Myths & Truths

FALSE. The evidence actually shows that breast self-exam (BSE) does not save lives or detect breast cancer at an earlier stage.

For decades, women aged 20 years and older have studied shower cards, read pamphlets, watched videos, and prodded silicone breast models to find a hidden lump – each resource teaching BSE as a life-saving personal responsibility. Seems to make sense. In reality, there is no scientific evidence to prove this is true. In fact, studies show an increase in harm from monthly, regimented BSE including elevated anxiety, more frequent physician visits, and unnecessary biopsies of benign lumps. The evidence does NOT show that BSE saves lives or finds breast cancer “early.”

Many organizations share NBCC’s viewpoint on BSE. The National Cancer Institute (NCI) no longer prints a BSE guide; the U.S. Preventive Services Task Force recommends against health care providers teaching breast self-examination; and the American Cancer Society no longer recommends regular breast self-exams.

FALSE. What’s the risk? False-positive results may lead to unnecessary, intrusive surgical interventions, while false-negative results will not find cancerous tumors.

This myth is about screening mammography programs—that is, mammograms (low dose x-rays of the breast) for healthy women who do not have any symptoms. Screening programs are public health programs. Screening mammograms are different from diagnostic mammograms—those that are given when there is a symptom (e.g., a lump in the breast). More than 80% of women who receive suspicious results from a screening mammogram do not have breast cancer.

There are risks associated with screening mammography. Evidence shows that in the United States, a woman’s cumulative risk for a false-positive result after ten mammograms is almost 50%; the risk of undergoing an unnecessary biopsy is almost 20%. In addition, women who are screened with mammography often have more aggressive and unneeded treatments.

In addition to false-positive results, unnecessary biopsies, and unneeded treatment, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime (known as “overdiagnosis”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment. These unnecessary treatments have their own significant harms.

Moreover, the evidence around claims that screening reduces mortality is controversial with widely differing perspectives from many stakeholder groups. Systematic reviews conducted by organizations with no conflicts of interest, such as the Cochrane Collaboration, the US and the Canadian Task Forces, and others have found substantial problems with the randomized trials that provide the evidence related to screening mammography.

Screening mammography of all women has demonstrated only a modest, if any, benefit in reducing breast cancer mortality and is associated with harms that may outweigh those benefits. Receiving a screening mammogram should be a personal choice, not a medical mandate. See also NBCC’s position statement on mammography screening and related educational videos.

References:

Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2016;164:256–67.

Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013 Jun 4;2013(6):CD001877.

FALSE. MRI (magnetic resonance imaging) is a more sensitive test, but it also leads to significantly more false-positive results.

There is currently no evidence to show that MRI used for routine breast cancer screening saves lives. MRI may be effective as a diagnostic tool, once there is a suspicious finding. However, when used for screening, MRI yields even more false-positive results than mammography. This is one reason why the use of MRI screening is not recommended for the general public. Even among those at high risk for developing breast cancer (i.e., greater than 20% lifetime risk), studies of women undergoing MRI have found that the number of unneeded biopsies more than doubled. And there is no evidence that it saves lives.

FALSE. In some cases, even when breast cancer is detected early and the tumor is very small, the breast cancer cells have already spread to other parts of the body. The spread of breast cancer to other parts of the body (metastasis) is responsible for over 90% of deaths related to breast cancer.

What is early detection? We probably think of it as early enough to intervene and save a life. But there are different kinds of breast cancer. For some of them, if they are surgically removed, the breast cancer has been effectively “cured.” For others, it can be found really early, yet no known intervention will “cure” it. Complicated? Yes. But the truth about breast cancer is just that. The question is, how do we find breast cancer at a time when we can intervene and make a difference in the outcome? The unfortunate answer is we do not yet know.

NBCC embraces evidence-based health care and has long raised questions about the value of mammography screening and other tests. This is important because patients need to be assured about the value of all medical interventions and understand their risks, and public health resources need to be used with certainty about the value to the public’s health.

TRUE. Breast cancer death rates changed little between 1930 and 1989 but decreased by a cumulative 41% from 1989 through 2018.

Breast cancer death rates changed very little between 1930 and 1989, and actually began increasing by about 0.4% per year in 1975, reaching a peak in 1989. Then annual death rates began declining a bit each year. Between 2009 and 2013, the death rate for women of all races combined declined by about 1.9% annually. However, annual declines have more recently slowed to 1.0% each year between 2014 and 2018. While a cumulative 41% reduction is good news, remember, there are still 43,600 women who will die of breast cancer this year. And the rate of decrease is declining, which is not good news.

