The specter of breast cancer strikes at some of our greatest fears and vulnerabilities, threatening our femininity, sexuality, and ability to nurture. As one woman said, “Breast cancer hits us where we live.” I want to address the issue of breast cancer here in a way that helps us move from anxiety to action. It isn’t always easy or straightforward, because there are no clear-cut, tidy answers that can put our concerns about breast cancer to rest. But we can better understand our risks and use the same solid reasoning that we use to make decisions about other aspects of our health. In that way we can feel like we are doing all that is currently possible to minimize the probability of developing breast cancer in our forties.

LOOKING AT THE NUMBERS

The information about breast cancer is hard to sort out. On the one hand we hear scary statistics about the rising incidence of the disease and warnings that one in eight women will develop it. Yet we also hear that breast cancer is being detected earlier and that the cure rate is increasing.

Let’s pause, take a deep, calming breath, and look at what these numbers really mean. First, the one-in-eight figure does not mean that if you’re sitting with a group of eight friends, one of you will develop breast cancer. That’s because not all women of all ages are equally subject to this “one in eight” risk. A woman’s risk of breast cancer changes as she ages: before age 40, her chance of getting breast cancer within the next ten years is 1 in 233, according to the American Cancer Society. Between 40 and 50, she has a l-in-65 chance. The risk increases as she ages: after 50 her probability of developing breast cancer within the next ten years is 1 in 41, and after age 60, 1 in 29. The majority of women who develop breast cancer do so after age 65. These numbers do not provide reassurance, but they provide perspective.

Other factors besides age are considered in assessing a woman’s risk of developing breast cancer:

- Number of first-degree relatives who have had breast cancer (sister, mother, grandmother, aunt)

- Age at first period (menarche)

- Age at first childbirth

- Number of breast biopsies that show abnormal tissue

Early menarche, delayed childbearing, and late menopause are all associated with an elevated risk of breast cancer. But even these risk factors are not precise indicators; they merely help to determine the probability that a woman will develop breast cancer. The reality is that the majority of all breast cancers appear in women who have no risk factors.

The presence of the breast cancer genes (BRCA1 and BRCA2), which were identified in 1994, also indicates a higher risk of breast cancer among certain women. When a copy of either gene is damaged or flawed, cancerous cells in the breast can develop, approximately 10 percent of breast cancers are caused by defective BRCAI or BRCA2 genes. The breast cancer genes have many mutations, and as yet no uniform guidelines are in place to advise a woman about treatment and prognosis if genetic testing reveals that she carries a damaged gene.

Breast cancer rates

After climbing by an alarming four percent per year from 1982 to 1987, the incidence of breast cancer appears to have stabilized in recent years, neither dropping nor rising dramatically. Each year more than 184,000 cases will be diagnosed, and nearly 45,000 women will lose their lives to breast cancer. Some researchers and advocates refer to the incidence of breast cancer as an epidemic. Regardless of how we view the incidence of breast cancer, it feels like an epidemic to every woman who has been touched by the disease, either personally or through someone she loves.

I was recently reminded of how vulnerable we feel in the face of breast cancer when Sharon came in for a follow-up visit. Her perimenopausal symptoms of fatigue and depression had been compounded by the fact that her husband was recovering from a serious illness. Now she learned that her husband’s mother, to whom she was very close, had had a recurrence of breast cancer several years after her original diagnosis. “I’m just numb,” Sharon said. “It seems like too much for our family to take.”

Numb. Too much to take. Those were some of my own feelings a few years ago, when my routine mammogram showed a possible abnormality. When I heard my doctor say, “We’re going to have to do a biopsy,” the room suddenly got very small, as if I were watching from a great, great distance, and my blood seemed to pound in my ears. So pure was my panic that I almost couldn’t drive home. I am deeply thankful that the breast tissue in question turned out to be benign in my case, but I will never forget those terrified few days, and I hope that if I ever have to repeat them, I will find the strength I need.

Knowing your body

The issue of breast cancer becomes even more highly charged for women in their forties who are considering hormone replacement therapy to relieve perimenopausal symptoms or for potential heart and bone protection. The research data are contradictory; with some studies showing a strong relationship between HRT and breast cancer and others finding that HRT has no effect on incidence of the disease. Before we get to that point, I want to outline the proactive steps you can take, giving yourself a measure of control even when you cannot precisely predict your risk of this disease and in spite of information that is often difficult to interpret.

You know your own body better than anyone, and you need to be as familiar with your breasts as you are with every other part of yourself. If you’re not yet in the habit of examining your breasts every month, make a commitment to start this month. You can hang a reminder in the shower¡ªsome health care facilities provide waterproof instruction cards when women come in for mammograms. The best time to examine your breasts is two to three days after your period ends, when your breasts are less likely to be tender. Women who no longer have regular periods can mark their calendars for the first of every month to remind themselves to examine their breasts. The goal of practicing regular breast self-exams (BSEs) is, again, to become more familiar with your breasts and to learn to recognize changes in them. It’s important to remember that most often; breast changes are normal and benign.

It may help you to feel more comfortable about examining your breasts if your health care provider goes over the procedure with you. He or she can point out areas in your breast that feel firmer than others, building confidence in your own ability to recognize changes in your breast tissue. In addition, your health care provider should examine your breasts yearly when you have your regular physical and Pap smear.

Related posts:

1. The Basics of Breast Cancer

2. The Basics of Perimenopause – Risks and Benefits Hormone Replacement Therapy

3. Menopause Tips – Check Your Breasts

4. The Basics of the Changes In The Mirror During Perimenopause – Breast Changes

5. The Basics of Importance of Breast Screening With Mammorgraphy During Perimenopause

6. How to Deal with Breast Cancer

7. Breast Cancer – Possible Radiation Side Effects

8. Nutrition for Breast Cancer Patients and Survivors

9. The Basics of Perimenopause – Planning Ahead for Healthy Heart, Bones, and Breasts

10. Changing your life … Or not – After Breast Cancer Treatment