Breast cancer risk factors and treatment options

Published: 12/14/2020 9:10:06 AM

In the United States, breast cancer accounts for the most new cancer cases in women. Only lung cancer accounts for more cancer deaths in women. One hundred seventy breast cancer deaths are expected in New Hampshire this year alone. The average woman has a 12 percent chance of developing breast cancer over her lifetime.

Improvement in breast cancer screening has led to diagnosis of breast cancer at earlier stages. Advances in cancer treatment have also led to improved survival with fewer treatment side effects. The five year survival rate for patients diagnosed with a stage I or II breast cancer is 90% or greater.

What are factors increasing the risk for developing breast cancer?

■Female gender (one percent of breast cancers occur in males).

■Family history (diagnosis in a first-degree relative doubles lifetime risk).

■Hormonal exposure - first menstruation before the age of 12 or menopause after the age of 55.

■Women who have not had children or have not breastfed have an increased risk, as do those who had their first delivery after the age of 30.

■Prior breast biopsy.

■Dense breast tissue.

■Previous radiation to the chest.

■Ethnicity: Ashkenazi Jewish, French Canadian and Icelandic patients have higher rates of BRCA mutations – mutations of the tumor suppressor genes BRCA 1 and BRCA 2 – which increases lifetime risk of developing breast cancer to 45-85 percent.

■Unhealthy weight and/or sedentary lifestyle.

■Alcohol consumption or smoking.

■Increased age.

■Combination hormone replacement therapy (HRT).

What can be done for women who have an increased risk?

Generally, women who have a 20 percent or higher lifetime risk are considered to be at increased risk of developing breast cancer. National guidelines recommend that these women have a clinical breast exam every six to twelve months. Annual mammograms should begin at age 40 or ten years prior to when the youngest family member was diagnosed with breast cancer (whichever comes first). Women should also be taught and encouraged to perform breast self-exams. Mammography and clinical exams together can identify up to 80 percent of breast cancers. Breast MRIs or ultrasounds can also be performed as well as genetic counseling and testing if necessary. Women at high risk may have options, such as a chemo-preventative medications like Tamoxifen and aromatase inhibitors, which can reduce the risk of developing breast cancer by 50 percent over five years. Prophylactic double mastectomy, or removal of both breasts before the development of cancer, is usually reserved for those women who have tested positive for a BRCA mutation.

What are the different types of breast cancer and why is that significant?

People tend to think of breast cancer as one disease, however there are many different types. Treatment of breast cancer is tailored to the patient and the biology of the cancer. The provider will review the pathology report to determine if the cancer is invasive or in situ, ductal or lobular, and whether the cancer is positive or negative for three receptors (estrogen, progesterone, and human epidermal growth factor receptor 2, HER2). This information influences the prognosis and course of treatment. While many patients are recommended for lumpectomy (removal of only the tumor and immediately surrounding tissue) and radiation, some patients may be recommended to proceed with chemotherapy, mastectomy or another combination. The major types of breast cancer are:

■Ductal Carcinoma In Situ (DCIS) - Also known as Stage 0, the cells are cancerous, but have not developed the ability to spread and leave the breast.

■Invasive Ductal Carcinoma (IDC) - The most common type of breast cancer accounting for 80 percent of all cases. The cancerous cells form in the milk ducts of the breast and have developed the ability to spread.

■Invasive Lobular Carcinoma (ILC) - The cancer cells form in the milk glands (lobules) of the breast. The cancerous cells have developed the ability to spread.

What are some of the recent improvements in the diagnosis and treatment of breast cancer?

Recently, there have been advancements in detection technology and methods for individualizing treatment of breast cancers. 3D mammography, as opposed to the traditional 2D mammogram, offers an arcing visualization of the breast which can be more helpful when evaluating dense breast tissue. Also, in some cases, an Oncotype test may be recommended to help determine whether or not chemotherapy may be beneficial for an individual.

What symptoms are important to report to a healthcare provider?

If you meet the criteria for increased risk, it is important that your healthcare providers know. Additionally, if you notice a new lump, a change in your nipple, spontaneous or bloody nipple discharge, skin redness or skin thickening, an evaluation is warranted. In the absence of symptoms, all women should discuss screening recommendations for breast cancer with their provider. Early detection is important, as currently the five-year survival rate for stage I breast cancer is over 90 percent.

(Dr. Sharon Gunsher, MD, is a board-certified surgeon serving as the medical director for the multi-disciplinary, patient-centered Concord Hospital Breast Care Center. Katie Cail, APRN, MSN, is a certified adult nurse practitioner as well as a women’s healthcare nurse practitioner caring for the patients of the Concord Hospital Breast Care Center. They recently presented on the risk factors associated with breast cancer and improvements in diagnosis and treatment at the October Concord Hospital Trust “What’s Up Doc?” Donor Lecture series. The monthly series features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Gunsher’s and Katie Cail’s presentation on Concord Hospital’s YouTube channel at

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