Who's at Risk and What You Can Do?
If you have knowledge, let
others light their candles in it.
— Margaret Fuller
What is breast cancer?
cancer occurs when abnormal cells in the
breast grow out of control. The cells clump
together and form a mass, or a lump. Not
all lumps in the breast are caused by breast
cancer. Breast cancer lumps are malignant
and can spread to other tissue and other
parts of the body.
are two main areas in the breast where
cancer can occur: the lobules (lobular
breast cancer), which produce milk when
a woman is breastfeeding, and the ducts
(ductal breast cancer), which carry the
milk from the lobule to the nipple. The
rest of the breast is mostly fat, connective
tissue, and lymph
and blood vessels.
breast cancers begin in the cells of
the ducts (ductal breast cancer). Some
begin in the cells of the lobules (lobular
breast cancer) or in other tissue in the
FACTORS FOR BREAST CANCER
Scientists estimate that one in eight
women in the United States (about
13.4%) will develop breast cancer in
their lifetime. Another way to think
of breast cancer risk is that seven of
every eight women in America (about 86.6%)
will never develop breast cancer.
What is not proven to cause breast
bruising, or touching the breast
- Underwire bras
- Breast implants
Breast cancer is not
contagious, and you cannot catch it
from nor can you give it to anyone
in the United States are diagnosed with
breast cancer more than any other type
of cancer except for skin cancer. Breast
cancer is also the second leading cause
of cancer death in women (lung cancer
is first). However, breast cancer death
rates are decreasing, probably as a result
of better and earlier detection and treatment.
exact causes of breast cancer are unknown.
However, the risk of breast cancer increases
as a woman gets older. Older women are
much more likely to get breast cancer than
young women. Nearly eight out of ten breast
cancers are found in women over age 50.
are the risk factors for breast cancer?
Anything that increases your chance
of getting a disease is called a risk
factor. Below is a list of risk factors
that may increase a person’s
chance of developing breast cancer.
However, these risk factors do not
predict who will get breast cancer
and who will not. Someone with many
of these risk factors may never get
breast cancer, while someone with no
risk factors could still develop it.
There may be other risk factors we
do not know about yet. Risk factors
for breast cancer include:
- Older age
(especially after age 50)
(having periods) at an early age (before
age 12) or going through menopause at
a late age (after age 55)
- Older age at first
birth (30+) or never having given birth
breast cancer before or having certain
types of benign (non-cancer)
- A mother or sister
with breast cancer (especially if they
had it prior to age 50)
- Treatment with
radiation therapy to the breast/chest
(especially if at a young age)
tissue that is dense on a mammogram*
hormones, such as estrogen and progesterone
- Drinking alcoholic
beverages (more than one per day)
- Being white
- Being overweight, especially
after menopause (when monthly
*A breast is said to
be dense if it consists mainly of ductal
tissue rather than fatty tissue.
A mammogram cannot “see” through
the ductal tissue in dense
breasts and is not as effective as a mammogram on a breast with
more “see-through” fatty
tissue. The only sure way
to tell if a breast is
mostly fatty or dense is
to have a mammogram.
reduce the risk of breast
The following lifestyle
changes have been shown
to decrease a woman’s
chance of developing breast
a healthy weight, especially
after menopause. A
healthcare provider can give you guidance
on what is a healthy weight for you.
alcohol intake. Limit yourself to one
drink per day or less.
- Breastfeeding for
12 months or more (combined over all
- Taking certain medications. For some
women at very high
risk of breast cancer, tamoxifen or raloxifene may lower their risk of the
disease. Researchers are still
studying their long-term side effects. Talk to your healthcare provider
if you have any
questions about these drugs.
- Exercising regularly.
for a Healthy Lifestyle
- Avoid smoking or
- Exercise regularly.
- Eat healthy.
- Have nine or more
servings/day of fruits and vegetables
- Eat whole grains
whenever possible (whole wheat
bread and pasta, oatmeal, brown
- Limit fats, oils
- Eat breakfast (people
who eat breakfast generally eat
less later in the day)
- Drink lots of water
(at least 64 ounces)
Tips for Everyday
- Exercise regularly.
Aim for 30 minutes of moderate
to vigorous exercise three or more
times a week. Even modest amounts
of exercise are beneficial. Start
by walking 10 minutes a day, three
days a week, and build up from
- Take the stairs
instead of the elevator
- Park farther away
- Take walking breaks
- Walk around the
mall, or around your block, or
at museums, zoos or other places
- Rake leaves or do
What is screening
for breast cancer?
