BREAST CANCER

Women 'unaware' of breast cancer

2009-04-17T07:06:00.000-07:00

More women are surviving breast cancer than ever before

Scottish women have an "alarming lack of awareness" about the symptoms of breast cancer, a charity has claimed.

Breakthrough Breast Cancer said it had carried out a survey which suggested one in six of those quizzed could not name any symptom of the disease.

Breast cancer is the most common cancer among Scottish women, with more than 1,000 dying of the disease every year and about 4,000 women diagnosed.

The Scottish Government said it would work to raise awareness of the cancer.

Breakthrough Breast Cancer said women needed to become more "breast aware" by carrying out regular checks and learning what signs to look out for, such as changes in the size or shape of the breast, changes to skin texture, or lumps.

The campaigners also called on women over 50 - who are more likely to be hit by the disease - to take advantage of breast screening.

Audrey Birt, the charity's director, said that while more women were surviving breast cancer than ever before, early diagnosis was key to achieving the best possible outcome.

She said: "Our message is show your breasts some TLC - touch, look, check.

"Do this by regular touching, looking for changes and checking anything unusual out with your doctor and attending breast screening if you are over 50, as these are the best ways to identify breast cancer early."

"If you find any unusual changes or are worried by anything, you should talk to your GP straight away."

The charity highlighted the case of Dorothy Denham, 52, from Bonnyrigg, Midlothian.

Ms Denham, whose mother died from breast cancer, noticed a wrinkle near her nipple but as she could not feel a lump did not believe there was a problem.

'Warning sign'

However, she later decided to get it checked out - and was diagnosed with breast cancer.

She underwent surgery and - as the disease was caught early - her long-term prognosis is good.

Ms Denham said: "I was lucky because, despite ignoring the first warning sign, when I did get diagnosed it was still early enough to remove the cancer before it could spread."

She urged other women to share any concerns with their doctor "no matter how small or trivial their worry".

The Breakthrough Breast Cancer research was carried out by pollster TNS System Three, who quizzed 542 women across Scotland over the age of 16 between 25 February and 4 March.

Health Secretary Nicola Sturgeon said: "It is important that people take every opportunity to take care of their health and wellbeing and I would echo Breakthrough's call to women to be more aware of the signs and symptoms of breast cancer.

"Information is available through the NHS and charities such as Breakthrough Breast Cancer Care, as well as advice and support.

"The Scottish Government and NHS Scotland will continue to work to raise awareness of breast cancer."

Breast Cancer

2009-04-11T10:10:00.000-07:00

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Breast cancer is the most frequently diagnosed malignancy in women. Consequently, women should become actively involved in routine breast screening. This protocol includes monthly self-examinations, a yearly examination by a healthcare professional, and an annual mammogram beginning at age 40. Women with strong family histories of breast or gynecologic cancer, a personal history of cancer, or other risk factors, may require earlier and more frequent examinations. Any abnormality identified on physical exam or mammography will require additional investigation. Often, your physician will order tests such as ultrasound or MRI to further characterize these findings.

When necessary, a tissue sample of the area in question will need to be obtained. If a lump can be felt in the breast, or if it can be seen on ultrasound, this area can easily be sampled in the office under ultrasound guidance using an automated core biopsy device. This requires no sedation or sutures, and is very accurate in acquiring tissue for the pathologist to examine. If the area in question can only be identified on mammography, then a sample must be taken either by a stereotatctic biopsy performed in the radiology department, or by a needle localized biopsy performed under sedation in the operating room. Your surgeon will discuss your options thoroughly, and assist you in making decisions regarding the type of biopsy best suited to your situation. The good news is that the majority of biopsies performed for suspicious areas in the breast prove to be benign (non-cancerous) lesions. The goal of breast screening is to identify breast cancer early, for early detection gives the best opportunity for cure.

