Everything You Need to Know About Breast Cancer

"It's cancer" are two words no one ever wants to hear, but the encouraging fact is that the earlierbreast cancer is detected, the better the prognosis. The National Cancer Institute places the five-year survival rate at 100 percent if breast cancer is caught in stage 1. That's why it's so important to get screened regularly—but it seems the more we learn about screening methods, the more questions there are. Our experts explain the latest.

The Scoop on Screenings

Self-exams. Experts have moved away from offering instruction on how to do monthly self-exams. Now they're more likely to tell women to be more alert to how their breasts look and feel in general so they can detect any changes. "Research has shown that there are no significant benefits to doing monthly self-exams," explains Therese B. Bevers, MD, medical director of the Cancer Prevention Center at M.D. Anderson Cancer Center in Houston. "We don't want to confine women to a specific technique, frequency or time—it's more about your overall awareness." That said, if you want to do self-exams it can't hurt, and it may very well help catch some early tumors that might otherwise spread. Photo: Getty

"The official recommendation may be to skip it, but I tell my patients that as long as they're comfortable doing self-exams, it's for their own benefit," says Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology at Yale School of Medicine. Not sure of your technique? Ask your doc to explain what she's doing at your yearly checkup, when most gynecologists will perform a clinical breast examination.

Mammograms. You've no doubt heard about the controversy stirred by the U.S. Preventive Services Task Force: In late 2009, the group recommended that women who are not at high risk for breast cancer start getting mammograms at age 50 instead of 40. Then, in September 2010, a study published in the New England Journal of Medicine found that getting screening mammograms cut the risk of dying from breast cancer by 10 percent versus the 25 percent that previous studies had indicated.

So does that mean mammograms aren't worth it—or that you should wait until 50 to start having one? First of all, a 10 percent improvement in survival is still pretty significant. Also important to note: The New England Journal of Medicine study was done in Norway, and their health care system is different from ours so the results might not be applicable here, says Catherine Lee, MD, an assistant professor of surgery specializing in breast cancer at Moffitt Cancer Center in Florida. "Currently, about 50 percent of breast cancers in the U.S. are detected by screening mammography," says Dr. Lee. 

As for when to start getting screened, it's a conversation every woman should have with her doctor, but you should know that many experts—including the American Cancer Society and the National Comprehensive Cancer Network, an alliance of 21 leading cancer centers—say mammograms should still start at age 40. If you have a strong family history (a first-degree relative, meaning a parent, sibling or child, who has developed breast cancer) or have tested positive for a BRCA1 or BRCA2 gene mutation, experts recommend beginning even sooner, usually 10 years earlier than the youngest family case, but not before age 25.

"You need to balance the risks and benefits, and weigh the severe cost of missing cancer against that of extra mammograms and possible biopsies," says Dr. Bevers. "I strongly believe that if even one fewer woman dies from breast cancer because she went through the screening process, we should be telling our patients to get mammograms earlier, not later." Women in their 40s often have denser breasts than older women, which can make it harder to read their mammograms. But many centers now use digital mammography, which can make it easier to spot potential problems on denser breasts.

Sonograms. If you're at higher risk or have very dense breasts, your doctor may recommend getting an ultrasound (also called a sonogram) along with your annual mammogram. "There's a chance you'll find something on an ultrasound that you wouldn't see on a mammogram, but it's not nearly as sensitive as getting an MRI," says Dr. Bevers.

MRIs. Many cancer experts advise high-risk patients (those with a strong family history of cancer or a BRCA mutation) to get an annual MRI spaced 6 months apart from their annual mammogram. "MRIs are highly sensitive and can pick up cancers at a very early stage," says Dr. Bevers. But they also have a high level of false positives, and the process itself (you lie perfectly still in a confining tube-shaped scanner) can be unsettling. Talk to your doctor about which screening method is most suitable for you.

6 Musts for Every Woman to Lower Her Risk of Breast Cancer

Although you don't have total control over your risk for this disease, the American Institute for Cancer Research says that nearly 40 percent of all breast cancer cases in the U.S. annually could be prevented with lifestyle measures like eating right and exercising. Get started today:

1. Stay at a healthy weight. Research shows that post-menopausal women who are obese are 1.5 times as likely to develop breast cancer as their normal-weight counterparts, and are at a significantly higher risk of dying from the disease. Experts estimate that up to 18,000 deaths per year from breast cancer in women over age 50 might be avoided by maintaining a body mass index (BMI) of under 25 throughout adulthood. One potential reason is that fat tissue can produce estrogen. Too much of it raises your estrogen levels, thus increasing your risk of cancer. Photo: ThinkStock

2. Exercise. There's a benefit to getting a move on, no matter what you weigh. Research from the National Cancer Institute shows that exercising four or more hours a week can decrease estrogen levels and in turn help lower breast cancer risk. Make your workout intense and your risk will decrease by as much as 30 percent. Try taking a brisk 30- to 45-minute walk, bike ride, swim or kick-boxing class or doing some other form of aerobic activity five or six days of the week. Do two of those workouts in intervals, increasing the intensity for a few minutes at a time, or pick up the pace for most of the session (jog instead of walk, ride a few miles per hour faster on your bike, etc.).