Screening looks for cancer before there
are any symptoms. The goal
is to find cancers before they start to cause symptoms, when they are
most treatable. Mammography
does not detect all cancers, but it is the best tool available
to detect breast
cancer at its earliest stage.
screening tests to find breast cancer
are not perfect, but they are the best
available right now. Most doctors feel
that these early detection tests for
breast cancer save many thousands of
lives every year. Screening will not
reduce your risk, but it will help find
cancer early, when it is more likely
to be treated successfully.
are commonly used to screen for breast
cancer: mammography, clinical breast
examinations and breast self examinations.
Mammography is currently one
of the most effective tools used to detect
breast cancer and other abnormalities in
breast tissue. A mammogram is a safe, low-dose,
X-ray picture of the breast. It can often
show changes in the breast before you or
your doctor can feel them.
75 to 90 percent of breast cancers. Mammograms
are less effective in younger women than
in older women because younger women tend
to have more dense breast tissue (harder
to read on a mammogram).
Your Mammogram Results
As of April 1999, mammography
facilities are required to give you
the results of your mammogram directly
and in understandable “lay” language
within 30 days of your mammogram. Your
physician will receive a more technical
report of your results.
diagnose breast cancer without other follow-up
tests. (An abnormal finding requires further
testing, such as biopsy, to be able to
diagnose whether breast cancer is present.)
Also, mammograms have a high “false
meaning that they sometimes show something
abnormal in the breast when no cancer
For more information about
follow-up tests, see Making
Do I need a prescription
(order) or physician referral to get a mammogram?
most cases, yes, you need a referral. It
could be from a doctor, physician’s
assistant or nurse practitioner. However,
some facilities have a list of physicians
who will take “self-requesting” women.
The woman’s mammography results
will be sent to this physician for follow-up
and further care, if needed. The reason
for this is to make sure women are receiving
follow-up care after they get a mammogram.
You do not need a referral to go to a
public health department and ask for
What is the difference between
a screening mammogram and a diagnostic
A screening mammogram is performed
when the breast is normal (there are no
signs or symptoms of anything abnormal) in
order to detect the disease early.
In the screening mammogram, usually two
pictures of each breast are taken.
Women should usually begin regular screening
mammograms at age 40.
A diagnostic mammogram
is performed if you notice changes in
your breasts such as a lump, thickening,
swelling, pain, nipple discharge or retraction
(the nipple or skin being pulled in).
It may also be performed if something
abnormal shows up on your screening
mammogram. The diagnostic mammogram
involves extra pictures that are not
included in the screening mammogram.
you notice any lumps or changes in your
breasts, it is important to tell your
doctor or mammography provider. They may
want to order extra views of your breast
and perform a diagnostic rather than a
screening mammogram. They may also perform
an ultrasound test.
If you have a lump in your
breast, make sure to tell your healthcare
provider BEFORE your mammogram.
One “normal” mammography
report alone does not equal good breast
health practice. Regular (yearly) mammograms—not
just one—find breast cancer at
its earliest, most treatable stage. If
your doctors have prior mammogram
pictures of your breasts, they will be
better able to tell if something in your
breast looks abnormal later.
way for your doctor or mammography provider
to interpret mammography film is by comparing
the films with your previous mammogram.
If you are going to a new facility, bring
your prior films with you if at all possible,
or have a copy sent to your new mammographer
Are mammograms covered by
North Carolina law requires health
insurance to cover screening mammograms,
including one baseline exam for
women ages 35-39, a mammogram every other
year for women ages 40-49, and
an annual mammogram for women age 50
and over. Coverage may include more frequent
exams for women at high risk. Medicare
now covers mammograms every year.
Strict guidelines are
in place to ensure that mammography equipment
is safe and uses the lowest dose
of X-ray radiation possible. To put
the dose in perspective, the American
Cancer Society notes that one mammogram
exposes a woman to roughly the same
amount of radiation as flying from
New York to California on a commercial
A QUALITY MAMMOGRAM
Quality Standards Act of 1992 (MQSA)
requires mammography facilities
to be FDA-certified. To be certified,
facilities must meet certain standards
for the equipment they use, the
people who work there, and the records
they keep. You should get your mammogram
in a facility that is certified.
During a mammogram, the breast
is placed between two plates to flatten
the tissue for a few seconds and produce
a good, readable picture of the breast.
It may be uncomfortable for a few moments,
but it does not harm the breast.
The thinner the breast can be compressed,
the less radiation is required to
obtain a good picture.
Are mammograms effective
for women of any age?
For the majority
of women, mammograms can detect abnormalities
in breast tissue. However, for younger
women, especially those under age 40, mammograms
may not be as effective in detecting
breast cancer. This is because younger
women tend to have more “dense” breast
tissue, and dense breast tissue
is harder to read on a mammogram. Mammograms
tend to be most effective in
women over age 50.
