10 Breast Cancer Myths, Busted
Misconceptions about this feared disease abound. Here’s the real deal.
These days it seems you almost need a medical degree to separate fact from fallacy when it comes to protecting yourself against breast cancer. From controversies over mammograms to questions about whether birth control pills raise your risk, it’s easy to be perplexed. But the truth isn’t really so elusive. Here are 10 misleading statements you may have heard about breast cancer—corrected.
1 “No one in my family had breast cancer, so I needn’t be concerned.”
More than 85 percent of women who are diagnosed with breast cancer have no family history of the disease, according to the American Cancer Society (ACS). The main risk factor is simply being a woman (the disease is about 100 times more common among women than men). Other than that, your risk increases as you age (about one in eight invasive breast cancers are found in women younger than 45, while roughly two-thirds of all breast cancers occur in women age 55 and older, according to the ACS). But it’s true that having a first-degree relative (mother, sister or daughter) with breast cancer doubles your risk, and having two firstdegree relatives increases your risk threefold.
2 “Antiperspirants and deodorants cause breast cancer.”
A 2003 study of breastcancer survivors found that those who used antiperspirants and deodorants and shaved their underarms most frequently were diagnosed at an earlier age. (Researchers theorized that this is because antiperspirants contain aluminum, which may be absorbed into the skin and acts like estrogen, a hormone that may play a role in breast cancer.) However, the study did not prove that using these products causes breast cancer. In another small study, parabens—preservatives used in some deodorants and antiperspirants—were found in 18 out of 20 tissue samples from breast tumors. Parabens have been shown to mimic estrogen in the body. However, the study did not prove that parabens cause breast cancer. More research is needed to determine what effect, if any, parabens may have on breastcancer risk. A 2006 study found that there was no association between antiperspirant use and the risk of breast cancer. The bottom line: There is no causal link between antiperspirants and breast cancer, so women need not worry. “I always say we’d all be in big trouble if there really was a link,” says Erika Brinkmann, M.D., director of breast surgery at Holy Name Medical Center in Teaneck.
3 “A breast lump is always cancer.”
Eighty percent of breast lumps are benign, says Deborah Axelrod, M.D., associate professor of surgery at New York University Langone Medical Center in New York City. Most lumps are due to benign conditions such as a simple cyst or a fibroadenoma, a mass that may be firm, easily moveable and painless. If you have a benign lump, your doctor may suggest monitoring the area and reporting any changes.
4 “A mammogram can actually cause breast cancer.”
When a mammogram—an X-ray image of the breast—is taken, the amount of radiation a woman receives is very small—much too small to cause a malignancy. It’s less than the amount you’re exposed to when you take a cross-country flight, explains Dr. Brinkmann. “The benefits outweigh the risks,” she says. The American College of Obstetricians and Gynecologists (ACOG) recently recommended that all women receive annual mammograms star ting at age 40. (Previously, the group had called for the screening “every one to two years” star ting at 40, and then every year beginning at age 50. The U.S. Preventive Services Task Force currently recommends that women begin getting mammograms at 50 and get them every other year.) ACOG based its new recommendation on the fact that every year about 40,000 women in their 40s are diagnosed with breast cancer, and about 20 percent of them ultimately die from it. Plus, tumors in younger women tend to grow more quickly than those in older people. “I’m thrilled [about the new guidelines],” says Lauren Cassell, M.D., chief of breast cancer surgery at Lenox Hill Hospital in New York City. “We see a significant number of women who develop breast cancer in their 40s, and previously I felt we were throwing them under the bus by not recommending annual mammograms.” Among women in their 40s, mammograms are estimated to save one in 1,900 from dying from breast cancer, but there are other benefits too. “For me, that number doesn’t take into consideration the number of breasts that can be saved,” says Dr. Brinkmann. “Losing a breast is a life-altering event. When breast cancer is detected early, many women are candidates for lumpectomy instead of mastectomy.”
5 “IF I get breast cancer, I’ll probably die from it.”
On the contrary, the outlook is positive: Thanks to early detection and better treatments, more than 90 percent of those who have been diagnosed survive the disease, according to Dr. Brinkmann. (See the chart below for survival rates by stages of breast cancer. Your doctor can tell you how these numbers may apply to you depending on your par ticular situation.)
6 “If I have a breast lump and it hurts, it’s not cancer.”
It’s true that about 90 percent of cancerous masses are not painful, says Dr. Cassell. That’s because painful breast lumps are typically caused by normal hormonal changes during the menstrual cycle. Still, some tumors can cause pain—especially if they grow beyond two centimeters. “I tell my patients that if they find a lump—any lump—they need to have it checked,” says Dr. Brinkmann.
7 “Breast cancer is preventable.”
