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Healthy Living

October is National Breast Cancer Awareness Month

Frequently Asked Questions About Breast Health

  1. How likely is it that I could develop breast cancer?
  2. What are the risk factors associated with breast cancer?
  3. What do I need to do to monitor my breast health?
  4. When should I see a doctor for a breast problem?
  5. What should I do if I find a lump or have nipple discharge?
  6. I am having nipple discharge, and it is gray/green/brown/clear. Is this a sign of cancer?
  7. How does having a family history of breast cancer affect my chances of developing breast cancer?
  8. What is fibrocystic disease, and does it affect my breast cancer risk?
  9. What are calcifications, and what do they have to do with breast cancer?
  10. I'm having a needle biopsy (also called a needle aspiration)--what is it?
  11. I'm having a needle localization--what is it?
  12. I'm having an open surgical biopsy--what will it be like?
  13. I am worried about my family history of cancer. Should I have the breast cancer gene test?

1. How likely is it that I could develop breast cancer?

It's very easy to be confused by the statistics that are used to describe your risk of breast cancer. Many people think that the risk for everyone at any time is 1 in 8. These people think that if they are in a room with eight other people, that one person in that room will get breast cancer that year. IT'S NOT TRUE.

The often used "1 in 8" statistic is used to describe an overall lifetime risk, not the risk for women in one year. That means that by the time you reach 85 years of age, which is considered a standard lifetime for women today, your risk would then be 1 in 8. If you have not yet reached this lifetime age, your risk is much less, overall.

When looking at the likelihood of developing breast cancer, it may help to see numbers that describe your risk for any given year as opposed to a lifetime risk.

The likelihood of developing breast cancer in any given year, by age is as follows:

0-39 years of age: 1 in 231
40-59 years of age: 1 in 25
60-79 years of age: 1 in 15
birth to death: 1 in 8
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2. What are the risk factors associated with breast cancer?

  • Age - majority of all breast cancer diagnoses are in women over age 50.

  • Family History - where one or more first-degree relatives have had breast cancer. (A first degree relative is your mother, daughter or sister.)

  • No experience of childbirth, or having your first child after age 30.

  • Early onset of menstrual period (before age 12)

  • Late onset of menopause (after age 55)

  • Obesity

  • Height (taller than 5'8")

  • Prior history of breast cancer

  • Significant radiation exposure to chest

  • Prior cancer of uterus or ovaries

  • Atypical hyperplasia or another pre-malignant condition

  • Multiple breast biopsies

Other possible risk factors may include use of alcohol, taking birth control pills for many years, and taking post-menopausal estrogen. While there is no clear cut evidence of a relationship between these factors and the development of breast cancer, many feel there is some interaction.

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3. What do I need to do to monitor my breast health?

  1. Get a routine mammogram.
    Y-ME and many other organizations support the following guidelines for mammography:

    • Have your first mammogram around age 40.

    • Beginning at the age of 40, have a mammogram every year.

  2. See your doctor on a regular basis.
    A breast examination should be a part of your routine checkup. If you are 20 years and older, you should have a clinical breast examination by your physician once every year.

  3. Perform breast self-examination once a month.

If you find something that you know is unusual for you, have your healthcare provider check it out. Click here to view directions on how to perform a proper breast self-exam (text link to Breast Self-Exam section).

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4. When should I see a doctor for a breast problem?

Knowing your body and your breasts will help you know when you are experiencing something that is abnormal for you. Remember that for most women, their breasts normally change in size during all phases of the menstrual cycle. So it will be normal for most women to feel tenderness and other standard cyclical changes. Lumpiness is also a very common menstrual consequence for many women.

Performing breast self-exam at first will feel strange, because it will be difficult to tell what is normal for your breasts. Over time, you will get to know what lumpiness is normal, so that if you ever have a lump, you'll be able to tell that it is new, right away.

When you notice a lump that is different in size, consistency or that is new, you should take notice of it. If it persists even after one menstrual cycle, it should be evaluated by a physician. If you are post-menopausal, you shouldn't wait to see your doctor.

Pain is not usually associated with breast cancer, and is more likely to be related to the presence of a cyst or your menstrual period.

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5. What should I do if I find a lump or have nipple discharge?

See your physician if these conditions are persistent. While this is not a situation where you need to see your physician immediately, you should not delay in scheduling an appointment.

Nipple discharge that is from both breasts, and is milky is most likely related to hormonal changes. Discharge that is from one breast, and is clear or bloody, can be more serious. In either case, you should be seen by your physician.

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6. I am having nipple discharge, and it is gray/green/brown/clear. Is this a sign of cancer?

