Every October, our attention turns to Breast Cancer Awareness Month. Which is a good thing, to be sure: The chance of a woman developing breast cancer in her lifetime is 1 in 8, according to the American Cancer Society (ACS). But you may be surprised to discover that some things you've heard about breast cancer simply aren't true. From the significance of an unexpected lump to the importance of your family tree, read on to learn about eight common myths.
One of the most popular misconceptions is that you can only get breast cancer if someone in your family had it. However, according to Julie R. Gralow, MD, director of Breast Medical Oncology at the , "70% of breast cancer is felt to be entirely sporadic, meaning there is no inherited component." That's why regardless of your medical history, it's critical to speak with your physician about a screening schedule that's appropriate for you. However, if you have a strong family history, "We recommend that screening start at a young age--sometimes as young as 25," says Dr. Gralow. "For everyone else…we support the ACS recommendation of starting [screening] at 40, and doing it annually." For those with a family history of breast cancer, your is higher if a first-degree relative (a mother, sister or daughter) was diagnosed, especially if she was younger than 50. Lillie Shockney, RN, BS, administrative director of the Johns Hopkins Avon Foundation Breast Center, suggests women start getting mammograms 10 years before the age of their relative's diagnosis. Megan Baker, MD, a breast cancer surgeon at the Hollings Cancer Center at the Medical University of South Carolina, recommends that anyone who does have a family history of any cancer see their doctor, who may be able to identify patterns and recommend additional screening or genetic counseling.
Because we've been conditioned to look for lumps during self-exams, our fears are heightened if we find one. However, "the vast majority [of women] who feel a mass in their breast won't have cancer," says Otis Brawley, MD, chief medical officer for the American Cancer Society. He adds that 75% of the time, a lump is something less serious, like a cyst or a benign non-cancerous growth. Carolyn D. Runowicz, MD, professor of obstetrics and gynecology at Florida International University, agrees; "Most lumps are benign, and are related to the menstrual cycle or are a ." This is especially true if you're under the age of 65. Remember: If you find a lump, don't panic—it may not be what you think—but schedule a visit to the doctor as soon as possible. She will want to perform a physical exam, and may decide to follow up with an ultrasound and/or mammogram if necessary.
Although developing breast cancer is a possibility at any age, older women—particularly those in their late 60s and beyond—are at an elevated risk. According to the , half of all women diagnosed with breast cancer are over the age of 65. And although that number is substantial, that still leaves the other 50%. According to data from the National Cancer Institute, of those women who are under 65, 7% are women under the age of 40. And despite the relatively low number of under-40 women developing breast cancer, Dr. Baker warns that it still happens; "I see it weekly," she says. That's why having regularly scheduled visits with the gynecologist is equally important for younger women. Especially because, according to Shockney, lump detection can be more difficult in younger women due to their denser breast tissue. "This is because of higher levels of estrogen; as we age, estrogen levels usually decrease and density is replaced with fatty tissue that's easier to evaluate," she says. That's why if you're over 20 years old and notice a change in one of your breasts (as mentioned above), "know that it's likely not cancer, but you should get a doctor to check it out," says Dr. Baker.
Though men are 100 times less likely to develop breast cancer than women, about 2,140 men will be diagnosed in 2011, according to the . The disease is typically discovered later in men, so it's often found at a more advanced stage. That's why it was once thought to be more deadly in males; however, a new in the Journal of Clinical Oncology found that men actually have a better survival rate than female patients. However, Dr. Gralow notes that "male breast cancer is less than 1% of all breast cancer." Why? "Men don't have estrogen and progesterone exposure, they don't lactate, and they have very few ducts and lobules (which is where breast cancer starts)," she says.
This is a common misperception, says Shockney. But, because the origins of your genes are split between your mother and father, you have to look at both sides of the family tree when assessing your risk. Although (a mother, sister or daughter) are the most important in assessing your risk level, Dr. Runowicz advises meeting with a physician to determine your genetic risk level if any relatives in your family tree have breast cancer. "Both sides are critically important," says Dr. Runowicz. "Your father counts. The difference is because your father is not likely to get breast cancer—but he can, it happens to some males—you have to look at the father's sisters and mother, which is second-generation [risk]."
A lump isn't the only change in your breast to watch out for, notes Shockney. That's why experts urge practicing "breast awareness"—or paying attention to individual changes that are out of the norm for your usual breast shape, size, appearance or feel. According to Dr. Brawley, possible changes that should prompt a doctor's visit include: an area of the breast that feels firmer or thicker; larger, more noticeable pores in one spot on the skin; skin puckering; nipple inversion or bloody or clear nipple discharge. In inflammatory breast cancer (a rare but aggressive form of cancer), one area of the breast may develop a rash-like patch or swelling in one spot or throughout the entire breast.
The pervasiveness of this myth stems from studies conducted in the '90s, which showed a slightly elevated breast cancer risk for women taking oral contraceptives (that increased risk went back down to normal after 10 years of stopping the pill). However, Dr. Baker notes that earlier forms of birth control contained higher levels of hormones (estrogen and progesterone) than those used today. "[Recent] population studies show that there's no elevated risk for women who use oral contraceptives, so there's no reason to suggest they stop taking them." The recommendation also applies to women with a family history of breast cancer; according to research cited by the National Cancer Institute, the presence of breast cancer in your family does not necessarily preclude you from being able to take an oral contraceptive. However, be sure to discuss your family history with your doctor before taking an oral contraceptive, as Dr. Runowicz notes that genetics—and your age—are important factors.
The likelihood of cancer recurring in the other breast isn't as great as most women think, says Shockney. "For women who don't carry a breast cancer gene (BRCA1 or BRCA2)—and less than 10% do—the risk is only about 5% that they'll get cancer in the other breast," she says. Women who carry the gene—or whom have a significant family history—often opt for a bilateral mastectomy (removing both breasts) as a preventative measure and to decrease their anxiety about recurrence. "It gives them peace of mind," says Shockney. For those who do carry a breast cancer gene, the risk of cancer appearing in the opposite breast is, in fact, much higher. According to Shockney, the chances are about 40% increased, since carriers of the gene are pre-disposed to breast cancer in general.