If you are diagnosed with breast cancer, be encouraged that current treatment is very effective in producing an excellent opportunity for cure and improved survival. In most cases, the first step in treating breast cancer is the surgical removal of the cancer itself. In the past, the removal of the cancer necessitated removal of the entire breast along with the lymph nodes under the arm. This operation is called a modified radical mastectomy, and there are still conditions in which it will be the best option for a woman. Most women, however, are treated with a segmentectomy, also called a lumpectomy, in which the cancer is removed with a margin of normal breast tissue around it. This operation, coupled with radiation to the breast, gives the same opportunity for cure and survival as the mastectomy, but allows the woman to keep her breast. As a part of the surgical treatment of breast cancer, the lymph nodes under the arm must be evaluated for the presence of cancer cells, which may have spread from the breast tumor. The presence or absence of cancer cells in the lymph nodes is an important part of staging the cancer and in helping to direct additional treatment.

Again, in the past, most all of the lymph nodes under the arm were removed at the time of mastectomy, often leading to pain, limited shoulder movement, and the potential for lymphedema (swelling of the arm). Current techniques allow us to remove the few most important nodes under the arm through a small incision. These ‘most important’ nodes are called sentinel nodes, and their identification and removal is called a sentinel node biopsy. The presence or absence of cancer cells in the sentinel nodes accurately predicts the presence or absence of cancer cells in the remainder of the lymph nodes under the arm. Cancer cells identified in the sentinel nodes at the time of operation, generally necessitates the removal of the remainder of the nodes. Using these techniques of breast conserving surgery, the cancer can be removed and the nodes evaluated through two small incisions. This has become the ‘gold standard’ for the surgical treatment of breast cancer. After your operation, you will have an ongoing relationship with your surgeon, as part of your post-cancer screening protocol.

Women with early-stage breast cancer increasingly having double mastectomies

2009-04-11T07:49:00.000-07:00

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Researchers at the University of Minnesota have found that more and more women, diagnosed with the earliest stage of breast cancer, are choosing to have both breasts surgically removed.

Dr. Todd Tuttle, an associate professor of Oncologic Surgery, has observed that the rate of contralateral prophylactic mastectomy (CPM) surgery among U.S. women with ductal carcinoma in situ (DCIS) increased by 188 percent between 1998 and 2005.

“The 10-year survival rate for women with DCIS is 98 to 99 percent. Therefore, removal of the normal contralateral breast will not improve the excellent survival rates for this group of women. Nevertheless, many women, particularly young women, are choosing to have both breasts removed,” Tuttle said.

A previous study conducted by Tuttle and his colleagues found more American women choosing to have both breasts removed when cancer has been found in only one breast.

He says that his new study indicates the same attitude among women with DCIS, described as the earliest stage of breast cancer when the cancer is small and confined within a duct area of the breast.

At this stage, the disease is considered highly treatable with breast-conserving surgery and radiation or hormone therapy, points out the researcher.

Tuttle and his colleagues used the National Cancer Institute’’s Surveillance, Epidemiology, and End Results (SEER) database to evaluate information about 51,030 women diagnosed with DCIS in one breast between 1988 and 2005.

The researchers observed that about 13.5 percent of the women chose breast removal surgery for their DCIS treatment.

According to them, the rate of women opting for the surgery increased by 188 percent between 1998 and 2005.

The study has been published in the Journal of Clinical Oncology.

More Women with Breast Cancer Opt for Removal of Both Breasts

2009-04-11T07:44:00.000-07:00

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New research from the University of Minnesota shows that more women with breast cancer opt for removal of both breasts rather than take a chance that breast cancer will spread.

Todd Tuttle, M.D., lead researcher of the study found an increase of 188 percent among young women who choose bilateral mastectomy in the earliest stages of breast cancer, between 1998 and 2005. Tuttle also wonders why women are opting to have both breasts removed for early and noninvasive breast cancer, "If there is so little convincing evidence about the benefits".