While these statistics are encouraging — we don’t actually know why mortality rates decreased.  We do need to make certain that any mortality decline is the same for all women. Learn more about how you can be a part of NBCC’s mission to end breast cancer.

References:

Siegel, RL, Miller, KD, Fuchs, H, Jemal, A.  Cancer Statistics, 2021. CA Cancer J Clin. 2021: 71: 7‐ 33. https://doi.org/10.3322/caac.21654

TRUE. White women are more likely to receive a diagnosis of breast cancer, but African American women have a higher mortality rate.

The incidence rate of breast cancer for African American women is about 127 per 100,000 women compared to about 132 per 100,000 for white women. The mortality rate of breast cancer for African American women is about 28 per 100,000 women compared to 20 per 100,000 white women. Although the incidence rates are similar, the mortality rate among African American women is 40% higher than among white women. (Among Hispanic women, the incidence rate is 94 per 100,000 women and the mortality rate is 14 per 100,000 women. Among American Indian or Alaskan Natives, the incidence rate is about 95 per 100,000 women and the mortality rate is 15 per 100,000 women.)

The reasons for the disparity in mortality are complex and include access to care. Another reason for the difference in mortality among African American women may be that young African American women are disproportionately affected by triple-negative breast cancer. About 21% of breast cancers in African American women are triple-negative which is approximately double the proportion of this subtype in other racial/ethnic groups. There is no targeted treatment for this subtype.

Find out more about the statistics of breast cancer and what you can do to get involved in important work to end this disease.

References:

Siegel, RL, Miller, KD, Fuchs, H, Jemal, A.  Cancer Statistics, 2021. CA Cancer J Clin.  2021: 71: 7‐ 33. https://doi.org/10.3322/caac.21654

American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.

FALSE. There are many sub-types of breast cancer, and they require different types of treatment.

Different women have different breast cancer types with unique disease characteristics including:

• the stage
• the size and grade of the tumor
• if there is lymph node involvement [nodal status]
• hormone receptor-positive or negative
• HER2/neu positive or negative

We also know that there are inherited gene mutations that affect breast cancer, such as BRCA 1 and BRCA2 mutations.

Breast cancer treatments have evolved over the years with the development of a range of chemotherapy drugs and therapies that target specific types of known breast cancers. About 15 to 20% of women with breast cancer are found to overexpress a protein called HER2. Nearly four out of five women with breast cancer have hormone receptor (HR) positive cancer, also called estrogen receptor (ER) and/or progesterone receptor (PR) positive. Hormonal therapies may keep these types of cancers from growing, increasing survival and reducing recurrence.

Triple-negative breast cancer is another subtype of breast cancer (called triple-negative because it lacks the receptors for estrogen and progesterone and has normal levels of HER2).

It is important to recognize that just like any other diagnosis, knowing the specific kind of breast cancer one has is important to finding the best treatment.

References:

American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.

TRUE. There are factors associated with increasing and/or decreasing the risk of breast cancer, but we currently do not know how to prevent breast cancer.

Don’t eat red meat. Eat a low-fat diet. Don’t wear deodorant. Don’t sleep in a bra. Women are bombarded constantly about what they can do to prevent breast cancer. Unfortunately, at this time, there is no known way to prevent the disease.

Current factors known to contribute to overall breast cancer risk are mostly uncontrollable, including age, personal and family breast cancer history, certain genetic factors, first menstrual period before age 12, menopause after 55, breast density, and race. A few factors that can be controlled that have been shown to increase breast cancer risk include obesity, alcohol consumption, and lack of physical activity.

For women who have a high risk of breast cancer, there are some drugs that may help reduce their risk of breast cancer, but they have significant side effects. The idea of a drug to reduce risk sounds exciting. But remember these are drugs with significant side effects that will be given to healthy women and there is no evidence they would prevent cancer from developing.

It is important to keep in mind that most women who have known risk factors do not get breast cancer. Except for growing older and certain genetic factors, most women with breast cancer have no clear risk factors. We currently can’t tell any individual woman, “Do this or take this and you won’t get breast cancer.”

Unfortunately, we still see the false statement that mammograms prevent breast cancer. Mammography is a screening test to detect cancer already present in the breast. It does not prevent cancer, nor will it definitively detect the disease or save lives.

