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CANCER
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Risk Factors You Cannot Change
Gender: Simply being a woman is the main risk factor for developing breast cancer. Although women have many more breast cells than men, the main reason they develop more breast cancer is because their breast cells are constantly exposed to the growth-promoting effects of the female hormones estrogen and progesterone, thus making breast cancer much more common in women than men. Men can develop breast cancer, but this disease is about 100 times more common among women than men.
Aging: Your risk of developing breast cancer increases as you get older. About 18% of breast cancer diagnoses are among women in their 40s, while about 77% of women with breast cancer are older than 50 when they are diagnosed.
Genetic risk factors: Recent studies have shown that about 5% to 10% of breast cancer cases are hereditary as a result of gene changes (mutations). The most common gene changes are those of the BRCA1 and BRCA2 genes. Normally, these genes help to prevent cancer by making proteins that keep cells from growing abnormally. However, if you have inherited either mutated gene from a parent, you are at increased risk for breast cancer.
See the section "Do We Know What Causes Breast Cancer?" for more information about genes and DNA. Women with an inherited BRCA1 or BRCA2 mutation have up to an 80% chance of developing breast cancer during their lifetime and at a younger age than those women who are not born with one of these gene mutations in their cells. Women with these inherited mutations also have an increased risk for developing ovarian cancer.
Other genes have been discovered that might also lead to inherited breast cancers. One of these is the ATM gene. ATM stands for ataxia-telangiectasia mutation. The gene is responsible for repairing damaged DNA. Certain families with a high rate of breast cancer have been found to have mutations of this gene. Another gene, the CHEK-2 gene, also increases breast cancer risk when it is mutated. Neither one of these genes, however, is a frequent cause of familial breast cancer.
Inherited mutations of the p53 tumor suppressor gene can also increase your risk of developing breast cancer, as well as leukemia, brain tumors, and/or sarcomas (cancer of bones or connective tissue). The Li-Fraumeni syndrome, named after the 2 researchers who described this inherited cancer syndrome, is a rare cause of breast cancer.
If you are considering genetic testing, it is strongly recommended that first you talk to a genetic counselor, nurse, or doctor qualified to interpret and explain these tests, before being tested. It is very important to understand and carefully weigh the benefits and risks of genetic testing before these tests are done. Testing is expensive and is not covered by some health plans. There is concern that people with abnormal genetic test results will not be able to get life insurance or that coverage may only be available at a much higher cost, but many states have passed laws that prevent insurance companies from denying insurance on the basis of genetic testing. To learn about your state, you can go to this internet site www.ncsl.org/programs/health/genetics/ndishlth.htm
For more information, see our position statement on genetic testing or go to the National Cancer Institute site on genetic testing for breast cancer.
Family history of breast cancer: Breast cancer risk is higher among women whose close blood relatives have this disease. Your risk of developing breast cancer is increased if:
You have 2 or more relatives with breast or ovarian cancer.
Breast cancer occurs before age 50 in a relative (mother, sister, grandmother or aunt) on either side of the family. The risk is higher if your mother or sister has a history of breast cancer.
You have relatives with both breast and ovarian cancer.
You have 1 or more relatives with two cancers (breast and ovarian, or 2 different breast cancers).
You have a male relative (or relatives) with breast cancer.
You have a family history of breast or ovarian cancer and Ashkenazi Jewish heritage.
Your family history includes a history of diseases associated with hereditary breast cancer such as Li-Fraumeni or Cowdens Syndromes. Having 1 first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk, and having 2 first-degree relatives increases her risk 5-fold. Although the exact risk is not known, women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, about 20% to 30% of women with breast cancer have a family member with this disease.
Personal history of breast cancer: A woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast. This is different from a recurrence (return) of the first cancer.
Race: White women are slightly more likely to develop breast cancer than are African-American women. But African-American women are more likely to die of this cancer. Many experts now feel that the main reason for this is because African-American women have more aggressive tumors (see basal-like breast cancer, below). The reasons for this are not known. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.
Previous abnormal breast biopsy: Women whose earlier breast biopsies detected any of these changes have a slightly higher risk of breast cancer (1.5 to 2 times greater than other women):
Fibroadenoma with complex features
Hyperplasia without atypia
Sclerosing adenosis
Multiple papillomas
Atypical hyperplasia (ductal or lobular) increases a woman's breast cancer risk by 4 to 5 times.
Having a biopsy specimen diagnosed as fibrocystic changes without proliferative breast disease or fibroadenoma does not affect breast cancer risk.
Previous breast radiation: Women who as children or young adults have had radiation therapy to the chest area as treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) are at significantly increased risk for breast cancer. Some reports found the risk to be 12 times normal risk. This varies with the age of the patient at the time of radiation. Younger patients have a higher risk. If chemotherapy was also given, the risk may be lowered if the chemotherapy stops ovarian hormone production.
Menstrual periods: Women who started menstruating at an early age (before age 12) or who went through menopause at a late age (after age 55) have a slightly higher risk of breast cancer.
Diethylstilbestrol (DES): In the 1940s through the 1960s some pregnant women were given diethylstilbestrol because it was thought to lower their chances of losing the baby. Recent studies have shown that these women have a slightly increased risk of developing breast cancer.
