By Cat Troiano
Although the rate of breast cancer diagnosis has decreased over the last two decades, it is estimated that more than 300,000 women will be diagnosed with breast cancer in 2019, with more than two-thirds of these cases being invasive breast cancer. While skin cancer is the most frequently diagnosed form of cancer in women, breast cancer comes in second. When it comes to cancer-related deaths, breast cancer also comes in second, with lung cancer being the number one cause of cancer-related death in women. The projected mortality rate for women with breast cancer in 2019 is nearly 42,000. For all women and for anyone with a mother, wife, daughter or sister, these numbers are alarming. However, the mortality rate has been declining over the last 30 years, thanks in part to heightened awareness and early detection.
Risk Factors of Breast Cancer
One of the first keys in early detection is awareness of the risk factors of breast cancer. The chances of developing breast cancer increase for individuals with the following risk factors:
Age. Women over the age of 55 account for two out of three breast cancer diagnoses, indicating that advancing age comes into play as a risk factor.
Family history. A woman’s chance of developing breast cancer doubles when a first-degree female relative, such as her mother, sister or daughter, is diagnosed.
Ethnicity. African-American women have a higher risk of developing aggressive forms of breast cancer and are typically diagnosed at a younger age. Overall, however, white women are at a slightly higher risk than African-American women for developing breast cancer, while Asian and Hispanic women have a lower risk.
Reproductive health history. Women who began menstruating prior to the age of 12 have a higher risk of developing breast cancer, as do those who go through menopause after the age of 55 and those who either never gave birth or who gave birth to their first child after the age of 30.
Prior breast cancer history. Women who have been previously diagnosed and treated for breast cancer are three to four times more likely to develop another form of breast cancer.
Prior radiation treatment. Women who receive radiation to treat a condition in the upper body, such as non-Hodgkin’s lymphoma or Hodgkin’s disease, at less than 30 years of age are at increased risk for developing breast cancer.
Breast composition. Women with non-cancerous, or benign, beast conditions as well as those with dense breast tissue have higher risks for developing breast cancer.
Chemical exposure. Women who are frequently exposed to certain chemical substances found in food, cosmetics, skin care products, lawn and gardening chemicals, plastics and even water have higher risks of developing breast cancer.
Lifestyle. Women who are overweight have a higher risk for developing breast cancer, as do women who practice unhealthy lifestyle habits, such as being sedentary, smoking, excessive alcohol consumption and consuming an unhealthy diet.
Genetics also take on a role in breast cancer risk. Up to 10 percent of breast cancer cases are believed to be linked to genetic mutations, which may be passed down from a parent.
Genes Linked to Breast Cancer
BReast CAncer gene one (BRCA1) and BReast CAncer gene two (BRCA2) are actually genes that everyone has in their bodies. These genes carry out cellular repair for maintaining the health and function of the breasts as well as of the ovaries and other cells in the body. When either of these genes undergoes a mutation, they can no longer carry out their tasks as effectively. These ineffective genes get passed down through subsequent generations. Having one of these mutations does not seal a patient’s fate that they will develop breast cancer, but their risk does increase. It is important to remember that, while the incidence is much lower, men can also develop breast cancer, and they can develop the BRCA1 and BRCA2 mutations and pass them down to their offspring.
Just as knowing the risk factors for developing breast cancer is a crucial step toward early detection, being aware of the factors that contribute to the likelihood of carrying a genetic mutation is important. Women are more likely to have the BRCA1 and/or BRCA2 mutation(s) if:
- They have blood relatives on either their maternal or paternal side of the family, including grandmothers, aunts or nieces as well as mothers, sisters or daughters, who were diagnosed with breast cancer prior to the age of 50.
- They have a male relative who has been diagnosed with breast cancer.
- There is a family history of other cancers, including ovarian, uterine, prostate, colon, pancreatic or thyroid as well as melanoma.
- There is a family history of both breast and ovarian cancers either on the same side of the family or in one individual family member.
- They are of Eastern European heritage.
- They are of African-American heritage and have been diagnosed with breast cancer prior to the age of 35.
- They have a relative who has a history of breast cancer in both breasts.
Laboratory testing to detect the presence of these mutations should be considered for any female patient who falls into any of the above groups or carries any of the aforementioned risk factors of breast cancer. Blood tests can detect the presence of BRCA1 and BRCA2 mutations.
Positive test results confirm the presence of one of these mutations and thus place the patient in a significantly higher risk category for developing breast cancer.
Tumors release specific proteins into the bloodstream. These proteins are known as tumor markers, and blood tests to seek out the presence of these tumor markers enable pathologists to detect cancer. There are several tumor markers that are associated with breast cancer:
- Cancer antigen 15.3 (CA 15.3), which is also present in cases of ovarian cancer
- Cancer antigen 27.29 CA 27.29, the presence of which may be indicative of breast cancer
- Cancer antigen 125 (CA 125), which may be seen in recurring cases of breast or ovarian cancer
- Carcinoembryonic antigen (CEA), which is a tumor marker used to detect the presence of lung, colon or liver cancer and can reveal if breast cancer has metastasized to these organs
The normal reference ranges for these tumor marker tests are:
- CA15.3 Less than 30 U/mL
- CA27.29. Less than 38 U/mL
- CA125 0 – 35 U/mL
- CEA Less than or equal to 3 ng/mL
While tumor marker tests alone are inadequate screenings for the initial diagnosis of breast cancer, they can be valuable tests for determining the best course of treatment for a patient with breast cancer, for evaluating the efficacy of the treatment protocol and for monitoring a patient for breast cancer recurrence.
The American Cancer Society guidelines recommend that women who test positive for BRCA1 or BRCA2, or women who have any of the aforementioned risk factors for developing breast cancer, should undergo annual mammogram screenings beginning at age 30. In addition to mammography, ultrasound and/or magnetic resonance imaging of the breasts may be recommended for some women based upon their risk factors and on findings from physical examinations and laboratory tests. Women who are not considered high risk for developing breast cancer are advised to undergo annual mammogram screenings starting at age 40 to 45. All women should discuss their risk factors with their physicians to come up with the appropriate plans of preventative screenings that will provide the best chances for early detection, less aggressive treatment protocols and complete and lasting remission.