Q: Who is most likely to get breast cancer?
A: Breast cancer occurs most often in women older than age 50. There are many things that may increase a woman’s risk for breast cancer. You cannot control some of these things. For example, your risk increases as you age. Some of the risks, though, are lifestyle choices that you can control. Some things may cause a large increase in risk, and some may only cause a small increase in risk.

Here are risk factors that you cannot control:

• Being female

•  Getting older

•  Carrying a breast-cancer gene. Families who carry a breast-cancer gene tend to have several members with breast cancer. Women with this gene are often diagnosed with breast cancer before menopause. These families may also have cancer of the uterine lining, called the endometrium. Or they may have cancers of the ovary or colon.

•  Having a long, uninterrupted menstrual history. Here are some examples of a long menstrual history. You began menstruating at an early age--before age 12. You started menopause at a late age--after age 55. Your periods have never been temporarily interrupted for pregnancy. That is, you don’t have children. Your first pregnancy was at a late age--older than age 35.

Here are some risk factors that you can control. Controlling these risk factors may be most important if you’re already at high risk for breast cancer because of your family history and you carry the breast-cancer gene.

• Taking estrogen after menopause
• Having more than 7 alcoholic drinks   a week
• Being obese after menopause
• Smoking

Q: Do men ever get breast cancer?
A: In 2005, about 1,690 men are expected to be diagnosed with breast cancer. Little is known about this rare cancer, but the risk factors for men seem to be the same as for women.

Q: Is breast cancer inherited?
A: All cancers involve changes in the genes. Usually, cancer occurs after more than one gene changes. If a person inherits a genetic change, called a mutation, from a parent, he or she has a higher risk for cancer. It’s believed that less than 10% of breast cancers involve an inherited genetic change. Most happen because of genetic changes that occur during the person’s lifetime.

If any of these people in your family had breast cancer before menopause, you may have a greater chance of breast cancer than someone with no family history.

• Mother
• Grandmother
• Aunt
• Sister

You may be able to find out if you’ve inherited a breast-cancer gene with genetic testing. Having the breast-cancer gene may increase the risk for these cancers as well. 

• Ovarian cancer
• Prostate cancer
• Pancreatic cancer

Q: Can breast cancer be prevented?
A: There is no sure way to prevent breast cancer. You can make healthy lifestyle choices to help lower your risk. The answers are not all in on prevention. Stay informed as new research is published. For women who are at higher-than-average risk, tamoxifen has been approved in the United States to reduce the risk for breast cancer. This hormonal treatment has its own side effects and risks, so the decision to use tamoxifen should be made in careful consultation with a doctor. It’s likely that other preventive measures will be approved in the future, based on ongoing studies and approvals in Europe. For women at extremely high risk, preventive surgery to remove the breasts, called preventive mastectomy, may be considered. While many breast cancers cannot be prevented, early detection and prompt treatment can save lives when breast cancer occurs.

Q: How does diet affect breast cancer?
A: Studies show that diet affects the risk for breast cancer. But stronger case studies need to be done before it is known for sure. Here’s what we do know. In parts of the world where the incidence of breast cancer is high, diets are high in fat and animal protein. Americans eat significantly more fat and animal protein than the Japanese, and they have proportionally more breast cancer. The National Cancer Institute and the American Cancer Society suggest limiting fat intake to 30% of calories.

Q: Can injuries to the breast cause breast cancer?
A: Injuries to the breasts do not cause breast cancer to develop. Often, injuries lead to the discovery of a tumor because it causes women to pay more attention to their breasts, but bumps and bruises do not cause tumors to appear.

Q: Does breast-feeding either cause or prevent breast cancer?
A: Some studies have found that breast-feeding may reduce the risk for breast cancer. The benefit seems to be related to how long a woman breast-feeds. Studies that show a benefit tends to be in societies where women may have more than one child, breast-feed each for 2 years, with a total breast-feeding time of almost 10 years. Studies that compare women who didn't breast-feed at all to those who did for a few months generally do not show a reduction in breast cancer. Still, there are other reasons a woman may opt for breast-feeding, such as the health benefits to the baby.

