What Everyone Should Know about Breast Cancer

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CHICAGO: An estimated 1 in 8 women will be diagnosed with breast cancer in their lifetime — more than any type of cancer diagnosed except for skin cancer.1

New standards released by the National Accreditation Program for Breast Centers (NAPBC) of the American College of Surgeons (ACS) describe in detail why understanding each patient’s unique journey through breast cancer treatment — from screening and prevention to diagnosis, treatment, and survivorship — is a vital component of comprehensive breast care.

For Breast Cancer Awareness Month, breast surgeons with the ACS discuss what every woman should know about breast cancer — and why caring for patients through survivorship remains an important, yet often under-addressed, issue for many women.

What to know about breast cancer in 2023

Young women are increasingly at risk — Though women over 50 are most commonly diagnosed with breast cancer, more young women are being diagnosed with the disease, sometimes at advanced stages.2,3 According to a recent study published in JAMA Network Open, cancer diagnoses in people younger than 50 are on the rise, with breast and gastrointestinal cancers rising at the highest rates in this population. The researchers found that the incidence of early-onset breast cancer rose by about 8% from 2010-2019.

In response to these alarming increases and other disparities, the U.S. Preventive Services Task Force (USPSTF) now recommends that women at average risk of developing breast cancer start receiving regular mammograms at age 40, which is ten years earlier than previously stated.

“I think it’s also important for women to know about breast cancer well before age 40. An individual woman’s risk for breast cancer will differ greatly depending on her family history and things that have happened to her in the past,” said Ingrid Lizarraga, MBBS, FACS, Commission on Cancer State Chair for Iowa and a breast surgical oncologist with the University of Iowa Hospitals & Clinics. “If you think, ‘Breast cancer can’t happen to me,’ or, ‘I don’t have to worry about that until I’m in my 40s,’ you may end up delaying a diagnosis or not receiving high-risk screening when you should.”

Women can protect their health by getting screened with mammograms (usually by age 40 or earlier if recommended by their doctor), scheduling a yearly wellness exam, and practicing breast awareness. Any lump or changes to the skin or nipple that persist should be reported to a doctor promptly.

Breast density is one factor that may increase risk — Starting in September 2024, all breast centers will be required by the U.S. Food and Drug Administration (FDA) to notify women of their breast density in their mammogram report. Breast density refers to the amount of fibrous and glandular tissue a woman has in her breast compared with fatty tissue. Women with more fibrous and glandular tissue tend to have denser breasts. Having dense breasts is very common, especially in younger women.

“Breast density is important for two reasons. First, it’s much harder to see through fibrous and glandular tissue on a mammogram, which may make it easier to miss abnormal findings. And secondly, women with very dense breasts have a higher risk inherently of developing breast cancer than women with less dense breasts,” Dr. Lizarraga explained. Breast density is not necessarily associated with breast size or BMI – it’s something that can only be determined through a mammogram, she added. Some women with dense breasts may benefit from additional screening options such as breast ultrasound or MRI.

While knowing breast density is important, it is just one risk factor among many others, including family history, inherited genetic mutations, and lifestyle factors.

Inequity persists and widens disparities — Black women are more likely to die from breast cancer than any other race or ethnic group and are also at increased risk of developing more aggressive forms of breast cancer. In addition, though less likely to be diagnosed with breast cancer than White women, Latina and Hispanic women are at higher risk of being diagnosed with more advanced stages of the disease.

These disparities are likely due to barriers that prevent some women from getting screened and reduced access to equitable care. Other factors, including geography, insurance status, and hospital type, can greatly influence care for all women. “There are so many aspects of breast cancer care where disparities still exist,” said Kathie-Ann Joseph, MD, MPH, FACS, a professor of surgery and population health at NYU Langone Health, a member of its Perlmutter Cancer Center, and senior author of a study published in the Journal of the American College of Surgeons on disparities in breast cancer care. “Even though services may be readily available to certain populations, there are still populations that don’t have access to the latest treatment or surgery options, or they may not have the full breadth of access.”

Decisions can be overwhelming — While breast cancer is common and advances in surgery and treatment are helping more women survive breast cancer, the disease, like any cancer, takes a significant toll on a woman’s well-being. Research shows that a significant portion of breast cancer survivors struggle with reduced physical function, mental health issues such as anxiety or depression, and fear of recurrence.4 Choosing between treatment options and deciding whether to undergo breast reconstruction is complex and will be different for every person.

Katharine Yao, MD, FACS, chair of the NAPBC and director of breast cancer research at NorthShore University HealthSystem, recommends that patients take time to reflect on factors that matter to them the most when choosing between treatment options, such as quality of life, cosmetic appearance, and how important it is to them to keep their breasts.

“Patients should seek out a team that they have confidence in, that they trust will have their back when they need it, and a team that they feel can have access to and that will help when they need it,” Dr. Yao said. “Remember that every patient’s journey with breast cancer will be different, and a patient’s values, well-being, and quality of life should be addressed every step of the way.”

One good marker to guide quality care is looking for a center accredited by the NAPBC, which has in place new guidelines that help accredited centers put patients and their care journey front and center of the treatment process, from diagnosis through survivorship. A list of centers accredited by the NAPBC can be found on the ACS website.

Journalists may email [email protected] to schedule media interviews with surgeons during Breast Cancer Awareness Month. Resources on breast cancer for the media and the public are also available on the ACS website.

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  1. Key Statistics for Breast Cancer, American Cancer Society, September 2023, www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html
  2. Koh, Benjamin, et al. “Patterns in Cancer Incidence Among People Younger Than 50 Years in the US, 2010 to 2019.” JAMA Network Open6.8 (2023): e2328171-e2328171.
  3. Cathcart-Rake, Elizabeth J., et al. “Breast cancer in adolescent and young adult women under the age of 40 years.” JCO oncology practice17.6 (2021): 305-313.
  4. Grusdat, Niklas Paul, et al. “Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression.” Supportive Care in Cancer30.5 (2022): 3733-3744.

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