For many women, having nipple discharge is a normal part of life, and one that many women don't talk about. This discharge can be a variety of colors, and mostly occurs bilaterally (in both breasts).

It is important to know that squeezing your nipples encourages discharge to occur. The amount of discharge that women have is usually very small, and can happen at any time during the menstrual cycle. The general rule is that most breast symptoms, when they are present in both breasts at the same time, represent a change in the hormonal cycle and are not considered to be related to cancer.

The sign that something may be problematic includes discharge that is persistent (without squeezing the nipples), spontaneous, and is in one breast and not the other. A bloody discharge from the breast is also an important symptom that should be evaluated by a physician.

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7. How does having a family history of breast cancer affect my chances of developing breast cancer?

Under 10% of breast cancer cases are genetically inherited. In other words, most women diagnosed with breast cancer do not have a family history of the disease.

If you have a first-degree relative (a mother, daughter or sister) who has had breast cancer, you have an increased risk of developing breast cancer.

If you have a family history with one or more first-degree relatives that have had cancer in both breasts (bilateral breast cancer), particularly arising before menopause, this could be an indication of genetically inherited breast cancer. A genetic counselor can help you assess your risk, and the risk of other women in your family.

Your Family History Your Increased Risk
A first-degree pre-menopausal relative diagnosed with breast cancer 3 times the average person
A first-degree postmenopausal relative diagnosed with breast cancer 1.5 - 2 times the average person
A first-degree pre-menopausal relative with bilateral breast cancer 9 times the average person
A first-degree postmenopausal relative with bilateral breast cancer 3-5 times the average person

If you have more questions about family history and its relationship to breast cancer, please call the 24-hour Y-ME National Breast Cancer Hotlines at 1-800-221-2141 (English) and 1-800-986-9505 (Spanish).

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8. What is fibrocystic disease, and does it affect my breast cancer risk?

Fibrocystic breast "disease" is not really a disease. Some women do have fibrocystic breasts or a fibrocystic condition. Fibrocystic conditions are used to describe a wide variety of breast problems, most of which are not associated with an increased risk of breast cancer. These problems include cysts (a fluid-filled lump), soreness associated with lumpy breasts and fibroadenomas (a benign lump).

Uncomplicated fibrocystic condition, including simple fibroadenomas have a negligible association with subsequent breast cancer.

The only aspect of a fibrocystic breast condition that has a strong association with increased risk for breast cancer is atypical hyperplasia.

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9. What are calcifications and what do they have to do with breast cancer?

Calcifications are tiny build-ups of calcium within the breast tissue. Most calcifications are benign (not cancerous) and are simply a sign of aging. Other calcifications are caused by changes in the breast tissue itself, and are most likely not cancer. However, some calcifications could indicate the presence of cancer, or a pre-cancerous condition.

To determine whether or not calcifications may be cancerous, the radiologist will look at the size and shape of the calcifications on a mammogram, as well as the total number present. If the calcifications are localized (in one area of the breast) and are clustered, this may be an indication of a pre-cancerous or cancerous condition. In the event that your radiologist (the person who reads your mammogram) recommends a six-month follow-up after detecting calcifications, the purpose is mainly to compare two sets of mammograms done six months apart. This helps the radiologist determine whether or not there have been any changes in the calcifications detected earlier. Comparing these mammograms can also give the radiologist information about the likelihood that the calcifications are problematic.

It is common to have a follow up set of mammograms done when calcifications are present. It is also common to feel very anxious about waiting six months for the follow up to occur. Be sure to discuss your concerns with your physician. He or she can clarify the potential risks and benefits of waiting six months for your mammogram to be taken again.

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10. I'm having a needle biopsy (also called a needle aspiration)--what is it?

When a needle aspiration (or biopsy) is performed, the physician will first numb the skin over the lump with an anesthetic. Then, a larger needle with a syringe on the end is inserted into the breast lump. After placing the needle, the physician will draw back the syringe, which will (in some cases) fill with breast fluid. When having this procedure, it is common to not have much fluid removed; this does NOT mean that you have cancer.

The first step in analyzing a breast lump is to determine whether or not it is fluid filled. If a lump is entirely filled with fluid, it is called a cyst, and the needle aspiration is used to drain it. After the needle aspiration, there is no lump left, and that is usually all the treatment that is necessary. The fluid will be sent for analysis by a laboratory.

If there is no fluid in the lump, or a lump remains after a needle aspiration, two events occur. The first is that any cells that were removed during the procedure are sent to a lab for analysis. The lab will look for suspicious cells. The second event is that the patient will most likely receive a recommendation for a surgical biopsy to remove the lump.

