If detected early, breast cancer can often be treated effectively with surgery that preserves the breast. Five-year survival after treatment for localized breast cancer is 96.3%. (Source: National Cancer Institute)
Current factors known to contribute to overall breast cancer risk are mostly uncontrollable, including age, personal and family breast cancer history, certain genetic factors, first menstrual period before age 12, menopause after 55, breast density, and race. A few factors that can be controlled that have been shown to increase breast cancer risk include obesity, alcohol consumption, and lack of physical activity.
For women who have a high risk of breast cancer, there are some drugs that may help reduce their risk of breast cancer, but they have significant side effects. The idea of a drug to reduce risk sounds exciting. But remember these are drugs with significant side effects that will be given to healthy women and there is no evidence they would prevent cancer from developing.
It is important to keep in mind that most women who have known risk factors do not get breast cancer. Except for growing older and certain genetic factors, most women with breast cancer have no clear risk factors. We currently can’t tell any individual woman, “Do this or take this and you won’t get breast cancer.”
A high-risk woman who has a strong family history of breast cancer may wish to consult a genetic counselor about testing for breast cancer genes, and surgical and chemopreventative measures.
Note: breast pain is very commonly due to benign conditions and is not usually the first symptom of breast cancer. (Source: National Cancer Institute)
What are the guidelines women should follow regarding breast health?
Women should follow these 3 steps to good breast health:
(Source: American Cancer Society)
Can men get breast cancer?
It is estimated that in 2022, 2,710 cases of breast cancer will be diagnosed in men and 530 will die from metastatic disease. On average, 1 in 883 men will be diagnosed in his lifetime.
Performing a Self Breast Exam:
Sand in front of a mirror with your hands first overhead and then on your hips. Move your body slowly so you see every part of your breasts, including underneath, to notice if any changes have occurred.
Next, put one hand behind your head and three fingers on each breast, one at a time, to feel for any change.
Move your fingers in small circles upward, with different levels of pressure. Choose easy, medium and then hard while walking your fingers from one area until the next. Be sure to feel the entire breast and under each armpit. Finishing by squeezing the nipple. If there is discharge or pain, contact your physician.
There are many sub-types of breast cancer, and they require different types of treatment.
Different women have different breast cancer types with unique disease characteristics including:
We also know that there are inherited gene mutations that affect breast cancer, such as BRCA 1 and BRCA2 mutations.
Breast cancer treatments have evolved over the years with the development of a range of chemotherapy drugs and therapies that target specific types of known breast cancers. About 15 to 20% of women with breast cancer are found to overexpress a protein called HER2. Nearly four out of five women with breast cancer have hormone receptor (HR) positive cancer, also called estrogen receptor (ER) and/or progesterone receptor (PR) positive. Hormonal therapies may keep these types of cancers from growing, increasing survival and reducing recurrence.
Triple-negative breast cancer is another subtype of breast cancer (called triple-negative because it lacks the receptors for estrogen and progesterone and has normal levels of HER2).
It is important to recognize that just like any other diagnosis, knowing the specific kind of breast cancer one has is important to finding the best treatment.
American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.
Breast Cancer Staging:
Stage 0
Stage 0 describes non-invasive breast cancers and is also called ductal carcinoma in situ (DCIS). In DCIS, cancer cells are still within a duct and have not invaded deeper into the surrounding fatty breast tissue. Paget disease (a cancer of the nipple that is very rare in men) is also stage 0 if there is no underlying tumor mass. There is no evidence of cancer cells invading the tissue.
Stage I
Stage I describes a tumor that is 2 cm or less and has not spread to the lymph nodes, or — if it has spread there — the cancer in the lymph nodes is microscopic (less than 2 mm in size).
Breast Cancer Staging Continued:
Stage II
Stage II describes a tumor that is between 2 and 5 cm or has spread to a few lymph nodes in the armpit and is is divided into subcategories known as IIA and IIB.
Stage IIA describes invasive breast cancer in which: No tumor can be found in the breast, but cancer cells are found in the lymph nodes. The tumor measures 2 centimeters or less and has spread to the lymph nodes. The tumor is from 2 centimeters to 5 centimeters and has not spread to the lymph nodes.
