Spotlight on Breast Cancer: Identifying Risk

 By Karen Siroky, RN, MSN

October is National Breast Cancer Awareness Month and the spotlight is on education to promote early detection of this deadly disease. In the United States, breast cancer is the most common non-skin cancer and the second leading cause of cancer-related deaths in women. Approximately $8.1 billion is spent each year on treatment of breast cancer. One in 8 women will be diagnosed with cancer of the breast during their lifetime; the median age for diagnosis is 61 years of age.

The incidence of breast cancer is highest in whites, but African Americans have higher mortality rates than other racial or ethnic groups in the U.S. The gap in mortality between African Americans and whites is wider now than it was in the early 1990s.

Although the breast cancer diagnosis rate has increased since the early 1990s, the overall breast cancer death rate has dropped steadily. This is largely due to increasing awareness of breast cancer resulting in earlier detection, as well as advances in medical technology producing more effective treatment options. In spite of these advances, in 2009 there were 192,000 estimated new cases and over 40,000 deaths.

Commonly known risk factors include age (risk increases with advancing age), previous history of breast cancer, family history, abnormal breast tissue changes, early onset of menses, late first pregnancy, nulliparous (never been pregnant), late menopause and certain hormonal therapy.

Other less commonly known factors include obesity, lack of physical activity and increased alcohol consumption. Studies are underway to determine if there are other environmental factors that may also link to breast cancer.

In addition to these risk factors, newer, significant risk factors relate to the identification of two  specific genetic mutations:  BRAC1  (breast cancer susceptibility gene 1) and BRAC2 (breast cancer susceptibility gene 2). A woman’s lifetime risk of developing breast and/or ovarian cancer is significantly increased if she inherits a BRCA1 or BRCA2 mutation. Such a woman has an increased risk of developing breast and/or ovarian cancer at an early age (before menopause) and often has multiple, close family members who have been diagnosed with these diseases. Both mutations also increase the risk of various other cancers.

Studies have shown that people who inherit these genes are five times more likely than the general population to develop breast cancer. If a woman (or man) has a very strong family history with several members who have developed breast cancer, they may pursue genetic testing for the BRAC1 or BRAC2 gene mutations. If the results are negative, the lifetime risk for that person will be the same as the general population-- in other words, there is no guarantee they will NOT develop breast cancer, especially if they have one or more of the other risk factors.

If the results are positive, several options exist, including close surveillance or prophylactic surgery, (hysterectomy, oophorectomy, and/or mastectomy). Additional steps may include avoiding behaviors that increase risk, and possible chemoprevention (taking specific medications that are shown to retard breast cancer growth, for example tamoxifen).

The message is clear: Great strides are being made in the fight against breast cancer; the added information from genetic testing is critical in reducing the occurrence and number of deaths from the disease. But there is still work to be done. Tests must be refined. We must continue to provide much needed counseling/education and to offer increased options for patients who test for the dangerous BRCA1 or BRCA2 mutation. (Source: National Cancer Institute, 2010).

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