According to Dr. Tuttle, professor of oncologic surgery with the University of Minnesota Medical School and researcher at the University's Masonic Cancer Center, more women with non-invasive breast cancer, confined to the milk ducts, are choosing to have both breasts removed, even though statistics show no difference in survival rates compared to less invasive forms of breast cancer treatment.

Surgery that preserves the breast, hormone therapy and radiation for breast cancer in its early stage is associated with 98 to 99 percent survival rates. Dr. Tuttle says, “Therefore, removal of the normal contralateral breast will not improve the excellent survival rates for this group of women. Nevertheless, many women, particularly young women, are choosing to have both breasts removed."

The new study supports previous research from Dr. Tuttle showing that more women with breast cancer prefer removal of both breasts once a diagnosis of breast cancer has been made, despite the excellent prognosis associated with early ductal breast cancer.

Dr. Tuttle suggests further research to clearly define the decision making process for women who choose to have both breasts removed in very early stages of cancer, especially given the potential risks and complications, and lack of solid evidence regarding the need. He suggests that physicians have a strong influence on the increasing rates of women who opt for removal of both breasts for early non-invasive breast cancer, but there is no way to evaluate what women are told. “Patients often think interventions can improve survival, even when explicitly told they do not”, says Tuttle.

Dr. Tuttle writes “Research is important and timely because it may ultimately provide decision making tools for women and their physicians”, based on multiple factors, such as breast size, genetic cancer risks, breast density, and tumor size.

Tuttle says that women who opt for removal of both breasts in early stages of breast cancer may be doing so for cosmetic rather than medical reasons, though he does not negate the value of peace of mind.

More Breast Cancer Patients Opting For Double Mastectomies

2009-04-11T07:41:00.000-07:00

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David Goodhue - AHN Reporter

Minneapolis, MN (AHN) - The number of women in the United States opting to have double mastectomies following certain breast cancer diagnoses increased almost 200 percent between the late 1990s and 2005, according to researchers at the University of Minnesota.

Dr. Todd Tuttle, the lead researcher in the study, and a cancer surgeon, said many of these surgeries are often unneeded because survival rates in women treated for ductal carcinoma in situ - or early-stage breast cancer -- is very high.

The 10-year survival rate for women with DCIS is 98 to 99 percent," Tuttle said in a statement. "Therefore, removal of the normal contralateral breast will not improve the excellent survival rates of this group of women. Nevertheless, many women, particularly young women, are choosing to have both breasts removed."

DCIS cancer is described by Tuttle as the earliest form of breast cancer, when it is confined within a duct area of the breast. It is very treatable with "breast-conserving" surgery, radiation or hormone treatment, Tuttle said.

Tuttle told the Minneapolis Star-Tribune that many women choosing double mastectomies do so for cosmetic reasons. But he said reconstructive surgery can be riskier and require more recovery time than having a lumpectomy, which can usu

Breast cancer leaflet to be rewritten

2009-02-24T10:34:00.000-08:00

Monday, 23 February 2009

A NHS leaflet informing patients about breast cancer screening is to be dropped and rewritten following complaints from experts.

Experts have said that the leaflet – sent out with invitations for women to attend screenings – is inadequate, misleading about the risks involved, and could mean women are being subjected to unnecessary surgery, chemotherapy and radiotherapy.

Professor Mike Richards has announced that the leaflet Breast Screening: The Facts will be completely rewritten and published later this year.

“A formal review is in progress and will be tested against the best available evidence,” he said.

“Our cancer screening programmes in this country are internationally recognised as being world-class and 1,400 lives are saved every year through breast screening. I want to reassure women that breast screening is safe and can lead to cancer being diagnosed and treated much earlier.”

The decision followed a letter published inThe Times newspaper last week signed by 23 doctors, surgeons, academics and health specialists, who claimed that "there are harms associated with early detection of breast cancer by screening that are not widely acknowledged".

“For example, there is evidence to show that up to half of all cancers and their precursor lesions that are found by screening, if left to their own devices, might not do any harm to the woman during her natural lifespan,” said the letter.

