October is Breast Awareness Month



The month of October is designated as National Breast Cancer Awareness Month.  The focus of this initiative is to increase public awareness about the importance of early detection of breast cancer and screening. Women are encouraged to talk to their healthcare provider about their risk for breast cancer, especially if a close family member has had breast or ovarian cancer.  Men need to know that breast cancer is not limited to only women.  Even though their lifetime risk of getting breast cancer is about 1 in 1,000, men who notice any breast changes should see their healthcare professional as well.  Even though the initiative is held in October, the importance of early awareness continues every day of each month throughout the year.

Other than skin cancer, breast cancer is the most common cancer among women in the United States.  According to the National Breast Cancer Foundation, Inc., about 1 in 8 women born today in the US will get breast cancer at some point during their lifetime. On average, every 2 minutes a woman is diagnosed with breast cancer and 1 woman will die of breast cancer every 13 minutes. The American Cancer Society estimates that 252,710 new cases of invasive breast cancers will be diagnosed among women (2,470 new cases in men) in the US in 2017.   An estimated 41,070 breast cancer deaths (40,610 women, 460 men will occur in 2017. In New Jersey, in 2017, there is an estimate of 7,890 new cases of female breast cancers and 1,250 deaths.  According to the Center for Disease Control and Prevention (CDC), breast cancer is the leading cause of death among Hispanic women and second among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.

Breast cancer occurs when cells in the breast divide and grow without their normal control. Tumors in the breast tend to grow slowly. By the time a lump is large enough to feel, it may have been growing for as long as 10 years. (Some tumors are aggressive and grow much faster.) Between 50-75 percent of breast cancers begin in the milk ducts (tubes that carry milk to the nipples), about 10-15 percent begin in the lobules (glands that produce milk) and a few begin in other breast tissues (connective tissue consisting of fibrous and fatty tissue that surrounds and holds everything together.)

When abnormal cells grow inside the milk ducts, but have not spread to nearby tissue or beyond, this is called ductal carcinoma in situ.  The term "in situ" means "in place." With DCIS, the abnormal cells are still inside the ducts. DCIS is a non-invasive breast cancer or a “pre-invasive breast carcinoma.”  Although ductal carcinoma in situ is non-invasive, without treatment, it can develop into invasive breast cancer.   Invasive breast cancer occurs when abnormal cells from inside the milk ducts or lobules break out into nearby breast tissue. Cancer cells can travel from the breast to other parts of the body through the blood stream or the lymphatic system. They may travel early in the process when a tumor is small or later when a tumor is large. The lymph nodes in the underarm area (axillary lymph nodes) are the first place breast cancer is likely to spread.   In advanced stages, breast cancer cells may spread to other parts of the body such as the liver, lungs, bones and brain (a process called metastasis). There, the breast cancer cells may again begin to divide too quickly and make new tumors. This is called metastatic breast cancer.

The most common symptom of breast cancer is a lump or mass in the breast, which is often painless. Less common symptoms include other persistent changes to the breast, such as thickening, swelling, distortion, tenderness, skin irritation, redness, scaliness, nipple abnormalities, or spontaneous discharge. Breast pain is more likely to be caused by benign conditions and is not a common symptom of breast cancer.

Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean a women will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer.  Modifiable factors associated with increased breast cancer risk include weight gain after the age of 18 and/or being overweight or obese (for postmenopausal breast cancer), use of menopausal hormone therapy (combined estro¬gen and progestin), physical inactivity, and alcohol consumption. In addition, recent research indicates that long-term, heavy smoking may also increase breast cancer risk, particularly among women who start smoking before their first pregnancy. The International Agency for Research on Cancer has concluded that shift work, particularly at night (i.e., that disrupts sleep patterns), may be associated with an increased risk of breast cancer.

Non-modifiable factors associated with increased breast cancer risk include older age; a personal or family history of breast or ovarian cancer; inherited mutations (genetic alterations) in BRCA1, BRCA2, or other breast cancer susceptibility genes; certain benign breast conditions (such as atypical hyperplasia); a history of ductal or lobular carcinoma in situ; high-dose radiation to the chest at a young age (e.g., for cancer treatment); high breast tissue density (the amount of glandular tissue relative to fatty tissue measured on a mammogram); high bone mineral density (evaluated during screening for osteoporosis); and type 2 diabetes (independent of obesity). Reproductive factors that increase risk include a long menstrual history (menstrual periods that start early and/or end later in life), recent use of oral contraceptives, never having children, having one’s first child after age 30, and high natural levels of sex hormones.