Stage IIB describes invasive breast cancer in which: The tumor is from 2 centimeters to 5 centimeters and has spread to the lymph nodes. The tumor is larger than 5 centimeters but has not spread to the lymph nodes.
Stage III
Stage IIIA describes invasive breast cancer in which no tumor is found in the breast but cancer is found in lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. The tumor is 5 centimeters or smaller and has spread to lymph nodes that are clumped together or sticking to other structures. The tumor is larger than 5 centimeters and has spread to lymph nodes that are clumped together or sticking to other structures.
Stage IIIB describes invasive breast cancer in which the tumor may be any size and has spread to the chest wall and/or skin of the breast. The tumor may have spread to lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIC describes invasive breast cancer in which there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast. The cancer has spread to lymph nodes above or below the collarbone.The cancer may have spread to lymph nodes or to lymph nodes near the breastbone.
Stage IV
Stage IV describes invasive breast cancer in which the cancer has spread to other organs of — usually the lungs, liver, bone, or brain.
Several mutations are thought to be necessary over a span of a number of years before the cell is in the mode of uncontrolled growth of abnormal cells we call cancer. It is hard to believe, but at the time of diagnosis, most women have probably had their breast cancer for five to eight years. The rate of division and rapidity of growth varies and unchecked, breast cancer can eventually form a mass (tumor) and spread to other parts of the body via the blood and lymph system.
In most cases, doctors cannot explain why a woman develops breast cancer. Studies show that most women who develop breast cancer have none of the risk factors listed below, other than the risk that comes with growing older. The median age of diagnosis at 62 years of age.
Also, most women with known risk factors do not get breast cancer. Scientists are conducting research into the causes of breast cancer to learn more about risk factors and ways of preventing this disease.
Must treatment decisions be made immediately upon diagnosis?
It is normal to feel a treatment decision must be made right away but taking time to decide on an appropriate course of action may be time very well spent. Second opinions can be very helpful as no two breast cancers are not the same and cannot be treated as such. Breast cancer is a complex disease with many variants needing different treatments.
The incidence rate of breast cancer for African American women is about 127 per 100,000 women compared to about 132 per 100,000 for white women. The mortality rate of breast cancer for African American women is about 28 per 100,000 women compared to 20 per 100,000 white women. Although the incidence rates are similar, the mortality rate among African American women is 40% higher than among white women. (Among Hispanic women, the incidence rate is 94 per 100,000 women and the mortality rate is 14 per 100,000 women. Among American Indian or Alaskan Natives, the incidence rate is about 95 per 100,000 women and the mortality rate is 15 per 100,000 women.)
The reasons for the disparity in mortality are complex and include access to care. Another reason for the difference in mortality among African American women may be that young African American women are disproportionately affected by triple-negative breast cancer. About 21% of breast cancers in African American women are triple-negative which is approximately double the proportion of this subtype in other racial/ethnic groups. There is no targeted treatment for this subtype.
Siegel, RL, Miller, KD, Fuchs, H, Jemal, A. Cancer Statistics, 2021. CA Cancer J Clin. 2021: 71: 7â€33.
https://doi.org/10.3322/caac.21654
American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.
It may seem logical that if breast cancer is found, removing the entire breast is more likely to be a lifesaving treatment. But in cancer treatment, more is often NOT better. Multiple randomized trials, now with long-term follow-up, have demonstrated that survival after lumpectomy (i.e., breast conservation surgery) combined with breast radiotherapy is equivalent to mastectomy for treating most early-stage breast cancers. Once you know the pros and cons of each treatment for your type of breast cancer and your situation, the choice is often a personal one. If a doctor recommends one instead of the other, ask why and educate yourself on the evidence.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227-32.