“Yet, if found at screening, they potentially label the woman as a cancer patient: she may then be subjected to the unnecessary traumas of surgery, radiotherapy and perhaps chemotherapy, as well as suffer the potential for serious social and psychological problems.”

The letter quoted research published last month in the BMJ, which said that 10 healthy women out of every 2,000 who were screened would be treated for cancer.

People signing the letter included Professor Michael Baum, Emeritus Professor of Surgery at University College London and Dr Paul Pharoah, Cancer Research UK Senior Clinical Research Fellow, University of Cambridge.

The experts called for the NHS to rewrite the information so they were properly informed and able to make an informed decision.

The letter also said: “None of the invitations for screening come close to telling the truth” and it said the leaflet was not being honest about the risks.

Consequently, the women “are being manipulated, albeit unintentionally, into attending”.

Husbands of Breast Cancer Patients Need Support Too

2009-02-24T10:33:00.001-08:00

Of all the illnesses, many believe hearing the word “cancer” is most terrifying, like an “out of body” experience. For me, I felt like leaping off the operating table. Not even awake yet, I heard the doctor’s words—“One was nothing. The other was breast cancer.” And he whooshed out of the room.

Like any partner of a breast cancer patient, Marc Silver reminds in his book Breast Cancer Husband: How to Help Your Wife (and Yourself) through Diagnosis, Treatment and Beyond, the man in my life was inextricably conjoined in the events.

Husbands or partners of breast cancer patients find themselves emotionally worn, Silver reminds, but few people are likely to ask how he feels. All the attention falls upon the patient, and the significant other is expected to be there to help in some imprecise, but complete, way.

And few human have those “innate” tools to “rise to the occasion.”

I’d phoned my husband, working overseas, when I got the news I’d need surgery. “Could you postpone it? I’ve got a full week at work.”

Doctors had been ignoring symptoms, despite my protests, for more than a year, and I finally had had enough.

“I think not,” I replied. He hopped a plane.

As a nurse and psychologist, working for many years with all sorts of illnesses, I wasn’t surprised. Most of the time, we’re all really capable of screwing up.

In fact, when my spouse fell outside the front door a few years later, breaking his foot, I wasn’t the most heroic, either. He drove himself to the hospital the next morning, where doctors promptly advised him that my “sprain” diagnosis was off the mark.

So for both the patient and partner, now is the time to think forward, not backward, to deal with the myriad of challenges facing those who enter the world of breast cancer.

Silver lists tips to get through it, among them:

1. It’s better to listen than to advise.

For many men, though, whose role is “fixing it,” cancer comes as a challenge in which assuming the role of listener is one of the hardest. Along with her physicians, she needs to make decisions for which he can offer little more than support and patience.

2. You matter, too.

Often taught to be strong, withhold emotion, keep up with one’s profession, pay the bills, and then help with the housework and kids, the cancer husband faces a huge span of emotions, sometimes quite the opposite of what she might be feeling.

No one enjoys this new role, and often one feels like a victim. Most therapists believe it’s positive for a husband to share his sadness or his annoyance in this situation. However, anger is a different matter, and channeling emotions with rational self talk (e.g. “I don’t like this but I can stand it”), exercise, activity, and, if times get really tough, a visit or two to a therapist, individually, or as a couple.

For most breast cancer husbands, once his wife has met her doctors and they’ve devised the plan of care, anxiety will be lessened for both, but up and down as treatments progress and change.

3. You can be a big help at the doctor’s office, and all along the way.

Often the newly diagnosed patient is so shocked that it’s her partner who asks, “What’s next?” Which then, while she is bombarded with information about tumor size and stage (From One, small and no lymph involvement, all the way to Four, meaning the cancer has metastasized to other organs), estrogen receptivity, chemotherapy or not, surgical alternatives, radiation.

