Breast cancer continues to be a perennial topic of discussion—and for good reason. Aside from non-melanoma skin cancer, breast cancer is the most common form of cancer among women in the United States. One in every eight American women will develop breast cancer.
There is some good news, though. Between 1998 and 2007, breast cancer rates began declining after steadily rising for 20 years. Many health professionals in the field believe that this may be due to a decline in the use of hormone therapy during menopause. A study called the Women’s Health Initiative linked hormone therapy to increased risk for breast cancer and certain heart diseases and conditions. Experts believe that continuing avoidance of hormone therapy, as well as a wider adoption of healthier lifestyles (avoiding cigarettes and alcohol use, for example) will continue to drive down breast cancer rates.
During the past year, the most significant news related to breast cancer involved a high-profile disagreement regarding screening guidelines. In November 2009, the U.S. Preventive Services Task Force announced that regular breast cancer screening should start for most women at age 50—not 40 (as was previously recommended). According to the report, the potential harms of the screening process outweighed the benefits for normal-risk women in their 40s.
Risks typically are connected to false-positives; after mammogram, women are told they have an abnormality and then follow up with further mammograms, ultrasounds, and biopsies—only to discover that they do not have breast cancer. Another possible risk is overtreatment; some women have cancerous cells detected early on and are then treated aggressively. The Task Force argues that in many cases, these cancers would have grown so slowly that they would never have become a problem in the woman’s lifetime. In cases such as these, women are unnecessarily exposed to dangerous radiation and chemotherapy treatments.
As American women tried to make sense of the new recommendations, a flurry of responses from various other research, advisory, and advocacy groups were issued. The National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network all welcomed the new guidelines, while the American Cancer Society (ACS), the American College of Radiology, and the National Cancer Institute all stated that they would continue to advise women to seek annual mammograms starting at age 40. Nevertheless, even these groups admit that the new research is meaningful. Dr. Otis Brawley, the chief medical officer of the ACS, told The New York Times that “the benefits of early detection are often overstated.”
The debate is ongoing. Another study, published on Sept. 29, 2010 in the journal Cancer, concluded that mammograms can cut breast cancer death rate by 26 percent for women in their 40s.
Despite the media confusion, all health professionals do agree on one thing: There is no one-size-fits-all guideline when it comes to breast cancer screening. Every woman is at some risk for breast cancer, and every woman should talk to her own doctor or healthcare provider to determine an individual timeline for screening mammograms.
The Latest Demographic Studies
A major trend in breast cancer studies is research into the ethnic and socioeconomic differences in breast cancer risk, diagnosis, outcome, and mortality rates. For years, public health officials have been aware of the fact that low-income and minority women have a significantly higher likelihood of dying from breast cancer than other women.
Some recent studies point to a later diagnosis and fewer first-course treatments as the causes of these discrepancies. Women in the lowest socioeconomic groups tend to be diagnosed with the lowest percentage of early-stage cancer and the highest percentage of cancer in advanced stages. This suggests that poorer women are not getting mammograms early or often enough.
African-American women, regardless of their socioeconomic situation, are more likely to be diagnosed with advanced breast cancer, and they have a higher breast cancer-related mortality rate than other groups of women. A study published in Cancer in late 2009 suggested that this might be caused, in part, by the fact that African-American women tend to wait longer between the exam that found an abnormality and the recommended diagnostic follow-up. Studies have shown that a delayed diagnosis of breast cancer—even one as short as three months—can significantly affect the outcome of the disease.
Another study, published in Hormones and Cancer, found that black women are more likely to have more aggressive tumors (and hormone-receptor-negative breast cancers) than other women, even though black women had mammographic screenings as regularly as other women. A fourth study, performed in the Netherlands and presented to the European Breast Cancer Conference of 2010, discovered that even after adjusting for factors like age, stage of the tumor, year of diagnosis, and year of initial treatment, there was still a significant relation between mortality rate and socioeconomic status. The poorest women where a fifth more likely to die within 10 years of diagnosis than the richest.
These findings point to the possibility that factors not related to screening—such as lifestyle and genetics—may contribute to higher rates of advanced breast cancer and breast cancer-related death. Scientists continue to look into potential genetic causes of breast cancer.
A New (Controllable) Risk Factor Identified
Breast cancer research is heavily invested in more accurately identifying factors that can raise a woman’s risk for developing cancer. Health professionals hope that by isolating risk factors, they can give women and their doctors better information to determine a course for breast cancer screening and, in some cases, to take steps towards disease prevention.
One important study, presented at the American Association for Cancer Research’s 2010 Annual Meeting, discovered that breast density is a fairly accurate indicator of breast cancer risk. Specifically, women who have a mammographic density of 75 percent or higher have four to five times greater risk of developing breast cancer than women with a lower density. Perhaps more importantly, the study found that women who take steps to decrease their breast density can significantly decrease their risk for breast cancer. Breast density now takes its place among a few lifestyle factors that make up the limited number of controllable risk factors for breast cancer.
New Light on Alternative Treatments
Many women happily survive breast cancer; the ACS estimates that there are more than 2.5 million breast cancer survivors in the United States, and, as stated previously, incidence rates are declining. The traditional treatment options—radiation therapy, surgery (mastectomy in particular), and chemotherapy—are still the primary means of fighting breast cancer, but researchers continue to study other potential treatments. For example, a study published in the June 2010 issue of the Journal of Agriculture and Food Chemistry found that two phenolic compounds in plum and peach extracts were effective in killing off cancer cells. Even better, they could destroy cancer cells without harming normal cells in the process. This property makes these fruit extracts an attractive potential alternative to chemotherapy and radiation.
Another novel treatment studied in the past year is acupuncture. A study published in the Journal of Oncology found that acupuncture, compared to drug therapy, had longer-lasting effect on the reduction of hot flashes and night sweats for women receiving hormone therapy for breast cancer treatment. This study was the first randomly controlled trial to compare acupuncture and drug therapy and should pave the way for further studies of the use of alternative medicine in breast cancer and other cancer treatment.
More Information on Breast Cancer:
- Awareness 101: Ribbons, Races, and More
- Breast Cancer Screenings: A Survivor's Perspective
- Slideshow: Telltale Signs of Breast Cancer
- Breast Cancer Learning Center