We must find out what causes breast cancer so we can end this disease. Learn more about the science of breast cancer through the NBCC Center for Advocacy Training and Project LEAD®.

FALSE. Only about 15 to 20% of women diagnosed with breast cancer report having a family history of the disease (i.e., in one or more first- or second-degree relatives), and less than 10% have a known gene mutation that increases risk.

Most women who get breast cancer do not have a family history of the disease. If you do have relatives who have had breast cancer, you may worry that you’re next. Family history of breast cancer usually refers to having two or more first-degree relatives (such as a mother, sister, or daughter) or second-degree relatives (such as an aunt, niece, or grandmother) who have had breast cancer. While it is true that women with a family history of breast cancer have an increased risk of developing the disease, most of these women will never get breast cancer.

We know that, among some women with a significant family history, certain inherited mutations of the genes BRCA1 and BRCA2 may exist that result in an increased risk of breast cancer. The mutations are sometimes (but not always) passed down to relatives. Even if you have a family history, it does not mean you have an inherited mutation.

Hereditary gene mutations associated with breast cancer (e.g., BRCA1, BRCA2 mutations, and other less common mutations) are found in about 5-10% of all breast cancer cases. Having the mutation does not mean you will automatically get breast cancer; it means you are at higher risk. And remember that 90-95% of breast cancer cases do not involve these inherited mutations.

Family history is one risk factor. But a risk factor doesn’t cause cancer, it just affects your chance of getting cancer. Other risk factors for breast cancer include getting older, benign breast problems, early exposure to ionizing radiation, having children late in life or not at all, longer exposure to estrogen and progesterone, lack of exercise, and drinking alcohol.

We know a little about breast cancer risk factors, but why some women develop breast cancer and others do not, is still often a mystery.

References:

Hu C, Hart SN, Gnanaolivu R, et al. A Population-Based Study of Genes Previously Implicated in Breast Cancer. N Engl J Med. 2021 Feb 4;384(5):440-451.

Pharoah PD, Day NE, Duffy S, Easton DF, Ponder BA. Family history and the risk of breast cancer: a systematic review and meta-analysis. Int J Cancer. 1997 May 29;71(5):800-9.

FALSE. It is estimated that in 2021, 2,650 cases of breast cancer will be diagnosed in men.

While less than 1% of new breast cancer diagnoses occur among men, it is still a possibility for men to develop the disease. Of the approximate 44,130 deaths from breast cancer this year, an estimated 530 of them will be men. For males, the lifetime risk of getting breast cancer is about 1/10th of 1%.

Although the odds are not overwhelming for men, it is important to focus on what causes this disease and join the mission to end breast cancer.

TRUE. Breast cancer is primarily a disease of older women, with the median age of diagnosis at 62 years of age.

It is estimated that a woman aged 20 has about a 1 in 1,479 risk of developing breast cancer in the next 10 years; for a woman aged 40, it is about 1 in 65, and for a woman aged 60, it is about 1 in 28.

Most people at every age, think they have a higher risk of breast cancer than they actually do. Assuming a group of 100 women live until the age of 90, about 12 may develop breast cancer in their lifetime.

Many of us have been in an audience and someone says, “Look around you, 1 in 8 of the women in this room will get breast cancer.” In reality, that is highly unlikely. Overall, a women’s lifetime risk of developing cancer is about 1 in 8. However, according to some surveys and studies, many women mistakenly believe that they have a 1 in 8 risk every year.

References:

American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.

FALSE. Completely removing the breast—known as mastectomy—is not more effective than just taking out the cancer—known as lumpectomy.

It may seem logical that if breast cancer is found, removing the entire breast is more likely to be a lifesaving treatment. But in cancer treatment, more is often NOT better. Multiple randomized trials, now with long-term follow-up, have demonstrated that survival after lumpectomy (i.e., breast conservation surgery) combined with breast radiotherapy is equivalent to mastectomy for treating most early-stage breast cancers. Once you know the pros and cons of each treatment for your type of breast cancer and your situation, the choice is often a personal one. If a doctor recommends one instead of the other, ask why and educate yourself on the evidence.

References:

Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227-32.

FALSE. It is normal to feel a treatment decision must be made right away but taking time to decide on an appropriate course of action may be time very well spent.

