Understanding Your True Breast Cancer Risk
Q. Are women with benign breast disease at an increased risk of developing breast cancer?
A. Most women with benign breast disease do not have an increased risk of breast cancer. Women with one type of benign breast disease, called atypical hyperplasia do have an increased risk. In this group, the actual breast cancer risk is about half a percent a year. As a woman goes through each year, she leaves the risk associated with that year behind her. As you can see, these women have an "increased risk" but not a "high risk"
Q. Why is ductal carcinoma in situ not really cancer?
A. To most of us, cancer is a disease that can spread to other parts of the body (metastasize). Ductal carcinoma in situ lacks the biological capacity to do this, and so is not properly a cancer. Like other cells in the body it can become a cancer cell and acquire the ability to metastasize. When ductal carcinoma in situ was first discovered scientists were unaware that these cells could not metastasize, and so used the term "cancer" to describe it.
Q. How much influence does age at onset of menstruation, age at onset of menopause, age at first childbirth, or never having a child have on breast cancer risk?
A. These are all minor factors that influence an individual woman's risk very little, if at all. A number of studies find that in women who have a mother or a sister with breast cancer, reproductive factors do not further increase breast cancer risk.
Q. How much does tamoxifen, taken as a preventative measure in high-risk women, decrease the risk of future breast cancer?
A. The largest study to date compared breast cancer rates in "high risk" women who did and did not take tamoxifen for nearly six years. Breast cancers grow for about seven to ten years before they are detected, so the cancers found in this less than six year study were probably present before any of the women started taking tamoxifen.
In actual or absolute terms, after nearly six years, the difference in the number of breast cancers found between the women who did and did not take tamoxifen was about 1.8 breast cancers per hundred women.
Q. When should a woman consider genetic testing to assess her risk of breast cancer?
A. Women find it useful to consider three key elements in considering genetic testing:
- the cost
- the chance that genetic testing will detect a mutation in her particular family, and
- the likelihood that her own or a relative's quality of life would be enhanced or that their health care would change as a result of test findings
Q. What else should women understand about personal breast cancer risk?
A. To most women, the chances of surviving breast cancer are more important than the risk of being diagnosed. Breast cancer size is the most important factor in breast cancer survival. By using both physical breast examinations and mammography a woman can be assured that if she should develop breast cancer it would be found at the smallest possible size.
Women whose breast cancers are found when they are a little less than half an inch in size or smaller, usually have no cancer spread beyond the breast. In these women, followed the survival all the way to twenty years is more than 90 percent. This makes it all the more important for a woman to set up a breast health program that includes quality physical breast examinations and mammography.
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I would like to thank Dr. Kelly for taking her time to answer my
questions. To learn more about the subjects discussed in this
article, as well as other issues surrounding breast cancer risk, read
her book Assess
Your True Risk of Breast Cancer.
I consider her book to be an invaluable resource for any woman
trying to decipher the often confusing hodgepodge of information
about breast cancer and personal breast cancer risk.
To learn more about Dr. Kelly visit her website Cancer Risk Assessment and Counseling.
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