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Breast Cancer Risk: What Does It Mean? |
We all know that every woman is at risk for breast cancer. But some women have a higher risk than others. Why? Each woman has a unique set of characteristics, and she experiences a unique set of environmental exposures during her life. While we still do not know exactly what causes the vast majority of breast cancers, we do know that certain characteristics and exposures can contribute to the development of the disease. These characteristics and exposures are called "risk factors." Women who have these risk factors have a higher risk of getting breast cancer. For instance, alcohol is a risk factor for breast cancer. Studies have shown that women who drink alcohol each day have a higher risk of getting breast cancer than women who do not drink alcohol.
But what does this mean for an individual woman? For an individual woman, risk is about probabilities. If a woman decides to drink alcohol, it does not mean that she will automatically get breast cancer. It just means that she has a higher chance of developing breast cancer than before she started drinking. Many women who drink alcohol never get breast cancer, and many women who abstain from drinking alcohol develop breast cancer at some point in their lives.
Instead of applying risk factors to individual women, it is more useful to think of risk factors on a population level. Scientists study populations so that they can determine which factors increase breast cancer risk and how much increase in risk is caused by each factor. For example, a scientist might compare a group of women who drink alcohol on a daily basis to a group of women who do not drink alcohol. If 1.4% of the women who drink alcohol get breast cancer while only 1% of the women who do not drink alcohol get breast cancer, the scientist will suspect that alcohol contributed to at least a few cases of breast cancer.
The scientist would then determine the "relative risk" -- that is the risk of breast cancer in one group relative to risk of breast cancer in the other group. The scientist would divide the percentage of alcohol drinkers who got breast cancer (1.4%) by the percentage of non-alcohol drinkers who got breast cancer (1%), which corresponds to a relative risk of 1.4. Since 1.4 is 40% greater than 1, the scientist would also say that women who drink alcohol have a 40% increase in risk when compared to women who do not drink alcohol.
In reality, studies have shown that you would have to drink 2-5 glasses of alcohol per day to increase your breast cancer risk by 40%. Women who drink 1 glass of alcohol a day have a 9% increased breast cancer risk when compared to women who do not drink alcohol (Smith-Warner, et al., 1998). This is not a large amount of risk increase. Most of the few risk factors that we know about each contribute only a small amount to the risk of developing breast cancer. The table below shows associated with each. | | Factors That Increase the Relative Risk for Breast Cancer in Women | | Relative Risk | Factor | | Relative Risk >4.0 | • Certain inherited genetic mutations for breast cancer • Two or more first-degree relatives with breast cancer diagnosed at an early age • Personal history of breast cancer • Age (65+ vs. <65 years, although risk increases cross all ages until age 80) | Relative Risk 2.1-4.0
| • One first-degree relative with breast cancer • Nodular densities on mammogram (> 75% of breast volume) • Atypical hyperplasia • High-dose ionizing radiation to the chest • Ovaries not surgically removed | Relative Risk 1.1-2.0
| • High socioeconomic status • Urban residence • Northern US residence | Reproductive Factors
| • Early menarche (<12 years) • Late menopause (=55 years) • No full-term pregnancies (for breast cancer diagnosed at age 40+ years) • Late age at first full-term pregnancy (=30 years) • Never breast fed a child | Other factors that affect circulating hormones or genetic susceptibility
| • Postmenopausal obesity • Alcohol consumption • Recent hormone replacement therapy • Recent oral contraceptive use • Tall • Personal history of cancer of endometrium, ovary, or colon • Jewish heritage | Reprinted from American Cancer Society, 2001.
Note: Most studies on oral contraceptives have examined the pills used by women decades ago. The types of oral contraceptives currently prescribed contain doses of hormones that are much lower than doses used in the past. Thus, we do not yet know whether the types of oral contraceptives currently prescribed affect breast cancer risk in any group of women. |
| | As you can see, many of the known risk factors have relative risks of less than 2.0. Knowing that you have some of these risk factors does not really tell you much. A woman could have all of the known risk factors, and still never get breast cancer during her lifetime. Another woman could have none of the known risk factors, yet she might develop breast cancer next year. In addition, many of the known breast cancer risk factors are characteristics that women cannot change or eliminate from their lives. For instance, the later a woman reaches menopause, the higher her risk of breast cancer. Unfortunately, women have no control over the age at which they stop menstruating.
There are a few known breast cancer risk factors that women do have some control over, including alcohol consumption. However, we cannot simply recommend that women cut these risk factors out of their lives because we do not know what effect this recommendation would have on women's total health. For instance, some evidence indicates that alcohol consumption may lower the risk of heart disease, and this disease kills more women each year than breast cancer. Some organizations have tried to promote simple messages about risk factors. Women are told that they can prevent breast cancer by following special diets and avoiding certain exposures. But the study of risk factors is complex, and women need to understand this complexity.
Our current knowledge of risk factors is of limited use to individual women. If we want to help individual women, we need to find something that is guaranteed to prevent every woman from ever getting breast cancer, and that does not increase the risk of other illnesses. So far, we have not found a real prevention for breast cancer.
Age and Breast Cancer Risk Women age 50 and older have a large relative risk for breast cancer when compared to women under the age of 50. This is because most breast cancers occur in women ages 50 and older -- about 77%. In general, breast cancer risk increases with age. These days, many news stories about breast cancer focus on young women who get breast cancer, giving the impression that breast cancer in young women occurs more often now than it did in past years. In reality, the incidence rate of breast cancer in women under 40 has remained about the same for the last 25 years. The table below shows the estimated number of breast cancer cases that were diagnosed in 2001 for each age group of women. | Estimated New Breast Cancer Cases in Women by Age, United States, 2001 | | Age | in Situ Cases | Percent | Invasive Cases | Percent | <30 30-39 40-49 50-59 60-69 70-79 80+ | 100 1,600 10,800 12,500 9,400 9,400 3,300 | 0.2 3.4 22.9 26.5 19.9 19.9 7.0 | 900 8,000 35,400 46,800 33,100 43,000 25,000 | 0.5 4.2 18.4 24.3 17.2 22.4 13.0 | | Total | 47,100 | 100.0 | 192,200 | 100.0 | | Adapted from American Cancer Society, 2001 |
| References:
American Cancer Society. Breast Cancer Facts and Figures 2001-2002. Atlanta, GA. 2001.
Hulka BS, Stark AT. Breast cancer: cause and prevention. Lancet 1995;346:883-887.
Kelsey JL. Breast cancer epidemiology: summary and future directions. Epidemiologic Reviews 1993;15:256-263.
Smith-Warner SA, Spiegelman D, Yaun SS, et al. Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA 1998;279(7):535-40 | |
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