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Breast Cancer

Breast Cancer

Breast cancer is highly curable if found in its early stages before it has spread to surrounding areas of the breast. Unfortunately, many are diagnosed once it has already begun to spread locally and more than 40,000 people die from breast cancer every year. While the incidence rate of breast cancer (new cases) is highest among white persons, studies report higher death rates among Black persons.

Diagram of breast

Screening

Transgender individuals should talk with their health care provider about their specific screening needs.

For persons of average risk:

  • From age 25 to 39: Three-year check-up

    Talk with your health care provider at least once every three years for risk assessment, risk reduction counseling and a clinical breast exam.

  • Beginning at age 40: annual check-up and 2D OR 3D screening mammogram (breast tomosynthesis)

    Get screened annually if you are at average risk. Discuss the benefits and risks of screening tests with your health care provider and talk about which screening method is right for you.

    2D mammograms take a picture of the breast from the side and from above. In 3D mammography, several pictures of the breast are taken from various angles to create a 3D image. This helps improve the accuracy of the test, which can be particularly helpful for women with dense breast tissue, which may make it harder to see cancers. Both types of mammograms are appropriate screening options.

  • Menopause: hormone replacement therapy
    Talk with your health care provider about breast cancer risks associated with hormone replacement therapy.

If you are at high risk, talk with your health care provider about beginning annual screening mammograms and magnetic resonance imaging (MRI) at a younger age.

Source: National Comprehensive Cancer Network 

Breast cancer is highly curable if found in its early stages before it has spread to surrounding areas of the breast.

What Puts You at Increased Risk for Breast Cancer?

If you were assigned female at birth, you are at increased risk for breast cancer. If you have a family history of cancer, talk to your doctor about genetic testing. You are at additional risk if you: 

  • Are overweight or obese.
  • Are not physically active.
  • Are currently using or have recently used birth control pills.
  • Are over 40.
  • Never had children or had your first child after age 30.
  • Used hormone replacement therapy (HRT) with estrogen and progesterone for more than 10 years.
  • Have mutations of BRCA1, BRCA2, PALB2 or other genes.
  • Have a family history of breast, colorectal or ovarian cancer.
  • Had high-dose radiation therapy on your chest.
  • Have already had cancer in one breast or your chest.
  • Smoke.
  • Drink alcohol in excess.

Reduce Your Risk Through These Lifestyle-Related Risk Factors

  • Do not smoke or use tobacco in any way. If you do, quit.
  • Exercise at least 30 minutes, at least 5 days a week.
  • Breastfeeding (chestfeeding) may lower the risk of breast cancer.
  • If you drink, limit your drinking to no more than one drink a day if you are a woman and no more than one or two a day if you are a man. Drinking alcohol is linked to breast and several other cancers. The more you drink, the greater your risk of cancer. Even drinking small amounts might increase your risk.
  • Maintain a healthy weight.

Genetic Testing

Genetic testing may be an option for those who want more information about their cancer risk. Women who test positive for BRCA1, BRCA2, PALB2 or several other gene mutations are at increased risk for breast or ovarian cancer. Men who have BRCA2 mutations have an increased risk of breast cancer. This is true to a lesser degree for men who have BRCA1 mutations.

Only 5%-10% of breast cancer cases are caused by hereditary gene mutations.

BRCA mutations occur in all races and ethnicities, but one in 40 women of Ashkenazi Jewish descent has a mutation in the BRCA gene.

A Florida study of Black women with invasive breast cancer found that 12.4% of them had BRCA mutations, leading the authors to conclude that it may be appropriate to recommend genetic testing to all young Black women with this diagnosis.

If you are considering genetic testing, meet with a genetic counselor. (You may want to check with your insurance company first to see if this is covered by your insurance.) If you have genetic mutations which put you at high risk of breast cancer, talk with your health care provider about additional ways to reduce your risk.

NOTE: This information refers to predictive genetic testing only, which is different from tumor profiling (also known as genomic, biomarker or molecular profiling). Tumor profiling is done after a cancer diagnosis to determine mutations that may affect how the patient responds to certain treatments.

Symptoms

If you notice any of these symptoms, take action and talk with your health care provider right away:

  • A lump, hard knot or thickening in the breast
  • A lump under your arm
  • A change in the size or shape of your breast
  • Nipple pain, tenderness or discharge, including bleeding
  • Itchiness, scales, soreness or rash on your nipple
  • A nipple turning inward or inverted
  • A change in skin color and texture such as dimpling, puckering or redness
  • A breast that feels warm or swollen

Treatment Options

Treatment depends on the type and stage of the breast cancer:

The most common treatment is surgery to remove the cancer (lumpectomy), combined with radiation. In some cases, it is necessary to remove the breast (mastectomy).

Chemotherapy, radiation therapy, hormone therapy, immunotherapy or targeted therapy may be used alone or in combination before or after surgery.

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