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11. I'm having a needle/wire localization--what is it?

When a suspicious lesion is detected on a mammogram, it can often be too small to feel or detect in an examination. In order for the surgeon to remove the correct area of breast tissue that contains the suspicious area, he or she will need a guide to show the exact location of the lesion.

A needle/wire localization involves the use of mammography to ensure the wire is correctly inserted into the suspicious area -- the skin of the breast will be anesthetized. The wire is inside the needle that is inserted into the breast. The technician inserting the needle will use a patient's mammogram to determine how far and at what angle to insert the needle. When it has been properly placed, the wire is disengaged and the needle is removed. This means that there is a wire sticking out of the breast, which can look somewhat strange. A second mammogram is taken to ensure that the needle properly identifies the area to be removed. The surgeon then uses the needle as a guide, and removes the area with a margin of tissue during the surgical biopsy.

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12. I'm having an open surgical biopsy--what will it be like?

Most patients who have an open surgical breast biopsy will have it done as an outpatient procedure; either in the surgeon's office, a hospital or surgical facility. You will be asked to check in at a certain time and to bring someone with you to drive you home after the procedure.

Before the surgery you will be visited by an anesthesiologist to insert an IV, which will dispense pain medication throughout the surgery. Your surgeon will probably check in just to overview how the surgery will proceed. The entire procedure usually takes about one hour, but depending on the location of the lump it can last longer.

During the procedure, the surgeon makes a small incision, usually in an area which will have a good cosmetic result. (For example, right at the edge of the areola, where the skin color changes.) The lump and a margin of tissue around it is removed, and in many cases a frozen section is taken from the lump right in the operating room.

The incision is sewn with stitches, and the biopsy is complete. You will be taken to an area to rest until you feel well enough to sit up. While you are in recovery, your doctor might come in to discuss the preliminary indications from the tissue that was removed. When you have your stitches taken out in a week or so, your full pathology report (text link to Pathology Brochure) will be available. The actual results of the biopsy are available within a day or two of the procedure.

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13. I am worried about my family history of cancer. Should I have the breast cancer gene test?

Finding out about your inherited susceptibility for developing breast cancer is a difficult decision, and one that has many implications. Most importantly, it is crucial to understand what genetic risk is, and how it may affect you. Unfortunately, most people still think of breast cancer as a disease that is passed on in families, and in most cases it isn't. Over 70% of people diagnosed with breast cancer have no family history of the disease, and a further 20-25% of individuals with breast cancer have risk factors that are not genetic in nature.

This means that 5-8% of all breast cancers diagnosed are caused by a damaged gene that is passed on in families.

There are specific characteristics of the cancer history in a person's family that could indicate the presence of a BRCA genetic alteration:

  • If you have one or more first-degree relatives (mother, sister, daughter) who have had breast cancer at a young age (premenopausal breast cancer in a female relative).

  • If you have one or more first-degree (son, father, brother) male relatives that have been diagnosed with breast cancer.

  • If you have one or more first-degree relatives that have been diagnosed with cancer in both breasts, at a young age.

  • If you have one or more first-degree female relatives that have been diagnosed with ovarian cancer when pre-menopausal.

  • If you are a person of Ashkenazi Jewish decent and have a history of cancer in your family.

Only you and your doctor can determine if genetic testing is the right option for you. Many large hospitals have cancer risk clinics where you can talk with a counselor who can help you assess your risk. Meeting with a cancer risk counselor can help determine the likelihood that you carry a genetic alteration.

Deciding to have the gene test has many implications, including:

  • affect on other family members

  • access to insurance

  • possible job discrimination

  • possibility of finding out you carry the gene (when other family members don't) or that you don't carry an alteration (when other family members do).

A cancer risk counselor can help you anticipate and deal with these implications.

While a lot is known about the BRCA1 and BRCA2 gene mutations, there are potentially hundreds of mutations yet to be discovered. If you choose to have the test, the laboratory will look for known genetic alterations (BRCA1 and BRCA2) and for specific mutations in families, which may not be present in the population at large. Although this available testing is very effective, it is still limited by our current knowledge of genetic alterations related to breast cancer.

Alterations in the BRCA1 and BRCA2 genes can predispose carriers to breast (in men and women), ovarian, and in men, prostate cancer. Should you test positive, be sure to talk with your physician about monitoring your health and screening for these types of cancers.

There is an excellent video on this topic, "Genetic Testing for Breast Cancer Risk: It's Your Choice", November 1997, which was developed by the National Action Plan on Breast Cancer. To obtain a copy, visit their website at www.napbc.org.

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