Q: What is a preventive mastectomy?
A: This is surgery to remove one or more breasts to reduce the risk for breast cancer. It’s also called prophylactic mastectomy. Some women who have a very high risk for breast cancer make this choice. This surgery has been shown to reduce the risk for breast cancer by 90% in very high-risk women. However, some women who have had this surgery have regretted it. This irreversible decision should be made carefully. It should be done only after extensive consultation with a breast-cancer expert and a genetic counselor. With each expert, talk about the risks, benefits, and other alternatives.

Women with the breast-cancer gene are also at higher risk for ovarian cancer. So women who consider this surgery are often told about preventive oophorectomy, which is the removal of healthy ovaries. In premenopausal women, this surgery may decrease breast cancer risk as well.

Q: What role does estrogen replacement therapy play in breast cancer?
A: The Women’s Health Initiative study provided helpful information on the impact of hormone replacement therapy (HRT) on breast cancer in women who still have a uterus. The study, which had been scheduled to continue until 2005, was stopped early. Researchers said the risks of taking hormones such as Premarin (estrogen) and Provera (progestins) outweighed the benefits. After the women had been on HRT for an average of more than 5 years, they had an increased risk for all of these.

• Breast cancer
• Stroke
• Heart attack
• Blood clots

They had a decreased risk for colorectal cancer and hip fracture. Each woman should work with her doctor to evaluate her own risk factors before deciding about HRT.

Q: How often should I have a mammogram?
A: The American Cancer Society recommends that women older than age 40 get a mammogram once a year. The National Cancer Institute recommends women older than age 40 get a mammogram every year or 2.

Q: Does it hurt to have a mammogram?
A: A mammogram may be slightly uncomfortable, but it shouldn’t hurt. To get a clear picture, the breast is compressed between two flat plates. The procedure lasts only a few seconds. It is a good idea to schedule a mammogram after your menstrual period. That’s when your breasts are less likely to be tender.

Q: What causes breast cancer?
A: Breast cancer occurs when there are changes in certain breast-cell genes. Normally, breast-cell genes work with a woman’s hormones, diet, and environment to keep her breasts healthy. Certain genes keep breast cells from dividing, growing out of control, and forming tumors. When these genes become damaged, the cells stop growing correctly. Breast cancer usually starts in a single normal cell that becomes malignant over time. A woman may inherit these genetic changes from a parent, or they may accumulate over a lifetime. Experts are just starting to learn what may cause genetic changes. Some causes are exposure to hormones, chemicals, and radiation. Many studies are being done to learn about and prevent exposures that may cause breast cancer.

Q: Can my doctor tell if I have cancer without doing a biopsy?
A: A biopsy is the only way to be sure if the lump is cancerous or not. By feeling the lump, the doctor may be able to determine if the lump is suspicious, but can’t tell if it’s cancer.

Q: Should everyone get a second opinion when they’ve been diagnosed with breast cancer?
A: There are many reasons a woman might want to ask for a second opinion from another doctor. Here are some.

• She is not comfortable with the treatment decision.
• The type of cancer is rare.
• There is more than one way to treat the cancer.
• She is not able to see a cancer expert.

Q: How can someone get a second opinion?
A: Here are ways to find someone for a second opinion.

• Ask the doctor for the name of a specialist.

• Call the Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). Callers can learn about centers and programs supported by the National Cancer Institute.

• Get the names of doctors from a local medical society.

• Get the names of doctors from a hospital, medical school, or cancer advocacy group.

• Ask people who have had the same kind of cancer for the names of doctors.

• Check the ABMS Directory of Board Certified Medical Specialists. This book lists doctors by state and specialty. It can be found at most libraries. The information is also on line at www.abms.org.
• Contact MD Expert. They offer a second opinion service. It can be found at mdexpert.com.