I know one husband who carried a tape recorder to all of his wife’s medical appointment. More than one or two physicians raised their eyebrows; however, he explained that neither he nor his wife could remember what the doctors said moments after their meetings.

Another got a three-ring notebook and filled it with documents about surgery chemotherapy, and radiation. His wife didn’t feel like looking, but she appreciated that he did.

4. New expectations.

After her treatment is finished, it’s important to remember that life likely won’t become “the same” right away, if at all. For several months, she’ll still feel exhausted from treatment, discomforts such as swelling of the surgical area if several lymph nodes were removed (lymphedema), post treatment check-ups, in some cases hormone therapy, and fear of recurrence, along with body disfigurement, both temporary like hair loss and permanent following surgery.

Moreover, any cancer, whether his or hers, affecting reproductive organs adds a whole host of issues about sexuality and relationships, for both people. Emotional support from loved ones is a strong predictor of coping in breast cancer patients.

During the last six months to a year, time depending on whether chemo was needed, her role definitions have become confused, too. She may refrain from asking for help, being used to being the caregiver. Or she may need encouragement and support to return to become independent again.

So offer, do not hover, and now is not the time to bring up every relationship issue you’ve had during the past ten years. Neither is now the time, if you’ve been a habitually inattentive husband, to shower with gifts. A hug is better. And Silver suggests you can’t go wrong with flowers.

Meanwhile, there are some excellent opportunities on the web for breast cancer husbands or partners to find support at websites set up to help breast cancer husbands.

Individualized Approach To Breast Cancer Treatment

2009-01-27T05:23:00.000-08:00

ScienceDaily (Jan. 26, 2009) — Not all breast cancers are the same, and not all will have fatal consequences. But because clinicians find it difficult to accurately determine which tumors will metastasize, many patients do not receive the therapy fits their disease.

Tel Aviv University has now refined breast cancer identification so that each course of treatment is as individual as the woman being treated.

The new approach -- based on a combination of MRI and ultrasound -- is able to measure the metabolism rates of cancer cells. The approach helps determine at an earlier stage than ever before which cells are metastasizing, and how they should be treated.

The method, expected to start clinical trials in 2010, is currently being researched in Israel hospitals.

New Field of Medicine

“We have developed a non-intrusive way of studying the metabolism of breast cancer in real time,” says Dr. Ilan Tsarfaty, a lead researcher from TAU’s Sackler Faculty of Medicine. “It’s an invaluable tool. By the time results are in from a traditional biopsy, the cancer can already be radically different. But using our technique, we can map the tumor and its borders and determine with high levels of certainty — right away — which patients should be treated aggressively.”

The research falls in a new field called "translational and personalized medicine", and Dr. Tsarfaty says it has the potential to save thousands of lives. Papers describing his methodologies were published recently in the journals Cancer Research and Neoplasia.

“Current breast cancer treatments are not tailored to individual patients,” Dr. Tsarfaty says. “Our approach to profiling individual tumors will not only help save lives today, it will provide the basic research for developing cancer drugs of the future,” he says.

Application to Other Cancers

The new research can be applied to all solid tumors, including those resulting from lung and brain cancer, and could be used to respond to a wide spectrum of neurodegenerative diseases, such as Alzheimer’s, Dr. Tsarfaty reports.

Dr. Tsarfaty’s MRI-and-ultrasound-imaging application monitors the metabolic changes that occur during cancer metastasis. Increased blood flow (which can be sensed by ultrasound) and an increase of oxygen consumption (measured with an MRI) can indicate cancer metastasis with unprecedented levels of sensitivity.

Normally scientists look for structural changes in the body, such as the presence of a tumor. But with their new methods, Dr. Tsasfaty and his team which includes his wife, a radiologist are actually able to “see” cancer metastasis within a small group of cells long before the cancer spreads to other organs in the body.

