• Age is a risk factor. The majority of women (80%) who get breast cancer are older than 50 yrs. (in our experience 67% newly diagnosed cancers are in women over 50 years).
• Unlike lung cancer in which there is a direct correlation between smoking and risk of lung cancer, there are no clear causes for breast cancer.  Estrogen exposure seems to promote the growth of some cancers. A small percentage of women (<5%) inherit the BRCA1/2 gene which puts them at increased risk for developing breast cancer.  The majority of women (75%) who develop breast cancer have no family history of beast cancer.  Thus, all women are at risk for breast cancer, and the risk increases as a woman ages.
• The best defense against breast cancer is to engage in activities that increase the chance for early diagnosis.  If breast cancer is caught early, the chance of being disease free at 10 years is 95%.  The main strategies for early detection are:

1. Yearly mammography starting at age 40 yrs (preferably digital).

2. Monthly self-exam starting at age 20.

3. Yearly physician exam starting at 20. 

4.  Second opinion when there are any concerns about the appropriateness of care

• High risk women, i.e. those with strong family histories should consider genetic counseling and in selected cases can consider risk reduction therapies which with estrogen blocking drugs.  In rare case prophylactic surgery can be considered.

• Hormone replacement therapy and cancer risk: 

• Taking birth control pill is not associated with an increased breast cancer risk, and is associated with some protection against ovarian cancer. 

• Risk of breast cancer is increased in patients receiving hormone replacement after menopause, but the major risk is with taking the combination of estrogen progesterone, but the risk associated with estrogen + progesterone therapy is not measurable for several years after starting replacement therapy.  Thus, symptomatic women who need the combination because of the presence of an intact uterus can take this combination for two years with no increase risk for breast cancer. However, they would be advised to take the lowest does possible, and to attempt to wean off the replacement within two years if possible.  The choice to continue should be left to well informed women who understand the risks and benefits of continued treatment.  Hormone replacement therapy requires ongoing medical supervision.

• The risk of estrogen only replacement (for women with no uterus) is much less than it is for the combination of estrogen and progesterone.  Thus, low dose ERT is reasonable treatment strategy to control symptoms for 3-4 years after menopause as long as the women is followed carefully and aware of both risks and benefits.

• The future for breast cancer:

The future is looking bright in terms of strategies to improve the early diagnosis of breast cancer as well as to treat it more effectively.  New imaging technologies are on the horizon to detect cancer early.  New treatment strategies are being implement that improve the effectiveness of treatment and have fewer side effects. Now, however, is not the time to be complacent.  To maximize the progress that is being made in the medical care of breast cancer, women must do their part in terms of committing to early detection efforts.  Significant reductions in mortality and costs of care could be achieved if women were to consistently follow early detection guidelines.  The goal of Be Aware is that ensure that if breast cancer is in a women’s future that she does everything in her power to detect it early so that she has the maximum chance for survival.