Certain medications, such as tamoxifen, raloxifene and exemestane, have been shown to reduce the incidence of cancer in women at high risk for developing the disease. But there is no proven way for healthy women to prevent cancer. “You can do everything right and still develop breast cancer,” says Dr. Cassell. Still, there are ways to reduce your risk (see “5 Habits That Can Save Your Life” on the next page).
8 “A cancerous lump feels different from a benign lump.”
Breast tissue in the upper, outer par t of the breast usually feels firm and slightly bumpy while that of the inner and lower par ts of the breast feels soft. Your breast tissue may feel more tender or lumpy just before you get your period. “When you’re in the shower, do a breast self-exam,” advises Dr. Cassell. “It’s best to do it af ter your period is over. Look for any thicker areas. If a new lump pops up and doesn’t disappear af ter your menstrual cycle, get it checked.” Other reasons to see your doctor: if a lump seems to have grown; if you have bloody discharge from your nipple; or if there are skin changes (such as redness or dimpling) on your breast. “Cancer doesn’t obey rules,” says Dr. Brinkmann. “One of my patients was told not to worry because her lump was sof t, but she had cancer anyway. There are no hard-and-fast guidelines about texture. In fact, by the time a breast lump is hard, it’s probably locally advanced because it has already adhered to skin or muscle.”
9 “Birth control pills permanently raise your risk of breast cancer.”
Women who are using bir th control pills do have a slightly greater risk of developing cancer, but the risk returns to normal af ter a woman stops taking the pill. Those who stopped using bir th control pills more than 10 years ago don’t seem to have any increased breast cancer risk, according to the ACS. Talk with your doctor about whether bir th control pills are right for you. And keep in mind, says Dr. Brinkmann, that they may prevent ovarian cancer.
10 “My mammogram was normal, so I don’t have to worry about breast cancer.”
Mammograms miss up to 20 percent of breast cancers at the time of screening, according to the National Cancer Institute. The cause is usually dense breasts, which are more common in younger women. As a woman ages, her breast tissue becomes more fatty, and mammograms become more accurate. “It’s important to have your doctor do a clinical exam during your annual checkup,” says Dr. Brinkmann. If you’re at high risk for breast cancer, your doctor may prescribe an ultrasound or MRI (magnetic resonance imaging) test of your breasts.
Survival Rates by Stage
Stage 0 93%
Stage I 88%
Stage IIA 81%
Stage IIB 74%
Stage IIIA 67%
Stage IIIB 41%*
Stage III C 49%
Stage IV 15%
* These numbers are correct as written (stage IIIB shows worse survival than stage IIIC). Numbers come from the National Cancer Data Base and are based on people who were diagnosed with breast cancer in 2001 and 2002.
Source: American Cancer Society
5 Habits That Can Save Your Life
Research shows that these are the best strategies for reducing your risk of developing breast cancer:
1. Get moving. In a study from the Women’s Health Initiative, as little as one to two-and-a-half hours per week of brisk walking reduced a woman’s risk of developing breast cancer by 18 percent. Walking 10 hours per week lowered the risk even more. The American Cancer Society (ACS) recommends 45 to 60 minutes of exercise for five or more days each week. “Exercise reduces your body fat composition,” says Dr. Brinkmann. “And body fat contains estrogen, which may play a role in breast cancer.”
2. Breast-feed as long as you can. Nursing your baby can help reduce your breast cancer risk, especially if you do so for one-and-a-half to two years. That’s only true, however, if your period has stopped, since skipping your period reduces your exposure to estrogen, which is implicated in breast cancer.
3. Limit your alcohol intake. Women who consume one alcoholic drink per day have a small increase in risk over teetotalers; those who have two to five drinks daily face a one-and-a-half times higher danger of developing breast cancer compared with those who don’t drink at all. The ACS recommends limiting your consumption to no more than one drink per day.
4. Maintain a healthy weight. Being overweight or obese raises your breast-cancer risk—especially if you’ve reached menopause. Prior to menopause, your ovaries produce most of your estrogen. Afterward, most of your exposure to estrogen comes from fat tissue (because your ovaries have stopped making the hormone). Having more body fat can raise your estrogen level, boosting your risk of cancer. In a new study of nearly 4,000 breast cancer survivors, researchers found that women with estrogen-dependent cancers who were obese had a 69 percent higher chance of dying from the disease than women at a healthy weight. Keep your body mass index (BMI)—a measure of your height and weight— below 30. (Find out your BMI at nhlbisupport.com/bmi.)
5. Avoid hormone replacement therapy (HRT ). Using combined hormone therapy (estrogen and progesterone) after menopause increases your risk of developing and dying from breast cancer. As little as two years of use can raise your risk. A new study recently published in the Journal of the National Cancer Institute found that women who start HRT as they begin to go through menopause have a higher risk of breast cancer than women who start taking the drugs later. HRT can also reduce the effectiveness of mammograms because the exposure to hormones increases your breast density. Fortunately, stopping HRT returns your risk to normal within five years.
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