagnosis by biopsy or a very strongly suspicious mammogram. Once a team of breast cancer specialists reviews her situation, surgery and treatment recommendations are made. The patient can then look into options closer to her home for radiation therapy and/or chemotherapy, if needed.
If the patient lives near a comprehensive or clinical cancer center that has been designated by the National Cancer Institute, she should definitely consider getting treatment, or at least a second opinion, there. These centers are involved in the latest research and their doctors can advise her about the newest and best treatments available.
Q: How does diet affect breast cancer?
A: Studies indicate that diet may be a factor in breast cancer, but the results are mixed. While the evidence of total fat intake impacting cancer outcome is not clear, we do know that diets high in fats tend to be high in calories. This may result in obesity, which is linked with increased cancer risk, increased risk of recurrence, and reduced chance of survival for many cancer sites, according to the ACS.
Maintaining a healthy weight is a recommendation of the ACS. The ACS also recommends that consumers limit consumption of red meats (such as beef, pork, and lamb) and avoid processed meats, like bacon.
Q: Do men ever get breast cancer?
A: According to the ACS, over 2,200 men are diagnosed with breast cancer in the U.S. each year. Little is known about this rare cancer, but the risk factors seem to be the same as female breast cancer.
Q: What role does estrogen replacement therapy play in breast cancer?
A: The results of the Women's Health Initiative have provided helpful information in understanding the impact of hormone replacement therapy in breast cancer. The researchers said the risks of taking hormones, such as premarin and provera, outweighed the benefits. After the women had been on hormone replacement therapy for an average of just over 5 years, they had an increased risk of breast cancer, as well as stroke, heart attack, and blood clots. They had a decreased risk of colorectal cancer and hip fracture. Each woman should work with her health care provider to evaluate her individual risk factors in making decisions about hormone replacement therapy. If hormone therapy is used, it is usually best to use it at the lowest dose needed to control symptoms and for as short a time as possible.
Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors conduct clinical trials to learn about how well new treatments work and what their side effects are. If they look promising, they are then compared to the current treatment to see if they work better or have fewer side effects. People who participate in these studies may benefit from access to new treatments before the FDA approves them. Participants also help further our understanding of cancer and help future cancer patients.
Q: Should everyone get a second opinion?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including if the person is not comfortable with the treatment decision, if the type of cancer is rare, if there are different ways to treat the cancer, or if the person is not able to see a cancer expert.
Q: How can someone get a second opinion?
A: There are many ways to get a second opinion:
Ask a primary care provider. He or she may be able to recommend a specialist, such as a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs.
Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
Seek other options. Patients can get names of doctors from their local medical society, a nearby hospital, a medical school, or local cancer advocacy groups, as well as from other people who have had that type of cancer.