Breast implants can
be a problem in obtaining accurate mammogram
readings because silicone implants are
not transparent on X-rays and can block
a clear view of the tissues behind them,
especially if the implant has been placed
in front of—rather than beneath—the
How do I find
a mammography facility in my area?
are more than 250 North Carolina mammo-graphy
facilities (including mobile mammography)
that are accredited by the American College
of Radiology. In North Carolina, to be
FDA certified, a facility must first
be accredited by the American College of
Radiology. To find a certified mammography
facility, ask your doctor or see the Resources
at the end of this section.
if I can’t afford
has programs in place to help women pay
for mammograms. One such program
is the North Carolina Breast
and Cervical Cancer Control
Program (NC BCCCP), available through
local health departments. The BCCCP
provides free screening for breast
or cervical cancer at no cost for women
who have limited or no insurance, do
not have Medicare or Medicaid, and
who meet certain income guidelines.
BCCCP does have age limitations, and
funding is limited. Most money is allocated
to the 50 and above age group.
CLINICAL BREAST EXAMINATIONS
A clinical breast examination
(CBE) is usually performed by your doctor
at an annual or biannual visit. CBE may
be done during a routine physical exam
or together with a mammogram. Your doctor
or health professional will carefully examine
the breasts and under the arms for lumps
or other abnormalities. You should also
be given the opportunity to ask questions
and express any concerns you may have.
Let your doctor know of any changes you
may have noticed in your breasts, such
as lumps, pain, nipple discharge, changes
in shape, differences between breasts, tenderness
or skin changes.
BREAST SELF EXAMINATIONS
Breast self examination (BSE)
consists of looking at and feeling the
breasts every month to detect a change
in one or both breasts. BSE is recommended
a few days after your period ends, when
your breasts are least tender and not swollen.
performing BSE on a regular basis, you
will be able to know your breast tissue
and recognize changes more quickly. Some
women may not perform monthly BSE because
they do not know, or have not been taught,
how to do it. A healthcare provider can
give you guidance about how to do breast
self-exam. You can also see the Resources
at the end of this section for organizations
that have BSE instructions and pictures.
OFTEN SHOULD YOU HAVE MAMMOGRAMS AND
CLINICAL BREAST EXAMS
The American Cancer Society
offers the following screening guidelines:
age 40 or older should have a screening
mammogram every year and a clinical
breast exam by a health professional
- Women in their 20s and 30s
should have a clinical breast exam
(CBE) as part of a regular health exam
by a health professional, preferably
every three years.
- Monthly breast self-exam
is an option for women beginning in
their 20s. Women should report any breast
changes to their healthcare professional
The above recommendations
are for women who are at average risk of breast cancer.
Women who are at higher
than average risk for breast cancer,
such as women with a family history, should
talk with their healthcare providers
about the benefits and limitations of starting
mammography when they are younger, having
additional tests (such as breast ultrasound
or MRI), or having more frequent exams.
in this section was compiled from National
Cancer Institute and American Cancer
Society educational publications.
are resources available in North
Carolina for low-income women to
obtain free or low-cost clinical
breast exams, mammograms, biopsies
and treatment for breast cancer.
and Other Assistance.
American Cancer Society (ACS)
800.ACS.2345 or 866.228.4327 (TTY)
Provides information, services and free booklets
for all forms of cancer; information on local
financial assistance and mammography facilities
in your area, diagnosis, treatment, and many
other topics, including quality mammography
and a breast health card.
American College of Radiology (ACR)
703.648.8900 or 800.227.5463
Provides information about mammography and
other tests used to detect breast cancer.
National Breast Cancer Coalition
202.296.7477 or 800.622.2838
The nation’s largest breast cancer
advocacy group, NBCC publishes fact sheets
and position papers on breast cancer issues
and an excellent Guide to Quality Breast
Cancer Information Service
800.4.CANCER (800.422.6237) or 800.332.8615
One of the best resources available for cancer
patients, CIS provides the toll-free hotline
above in English and Spanish for questions
about any type of cancer or to order free
booklets. Call to find mammography facilities
in your area or to order free booklets about
breast cancer, breast changes, and mammograms.
Susan G. Komen Breast Cancer Foundation
Foundation for breast cancer research, education,
screening and treatment. Call the toll-free
helpline above for breast health/cancer questions
or to order information about how to do BSE.
U.S. Food and Drug Administration
(FDA) - Center for Devices and Radiological
At the FDA web site, under Consumer Information,
there is a list of all mammography facilities
certified in the United States (updated monthly).
You can locate mammography practices by zip
code, state, city and facility name, or call
Cancer Information Service at 800.4.CANCER.
Y-ME National Breast Cancer Organization
312.986.8338 or 800.221.2141
Offers breast cancer education and support,
and a national 24-hour toll-free breast cancer