The below is written by Rachel Gorham, MSN, WHNP-BC, AGN-BC. Ms. Gorham is on the NPWH Board of Directors.
October is Breast Cancer Awareness Month – an opportunity for us all to focus on breast cancer and its impact on those affected by the disease in our community. Even though we’re nearing the end of the month and the pink ribbons are being put away, we cannot let our dedication to educating patients fade. Here’s a refresher on the breast cancer risks, symptoms, and screening guidelines that all WHNPs should be familiar with in order to support our patients.
Breast Cancer Statistics
First, let’s talk about who is affected by breast cancer:
- Advancements in breast cancer screening and treatment has improved survival rates dramatically since 1989. According to the American Cancer Society an estimated 268,000 women will be diagnosed with invasive breast cancer, and 62,930 women will receive a diagnosis of noninvasive breast cancer in 2019. ACS reports over 3.1 million breast cancer survivors in the United States.
- About 1 in 8 U.S. women (about 12%) will develop invasive breast cancer during her lifetime.
- A man’s lifetime risk of breast cancer is about 1 in 883. Approximately 2,670 new cases of invasive breast cancer are expected to be diagnosed in men during 2019.
- For women, breast cancer death rates are higher than those for any other cancer, besides lung in the U.S.
- African American women under the age of 45 are more commonly diagnosed with breast cancer than white women.
- A woman’s risk of developing breast cancer doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer.
- About 5-10% of breast cancers can be linked to gene mutations inherited from one’s mother or father.
- The most significant risk factors for breast cancer are gender (being female) and age (growing older).
We know a lot about what factors can influence a patient’s risk of breast cancer:
Age: The risk of breast cancer increases with age. At 20 years, the probability of developing invasive breast cancer in the next 10 years is .06%, or 1 in 1,732. This means that 1,732 women in this age group can expect to develop breast cancer. Age 70, the probability of developing invasive breast cancer in the next 10 years is 3.84%, or 1 in 26.
Family history of breast cancer: Up to 10% of breast cancers are due to specific mutation in single genes that are passed down in a family. Multi-gene testing for hereditary forms of cancer has rapidly altered the clinical approach to testing at-risk patients and their families. Genes associated with hereditary breast cancer includes the following that could potentially be included in a multi-gene test: BRCA1, BRCA2, ATM, BARD1, CHEK2, PALB2, TP53, PTEN, STK11, and CDH1.
Personal history of breast cancer: Women who have previously been diagnosed with breast cancer are at risk of developing it again, either in the same breast or the other, and is higher than if you never had the disease.
Dense breast tissue: Dense breasts are common, particularly in younger women. Dense breasts are associated with an increased breast cancer risk and may impair detection, however there are currently no recommendations for screening women with dense breasts.
Exposure to estrogen: Estrogen stimulates breast cell growth and exposure to estrogen over long periods of time, without any breaks, can increase the risk of breast cancer. Some of the risk factors that are nonmodifiable include: starting menstruation before the age of 12, going through menopause after age 55, and exposure to estrogen in the environment.
Body weight: Women who become overweight or develop obesity after menopause may also have a higher chance of developing breast cancer, possibly due to increased estrogen levels. High sugar intake may also be a factor.
Alcohol consumption: A higher rate of regular alcohol consumption appears to play a role in breast cancer development.
Radiation exposure: Prior exposure to high-dose therapeutic chest irradiation at age 10-30 years may increase the risk of developing breast cancer later in life.
It’s critical that patients know and regularly look for these symptoms, and that they know to talk to us if they experience any:
- new lump or lumpiness, especially if it’s only in one breast
- a change in the size or shape of your breast
- a change to the nipple, such as crusting, ulcer, redness or inversion
- a nipple discharge that occurs without squeezing
- a change in the skin of your breast such as redness or dimpling
- an unusual pain that doesn’t go away.
- peeling, flaking, or scaling of the skin on the breast or nipple
Finally, providers need to know the difference in screening guidelines for women with average breast cancer risk, and women whose risk is above average:
Screening Guidelines for Women at Average Breast Cancer Risk
(no symptoms of breast cancer, no history of breast cancer or atypia, no family history of breast cancer, no suggestion of a hereditary cancer syndrome, and no history of mantle radiation)
- Women between the ages of 25 and 40 should have an annual clinical breast examination.
- Women 40 and older should have an annual mammogram in addition to an annual clinical breast examination.
- Ultrasound may be recommended for women with dense breast tissue.
- All women should consider performing a monthly self-breast exam beginning at age 20 and become familiar with their breasts so they are better able to notice changes.
Screening Guidelines for Women at Above-Average Breast Cancer Risk
- A clinical breast exam every six months starting no later than ten years before the age of the earliest diagnosis in the family (but not earlier than age 25 and not later than age 40).
- An annual mammogram starting no later than ten years before the age of the earliest diagnosis in the family (but not earlier than age 25 and not later than age 40).
- Possible supplemental imaging (for example, with ultrasound) for women with dense breast tissue.
- Possibly alternating between a breast MRI and a mammogram every six months, as determined by your provider.
We have made so many advancements in screening for and treating this cancer. As providers, we need to keep up the fight, stay vigilant, and support our patients with the best care we can provide.