A breast cancer diagnosis is terrifying, and new patients often scramble to start treatment immediately. But there’s no evidence that taking some time to learn about the diagnosis and to select the right health care providers will adversely affect the outcome. There is a lot to learn—the details of the diagnosis, surgery options, drug dosing and scheduling, possible side effects, etc. Second opinions can be extremely valuable. There is enough time for you to gather the information you need to make an informed decision.

Learn more about the science of breast cancer research, diagnosis, treatment and quality care at Breast Cancer Information.

FALSE. While you definitely should get a second opinion on how to treat your breast cancer, that is not enough. Know that all breast cancers are not the same and cannot be treated as such. Breast cancer is a complex disease with many variants needing different treatments.

A breast cancer diagnosis is often made following a breast tissue biopsy, in which a small sample of tissue is taken from the suspected tumor and given to a pathologist. A pathologist (a doctor specializing in diagnosing cancer) runs a series of tests on the breast tissue. A pathology report describes the type of cancer and helps determine your specific diagnosis. A pathology second opinion can help you be more certain that your diagnosis and disease characteristics are correct. This is very important because doctors base their treatment advice on your pathology report.

Treatment options vary depending on the specific diagnosis you have. And that diagnosis is explained on the pathology report. Since treatment choices depend on having a complete and accurate diagnosis, it is important for patients to know they can get a second opinion on the diagnosis itself.

To learn more, explore Breast Cancer Information for scientific and health care information in plain language.

TRUE. According to the Women’s Health Initiative (WHI), Postmenopausal Hormone Therapy Trials—an estrogen-plus-progestin replacement therapy—increases the risk of breast cancer, along with heart disease, stroke and blood clots.

The WHI clinical trials, launched in 1991, studied a group of 161,808 generally healthy postmenopausal women for the effects of HRT, diet modification and calcium and vitamin D supplement use on heart disease, fractures as well as breast and colorectal cancer. Results from the trial on HRT, published in 2002, found that while the estrogen-only replacement therapy did not increase breast cancer risk, the risks far outweighed the benefits in the estrogen-plus-progestin study. Overall, there was a 24% increase in the risk for breast cancer due to estrogen-plus-progestin.

FALSE. Not all breast cancer research is created equal. Science can be complex, and research must be well designed and rigorous. No matter what kind of research. But it is not just about research design. If research focuses on issues that ultimately will not help people, it doesn’t matter how scientifically sound it is.

It seems hard to believe that breast cancer research is not always valuable. But the truth is, poorly designed research—including clinical trials—provide no meaningful information and can actually be harmful because the results can be very misleading. On the other hand, the most elegant study in the world can only answer the questions it was designed to answer. A small and limited research question will inevitably produce a small and limited answer.

There are many potential breast cancer research topics. The scientific community alone should not prioritize research based on what’s most important to them. What’s important to patients has to be a main component. That’s why breast cancer advocates need to be involved in all levels of the research process. NBCC trains breast cancer advocates so they can help shape the future of breast cancer research.

Learn more about NBCC’s Research Initiative.

FALSE. We still do not know how to cure breast cancer. We do have more treatment options and more targeted therapy, but we don’t understand the disease well enough to know for certain which cancers will come back and/or spread, and which cancers will not.

Many breast cancer survivors are now celebrating 10, 20, 30 or more years of being “cancer-free,” which is certainly a cause for celebration. Breast cancer mortality rates have actually decreased a cumulative 41% from 1990 to 2018. Although no one knows the exact cause of the decrease, many attribute it to the introduction of better treatments.

But until we better understand the biology and progression of the disease, being “cancer-free” is not the same thing as being cured. And we cannot tell any individual woman at the end of her treatment that she is “cured.” We just do not know. It’s hard to look at the disease in this way—it seems pessimistic. But creating a false sense that we already have a “cure” is simply misleading and we may stop looking for the correct answer.

If you don’t like this current truth, take action to change it. Learn more about important grassroots advocacy work that makes strides toward creating a future without breast cancer.

References:

Siegel, RL, Miller, KD, Fuchs, H, Jemal, A. Cancer Statistics, 2021. CA Cancer J Clin.  2021: 71: 7‐ 33. https://doi.org/10.3322/caac.21654

FALSE. Advocates can become educated and able to understand and influence breast cancer research. Their perspective is key to finding answers.