3. Limit alcohol. There's a well-defined link between drinking and breast cancer risk: The more alcohol you consume, the greater the danger. Women who have two to five alcoholic drinks a day have about 1.5 times the cancer risk of those who don't drink any. Limit yourself to no more than one alcoholic beverage a day (typically a 12-oz beer, a 5-oz glass of wine or 1.5 oz of liquor).

4. Know your family history. If your mother, grandmother or maternal aunt developed breast cancer at age 50 or earlier, you may carry the gene mutation BRCA1 or BRCA2, which can place your lifetime risk of breast cancer at 60 percent (and your risk of ovarian cancer at 15 to 40 percent). Talk to your doctor about genetic testing and find out what protective actions you can take.

5. Eat healthy. Research shows that a diet rich in fruits, vegetables, fish, olive oil, whole grains and legumes is linked to a reduced risk of breast cancer in post-menopausal women. A recent study also showed that women who carried the BRCA mutation and ate a wide variety of fruits andvegetables had up to a 73 percent lower risk of breast cancer than women with the mutation who didn't eat their veggies.

6. Check your D levels. Although some experts say the link between vitamin D and breast cancer is uncertain, a few studies have highlighted a connection. One study found that higher levels of D meant a 50 percent lower risk of breast cancer. Another revealed that women who got a lot of vitamin D from diet, supplements or spending time outdoors were 25 to 45 percent less likely to develop breast cancer than those with lower levels.

6 Things that Definitely Won't Give You Cancer

1. Deodorant or Antiperspirant. Despite the persistent rumors, experts are unanimous in emphasizing that the stuff that keeps you dry won't boost your risk. In fact, a 2002 epidemiologic study of about 1,600 women found no link between breast cancer risk and antiperspirant or deodorant use. Photo: Brigitte Sporrer/Getty

2. Underwire bras. Another oft-reported myth: The wire is said to compress the lymphatic system, causing "toxins" to accumulate and lead to cancer. Pure nonsense, says Dr. Bevers. No clothing can increase your cancer risk.

3. Caffeine. Although it can make some breasts feel lumpier, multiple studies have shown that there's no connection between caffeine consumption and cancer. In fact, a recent Harvard study found that women who drank four or more cups of coffee a day had the same risk of breast cancer as women who drank none.

4. Your yearly mammogram. The amount of radiation you receive from a mammogram is extremely small—about as much as you would get flying from New York to California in a commercial jet, according to the American Cancer Society.

5. Having big breasts. This is one area where size truly doesn't matter. Anyone with breasts is at risk of developing cancer! However, if your breasts are dense—and they can be dense at any size—you may want to talk to your doctor about additional screening methods beyond mammograms. Up to 35 percent of breast cancer goes undetected by mammography, and this is most often a problem when breasts are very dense.

6. Breast implants. There's no connection between surgical enhancement and cancer risk, says Cynara Coomer, MD, chief of breast surgery at Staten Island University Hospital and an assistant clinical professor of surgery at Mount Sinai School of Medicine in New York. But keep in mind that implants may make it more difficult for a radiologist to read your mammograms. "You may have to have more images taken, and it can be uncomfortable to move the implant out of the way during the mammogram."

"I Found a Lump. Now What?"

A "don't panic" guide if you do find something that doesn't feel right

1. Stay calm. It's hard not to freak out, but take some comfort in the fact that the vast majority of lumps end up being a fatty nodule or some other noncancerous mass, says Dr. Coomer.

2. If you can stand to wait, go through your menstrual cycle, cut out the caffeine and see if the lump is still there in a couple of weeks.

3. Call your health care provider. She may refer you to a breast specialist or send you for a mammogram and/or ultrasound. If a lump is found, you may need to get a needle biopsy, a procedure in which a needle is inserted into your breast to take a sample of cells to figure out what's causing the lump. But this still doesn't mean it's cancer. In fact, about 80 percent of breast biopsies find benign lumps. Photo: ThinkStock