Remember, it is more important to make an informed decision about your healthcare team and treatment than to make a quick decision. Give yourself time to get all the information you need to make the best choice for yourself.

Q: Where is the best place for me to get treated for breast cancer?
A: There are many things to consider when deciding where to get treatment. Ideally, a woman is treated by a team of doctors who specialize in treating breast cancer. That team is supported by other healthcare professionals. These may include:

• Oncology nurses
• Social workers
• Physical therapists
• Nutritionists

This collaboration helps ensure that all options are considered and that the best treatment plan is developed and provided.

Often, these resources may not be available close to a woman’s home. In that case, decisions must be made that balance the healthcare needs with other parts of the woman’s life. If possible, she should consider going to a multidisciplinary breast program at a major cancer center if she has a new breast-cancer diagnosis by biopsy or a strongly suspicious mammogram. Once a team of breast cancer specialists reviews her situation, surgery and treatment recommendations are made. The woman can then look into options closer to her home for radiation or chemotherapy, if needed.

If the woman lives near a comprehensive or clinical cancer center that has been designated by the National Cancer Institute, she should definitely consider getting treatment, or at least a second opinion, there. These centers are involved in the latest research, and their doctors can advise her about the newest and best treatments available.

Q: Can breast cancer be cured?
A: Ninety-five percent of women diagnosed with breast cancer in the early stages are alive after 5 years. Many women with breast cancer will be successfully treated and never have breast cancer again. However, all women who have had breast cancer are at risk for recurrence or for a second primary breast cancer. So, regular checkups and mammograms are essential. At this time, there is no cure for women whose breast cancer has spread to other parts of the body. Many of these women can live for many years, having treatment for breast cancer as a chronic illness.

Q: Is a mastectomy safer than a lumpectomy and radiation?
A: Lumpectomy is a type of breast-conserving surgery. The National Cancer Institute found that lumpectomy followed by radiation was as effective as a mastectomy in saving women’s lives from breast cancer. The risk of local recurrence is still higher with lumpectomy. But if cancer recurs in the breast after a lumpectomy and radiation, a mastectomy can still be done and can be just as effective.

Q: If I have chemotherapy, will I still be able to have children?
A: Almost half of women younger than age 35 remain fertile after chemotherapy and can have safe and successful pregnancies. Women older than age 35 are less likely to retain their fertility after treatment.

Q: Why is chemotherapy such a long treatment?
A: Cancer cells divide quickly, but they also take rests between divisions, just like normal cells do. Chemotherapy drugs attack only while the tumor cells are growing or dividing. That means the cancer cells may not be affected by chemotherapy during resting periods. Chemotherapy is given over a few months to reduce the chance that resting cancer cells will be left behind and cause a recurrence.

Q: How will breast cancer affect my sexuality?
A: Breast cancer can affect your sexuality in many ways.

• Local treatments for breast cancer--surgery and radiation therapy--may affect the appearance and sensations in the breast. You may feel uncomfortable being touched, and your partner may feel uncomfortable touching you. Talking with your partner about any concerns can help ease fears.
• Both radiation and chemotherapy may drain the energy you need for your daily activities, leaving little energy for sex.
• If you were premenopausal at diagnosis, chemotherapy may send you abruptly into menopause.
• If you had to stop hormone replacement therapy abruptly at diagnosis, you may have vaginal dryness.

Sex may not seem like a high priority during treatment. However, intimacy, in its many forms, can help both you and your partner through these difficult times. It will help if you can talk with your partner about your needs and feelings during treatment. That will help keep the communication paths open as you work together to resume and rebuild your sexual relationship when you are feeling better. You should not hesitate to discuss sexuality issues with your doctor or nurse.

Q: If I have breast cancer, do I have a higher chance of getting other cancers?
A: Women who have breast cancer are at higher risk of getting cancer of the endometrium, ovary, and colon. You also have a higher chance of getting breast cancer in the other breast.

This information was provided by the Women's Cancer Network (www.wcn.org).