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What is breast cancer?
Breast cancer begins in breast tissue. Most of the tumors that develop in breast tissue are benign (not cancerous). Some breast tumors are cancerous, but have not yet spread to other parts of the body. This type of breast cancer is called “in situ,” and it can almost always be cured with treatment. The most serious type of breast cancer is invasive, meaning that the cancerous tumors have spread to other parts of the body.
Breast cancer is the most common cancer among Canadian women (excluding non-melanoma skin cancers).). The good news is that the rate of death from breast cancer has declined over the last few years. This is probably because more tumors have been found early, when treatment can help the most. Regular screening mammograms and breast exams (both self-exams and exams by a healthcare provider) can help find breast cancers early.
CAUSES & RISK FACTORS
What causes breast cancer?
It is not known exactly what causes breast cancer, but there are certain risk factors that seem to increase a person’s chance of getting the disease. It’s estimated that about 10% of breast cancer cases are hereditary (run in the family). In many of these cases, a person has inherited a gene from his or her parents that has mutated (changed from its normal form). This mutated gene makes it more likely for a person to get breast cancer.
What genes can cause breast cancer to be inherited?
Everyone has two genes called BRCA1 and BRCA2. Normally, these genes help to prevent cancer tumors from growing. But sometimes a person inherits an abnormal (mutated) form of BRCA1 or BRCA2 from their family. This person’s chance of getting breast cancer increases. Women from Ashkenazi Jewish families are more likely than other women to carry abnormal BRCA1 and BRCA2. Mutations in these genes have also been linked to ovarian cancer.
Besides BRCA1 and BRCA2, there are other mutated genes that may make it more likely for a person to get breast cancer. Scientists know about some of these genes, and they are working to identify others.
What clues in my family history might show I’ve inherited a risk of breast cancer?
Breast cancer in 2 or more first-degree relatives is a sign that the mutated form of BRCA1 or BRCA2 might run in your family. First-degree relatives include your parents, siblings and children. Another sign of a risk of inherited breast cancer is a first-degree relative who got breast cancer before the age of 50. If you have a first-degree relative with ovarian cancer for example, that might also mean that you risk carrying one of the mutated genes.
Does everyone who has family members with breast cancer have these mutated genes?
No. The chances of inheriting breast cancer aren’t high, even if someone in your family has had the disease. Many people have parents, siblings or children who have had breast cancer without carrying a mutated form of BRCA1 or BRCA2. Although anyone with first‑degree relatives who have had breast cancer is at increased risk, most people don’t get the inherited kind of breast cancer.
Breast cancer seems to run in my family. What should I do?
Discuss with your healthcare provider about your family history. For example, your healthcare provider will want to know how you are related to any family members who have had breast cancer. Your healthcare provider will also want to know how old your relatives were when their breast cancer was diagnosed.
Should I have a test to find out if I carry the breast cancer gene?
The choice is up to you and your healthcare provider. Your healthcare provider can help you decide if a gene test might be useful to you. They can also discuss the pros and cons of taking the test. Talking with a genetic counselor might also be helpful.
Think about how you would feel if the test results show that you carry an abnormal BRCA1 or BRCA2 gene and are at greater risk of getting breast cancer. Some people want to know if they have one of the mutated genes. Knowing, instead of wondering, helps them deal with the risk of breast cancer. It allows them and their healthcare providers to watch more closely for early signs of cancer. But other people would rather not know they have the abnormal gene because it would be too hard to cope with. Discuss with your healthcare provider your feelings. It’s important to note that even if you have a mutated BRCA1 or BRCA2 gene, your chances of developing breast cancer are still very low.
DIAGNOSIS & TESTS
How can I find breast cancer early?
The best way to find breast lumps is to do 2 things:
- Have regular mammograms (talk to your healthcare provider about your risk factors for breast cancer, including your family history, to decide when regular mammogram screenings are appropriate for you).
- Talk to your family healthcare provider about whether you should have a breast exam.
Doing all of these things gives you the best chance to find cancer as early as you can. Finding breast cancer early makes treatment much easier and more effective.
What is a mammogram?
A mammogram is the most effective way to find breast cancer early, up to 2 years before the lump is even large enough to feel. A mammogram is a special kind of X-ray of your breasts. The amount of radiation used in the X-ray is very small and not harmful.
Mammograms detect cancer because cancer is more dense (thicker) than the normal part of the breast. A radiologist will look at the X-rays for signs of cancer or other breast problems.
How is a mammogram performed?
Your breast will rest on a shelf and the X-ray machine will slowly press against your breast until you feel pressure. This pressure is needed to spread your breast out so that a better X-ray can be taken. The X-ray takes 1 or 2 minutes, and the entire process usually takes no more than about 20 minutes.
Do mammograms hurt?
Mammograms can be uncomfortable. But they don’t take very long. You may find that planning to have your mammogram shortly after your period makes it less uncomfortable. Your breasts may be less tender at this time.
How often should I get a mammogram?
In Nova Scotia, women between ages 40-49 are recommended to have annual screening mammography. Women in Nova Scotia, aged 50-69, are recommended to have screening mammography at two year intervals. Women 50-69 can also be recommended to return on an annual basis if they:
- have a strong family history of breast cancer (mother, sister, daughter, father, brother, son),
- are currently on HRT or
- the radiologist has recommended returning sooner.
Women over the age of 70 are recommended to continue to have screening mammography if they are in good health.
In Prince Edward Island, women between ages 40-49 are recommended to have annual screening mammography. Women in PEI aged 50-75, are recommended to have screening mammography at two year intervals
In Prince Edward Island, a screening mammogram is recommended for women aged 40-75 who:
- have never had breast cancer;
- do not have symptoms such as a breast lump, puckered skin, rash or nipple discharge;
- have not had a mammogram in the last 12 months;
- do not have breast implants; or
- have a parent or sibling with breast cancer.
- Your health care provider may request a diagnostic mammogram if you find a change in your breast such as a lump or nipple discharge. In this case, the mammography department will contact you to schedule an appointment.
If you have risk factors for breast cancer, such as a family history of breast cancer, your healthcare provider may want you to have mammograms more often or start having them sooner.
When should I talk to my healthcare provider about a change in my breast?
Although there is no evidence that breast self-exams can help prevent breast cancer, they might help you get familiar with how your breasts normally feel so you may more easily notice any changes. Contact your healthcare provider if you notice any of the changes listed below.
Changes to look for in your breasts:
- Any new lump (which may or may not be painful or tender)
- Unusual thickening of your breasts
- Sticky or bloody discharge from your nipples
- Any changes in the skin of your nipples or breasts, such as puckering or dimpling
- An unusual increase in the size of one breast
- One breast unusually lower than the other
QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER
- Am I at risk for breast cancer?
- Should I have genetic testing to find out whether I have the breast cancer gene?
- I have the breast cancer gene. Should I talk to my family members about getting tested to find out whether they have it, too?
- I found something when I did my breast self-exam. What should I do now?
- How often should I have mammograms?
- I have breast cancer. What are my treatment options?
- How often should I do breast self-exams?
- I have breast cancer. Is my daughter more likely to have it, too?
FOR MORE INFORMATION
Screening for Genetic Risk of Breast Cancer by TC Rosenthal, SM Puck (01/01/99, http://www.aafp.org/afp/990101ap/99.html )