Early detection saves lives and increases treatment options.  Breast cancer screening can help find breast cancer early, when the chances of survival are highest. Screening is important for all women. Women at higher risk may need breast cancer screening earlier and more often than women at average risk. Screening is not recommended for most men. However, some men at higher risk (inherited gene mutation or a strong family history of breast cancer) should get screened.

At this time, the best way to find breast cancer is with a mammogram.  Mammography is a low-dose x-ray procedure used to detect breast cancer at an early stage. Numerous studies have shown that early detection with mammography helps save lives and increases treatment options. However, like any screen¬ing tool, mammography is not perfect. For example, it can miss cancers, particularly those in women with very dense breasts, and also detects cancers that would never have caused harm, resulting in some over diagnoses. Most (95%) of the 10% of women who have an abnormal mammogram do not have cancer. For women at average risk of breast cancer, recently updated American Cancer Society screening guidelines recommend that those 40 to 44 years of age have the choice for annual mammography; those 45 to 54 have annual mammography; and those 55 years of age and older have biennial or annual mammography, continuing as long as their overall health is good and life expectancy is 10 or more years. For some women at high risk of breast cancer, annual screening using magnetic resonance imaging (MRI) in addition to mammography is recommended, typically starting at age 30.  According to the United States Preventive Task Force, the decision to start screening mammography in women prior to age 50 years should be an individual one.  They recommend that women should consult with their health care provider for informed decision-making on screening ages 40-49 and every 2 years ages 50-74.  Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.

Other examinations include a clinical breast exam, an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.  Women can conduct breast self-awareness, or visual inspection of their breasts since six of the eight warning signs of breast cancer are visual and cannot be felt if women conduct breast self-exam or BSE.  By conducting routine breast self-awareness, women will begin to become familiar what is normal for them regarding how their breasts look and feel and can help them notice symptoms such as lumps, pain, or changes in size that may be of concern.  These could include changes found during a breast self-exam. Most importantly, women or men should report any changes that they notice to their doctor or health care provider.

According to the American Cancer Society, the 5-and 10-year relative survival rates for invasive breast cancer are 90% and 83%, respectively. Most cases (61%) are diagnosed at a localized stage (no spread to lymph nodes, nearby structures, or other locations outside the breast), for which the 5-year survival is 99%.  Survival rates have increased over time for both white and black women, although they remain 11 percentage points lower, in absolute terms, for blacks.

In addition to early detection and screening, women may reduce their risk by making healthy lifestyle choices—maintaining a healthy weight, add exercise into their routine, limit alcohol intake, limit postmenopausal hormone use and breastfeed, if possible.

The New Jersey Cancer Education and Early Detection Screening Program (NJCEED) is part of the New Jersey Department of Health. NJCEED provides comprehensive screening services for breast, prostate, cervical, and colorectal cancer. The services include education, outreach, early detection, case management, screening, tracking, and follow-up.  Persons eligible for these services must be at or below 250% of the Federal Poverty Level and be uninsured or under-insured.

For more information about the Bergen and Hudson CEED Programs respectively and eligibility, please visit Bergen CEED-Bergen County Department of Health Services at www.co.bergen.nj.us/359/Cancer-Education-and-Early-Detection, 201-634-2660; and/or visit Hudson CEED-Hoboken Family Planning www.hobfamplan.net/our-services.html, 201-963-0300.

For more information on breast cancer and screening visit the website of the Center for Disease Control (CDC) at www.cdc.gov/cancer/breast or the American Cancer Society at www.cancer.org.

To promote Breast Cancer Awareness Month, attached are two breast cancer fact sheets to post and/or network to your personal and professional contacts.

Today, there are more than 6 million breast cancer survivors around the world. During this awareness month and throughout the year, women who have breast cancer risk factors should consult with their health care provider throughout the year to discuss ways they can lower their risk and screening recommendations.


iconBreast Cancer Fact Sheet 01-2017

iconBreast Cancer Fact Sheet 02-2017