Children can inherit an altered breast cancer susceptibility gene from either their mother or father. Most women—about 80%—who get breast cancer do not have a sister or mother who has breast cancer. While all breast cancer is genetic in origin, most of it is not inherited. (Source: The Breast Cancer Survival Manual by Dr. John Link, American Cancer Society)
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Breast Cancer Alliance Information Use and Disclosure
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BREAST CANCER ALLIANCE WHISTLEBLOWER POLICY
General Statement
Breast Cancer Alliance (the “BCA”) is committed to observing high standards of legal and ethical business conduct. Breast Cancer Alliance expects its officers, directors and employees to exercise honesty and integrity in fulfilling Breast Cancer Alliance’s responsibilities and complying with all applicable laws and regulations. This policy is intended to encourage and enable good faith reporting of Wrongful Conduct and to protect individuals from retaliation who make such reports.
Purpose
This policy creates a mechanism for officers, directors and employees to report Wrongful Conduct. Wrongful Conduct is defined as a violation of applicable law or regulations or material violations of Breast Cancer Alliance’s operating policies (“Wrongful Conduct”).
Examples of Wrongful Conduct that this policy is intended to address include, but are not limited to:
No officer, director or employee (a “Reporting Person”) who in good faith reports Wrongful Conduct will suffer retaliation, harassment or adverse employment consequences.
Reporting
A Reporting Person may report Wrongful Conduct directly to the Executive Director, any director-level employee, any officer or any member of the Executive Committee of the Board of the Breast Cancer Alliance. Such persons are required to report immediately any allegation of Wrongful Conduct to the President of the Board of Directors, in his capacity as Chairperson of the Executive Committee, who has specific and exclusive authority to investigate all reported violations. If the Reporting Person believes that the concerns reported will not be fairly considered, the Reporting Person may report Wrongful Conduct directly to any member of the Board of Directors.
Breast Cancer Alliance will make every effort to treat the Reporting Person’s identity with confidentiality, with the understanding that details of the allegations concerning the Wrongful Conduct may need to be shared with others in order to conduct a comprehensive investigation.
Anonymous reports, while accepted, impact the Breast Cancer Alliance ’s ability to conduct an investigation. Thus, Reporting Persons are encouraged to disclose their identity to increase the credibility of the report and to enable the Breast Cancer Alliance to investigate the matter thoroughly.
The Reporting Person will not be expected to prove the truth of his or her allegations of Wrongful Conduct, but he or she should be prepared to demonstrate that the allegations are made in good faith and to submit whatever evidence is available to support the allegations. Reports of unfounded allegations of Wrongful Conduct that are demonstrated to have been made recklessly, maliciously or with the knowledge that the allegations were false may lead to disciplinary action, up to and including termination.
Response
The President of the Board of Directors, in her capacity as Chairperson of the Executive Committee, is resonsible to supervise and direct a prompt investigation. The action taken will be dependent on the nature of the concern. The President of the Board of Directors, in her capacity as Chairperson of the Executive Committee, shall provide a report of the conclusions of the investigation and a recommendation for the disciplinary and corrective action to be taken, if any, to the Board of Directors, who will determine by majority vote whether to adopt such recommendation or adopt an alternative action.
Due to the important yet sensitive nature of the suspected violations, effective professional follow-up is critical. Reporting Persons and officers who become aware of Wrongful Conduct, while appropriately concerned about “getting to the bottom” of such issues, should not in any circumstances perform any investigative or other follow-up steps on their own. Accordingly, a Reporting Person or officer who becomes aware of Wrongful Misconduct:
Retaliation Prohibited
No Reporting Person who reports Wrongful Conduct in good faith under this policy shall suffer threats, abuse, harassment, retaliation, discrimination or any other or adverse employment consequence. A person within the Breast Cancer Alliance who does retaliate against a Reporting Person is subject to discipline up to, and including, termination of employment.
Any Reporting Person who believes he or she has been retaliated against should report it to the President of the Board of Directors, Executive Director or other member of the Board of Directors.
Certification of Compliance
When an individual is first appointed or employed, he or she must complete and deliver to the Breast Cancer Alliance a certificate in the form specified by the Breast Cancer Alliance , which, can be obtained from the office as Annex A.
Violations of this policy will be subject to such disciplinary and corrective action as the Board of Directors deems appropriate.
Periodic Reviews
The Board of Directors shall review this policy periodically to ensure that it continues to satisfy the obligations of the Breast Cancer Alliance. Any changes to the policy will be communicated timely to all employees.