There was a time when patients and advocates were not included in the analysis of scientific research, clinical trials design, and treatment options. Since its inception in 1991, NBCC has worked tirelessly to ensure that patient advocates are not only included in the process but also are knowledgeable, contributing participants.

Breast cancer survivors who have been trained and educated have both the first-hand patient knowledge, as well as the ability to advocate on behalf of others, which is an important check and balance in determining research value and funding.

Why exclude those that have intimate knowledge of the very important quality of life issues and treatment options of the disease? Why exclude those who have no agenda other than to end breast cancer? Consumers who have been trained to understand the research process add a crucial element to all panels where breast cancer decisions are made—a reality check.

Project LEAD® is NBCC’s innovative science training program that provides a foundation of scientific knowledge upon which participants can strengthen and empower themselves as activists. Graduates of NBCC’s Project LEAD Institute and other courses are equipped to meaningfully participate in the research process and better explain basic breast cancer science and research information to their colleagues, clients, friends and family. As critical thinkers of the breast cancer science that appears in the news every day, these advocates serve as a resource to their organizations and the constituency that they represent.

Make sure educated and trained patients and advocates always have a voice in determining priorities and that the right kind of research gets the appropriate amount of funding. Learn how to be an effective advocate today.

TRUE. The federal government funds a significant portion of research for many types of cancer.

In 1992, NBCC launched its 300 Million More campaign to increase federal funding for breast cancer research. It was a success, and in 1993 federal appropriations for breast cancer research rose to more than $400 million. The National Cancer Institute funding went from $100 million to $225 million, and $210 million of defense funding went to launch the Department of Defense Peer Reviewed Breast Cancer Research Program (DOD BCRP), all due to NBCC’s campaign.

Why is the Department of Defense funding breast cancer research? Learn more about the program’s creation, unique features and demonstrated success. In response to NBCC’s ongoing grassroots advocacy, as of 2021, Congress has approved more than $4 billion in funding to the worldwide scientific community since the program began in 1993.

In addition, the National Institutes of Health has provided significant funding for breast cancer research for decades. Since 2001, NIH has spent roughly a half-billion dollars each year on breast cancer research.

Read more about the DOD BCRP and how your tax dollars make a difference in funding quality research.

FALSE. Breast cancer is a political issue. Congress and the Administration make important funding and policy decisions in breast cancer detection, prevention, treatment, and care.

The government is the only body with access to the amount of money needed to sustain the appropriate level of breast cancer research and to explore cause and effect relationships that could lead to breast cancer prevention and a cure. Sustained and significant involvement on the federal level is the only way to end breast cancer.

Elected officials also have the power to change systems of access to care and treatment, including the reform of the health care system, regulation of insurance and the drug approval process, and public health campaigns and access to new drugs. This is why, since our founding, NBCC has addressed breast cancer as a political issue.

Make sure your members of Congress know where you stand in the mission to end breast cancer. Take action using NBCC’s Action Center. You can also join NBCC’s National Action Network, and we will notify you when we need your help the most — about bills that need cosponsorship, breast cancer priorities, and the right time and how to reach out to your elected officials.

TRUE. When you speak, members of Congress and your statehouse listen. Adding your voice to thousands of other breast cancer advocates ensures the message is clear—we want an end to breast cancer now.

For 30 years, NBCC has worked to amplify voices of those determined to end this disease. By lobbying Congress for research funding and access to care, by challenging drug companies and the medical community on treatment standards, and by training survivors and allies to take their rightful place at the decision-making table, NBCC has made certain that breast cancer remains at the forefront of the scientific, healthcare and legislative agendas. Continued advocacy is the only way to ensure this issue remains a top priority.

TRUE. Learning about breast cancer science and public policy is well within your reach.

You don’t have to accept oversimplified or sensational media reports or health care information about breast cancer. You have the option to take control of your education to learn the latest in breast cancer research, care, and clinical trials and what Congress, the White House, and the States are doing about these issues.

NBCC offers a suite of top-notch science and advocacy education courses through the NBCC. New to advocacy? Visit NBCC’s Center for Advocacy Training Online and view the many breast cancer presentations that speak on the key issues. You may also want to consider attending NBCC’s annual Advocate Leadership Summit to learn more about the issues and build your advocacy skills. Want to take your already solid knowledge to the next level? Experience the Project LEAD® Institute, or one of our other more advanced programs.

Now we must do—and demand—more. We can do it. We can end breast cancer. Join our mission and get involved to end this disease.