Earlier Detection, Earlier Treatment

“Today, clinicians only diagnose cancer when they see a tumor several millimeters in size. But our diagnosis can be derived from observing only a few cells, and looks specifically at the activation levels of a protein called Met. Activated Met is an oncogen,” he says. “If the tumor cells show activation of Met, we can design personalized medicine to treat a specific kind of breast cancer.”

Symptoms & Diagnosis

2008-04-12T12:09:00.001-07:00

Symptoms & Diagnosis

Breast cancer symptoms vary widely — from lumps to swelling to skin changes — and many breast cancers have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like infection or a cyst.

Breast self-exam should be part of your monthly health care routine, and you should visit your doctor if you experience breast changes. If you're over 40 or at a high risk for the disease, you should also have an annual mammogram and physical exam by a doctor. The earlier breast cancer is found and diagnosed, the better your chances of beating it.

The actual process of diagnosis can take weeks and involve many different kinds of tests. Waiting for results can feel like a lifetime. The uncertainty stinks. But once you understand your own unique "big picture," you can make better decisions. You and your doctors can formulate a treatment plan tailored just for you.

Treatment & Side Effects

2008-04-12T12:08:00.003-07:00

Treatment & Side Effects

In recent years, there's been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement. Instead of only one or two options, today there's an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer. The decisions—surgery, then perhaps radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy—can feel overwhelming.

breastcancer.org can help you understand your cancer stage and appropriate options, so you and your doctors can arrive at the best treatment plan for YOU.

Recovery & Renewal

2008-04-12T12:08:00.001-07:00

Recovery & Renewal

When breast cancer treatment is over and you're unsure about what life will be like, we want to encourage you to act today as if there is a tomorrow—a lot of tomorrows! We hope the information you find here will help you get as much joy and satisfaction as possible out of every day for the rest of your life.

Breast Cancer Pictures

2008-04-12T11:55:00.001-07:00

Pictures of Breast Self Exam

Image - Breast Self Exam - Step 1

Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

Here's what you should look for:

Breasts that are their usual size, shape, and color.

Breasts that are evenly shaped without visible distortion or swelling.

If you see any of the following changes, bring them to your doctor's attention:

Dimpling, puckering, or bulging of the skin.

A nipple that has changed position or become inverted (pushed inward instead of sticking out).

Redness, soreness, rash, or swelling.

Image - Breast Self Exam - Step 2 and 3

Raise your arms and look for the same changes.

While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).

Image - Breast Self Exam - Step 4

Feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.

Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Image - Breast Self Exam - Step 5

Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in Step 4.

Learn more about breast self exam in our Diagnosis section, including a recent controversial research report on the effectiveness of breast self exams for saving lives.

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Pictures of Types of Breast Cancer

Image - Ductal Carcinoma in situ (DCIS)

Normal breast with non–invasive ductal carcinoma in situ (DCIS) in an enlarged cross–section of the duct.

Breast profile:

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wall/rib cage

Enlargement:

A normal duct cells

B ductal cancer cells

C basement membrane

D lumen (center of duct)

Image - Range of Ductal Carcinoma in situ (DCIS)

Image - Lobular Carcinoma in situ (LCIS)

Normal breast with lobular carcinoma in situ (LCIS) in an enlarged cross–section of the lobule.

Breast profile:

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wall/rib cage

Enlargement:

A normal lobular cells

B lobular cancer cells

C basement membrane

Image - Invasive Ductal Carcinoma (IDC)

Normal breast with invasive ductal carcinoma (IDC) in an enlarged cross–section of the duct.

Breast profile:

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wall/rib cage

Enlargement:

A normal duct cells

B ductal cancer cells breaking through the basement membrane

C basement membrane

Image - Invasive Lobular Carcinoma (ILC)

Normal breast with invasive lobular carcinoma (ILC) in an enlarged cross–section of the lobule.

Breast profile:

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wall/rib cage

Enlargement:

A normal cells

B lobular cancer cells breaking through the basement membrane

C basement membrane

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Image - Breast Anatomy

Breast profile:

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wall/rib cage

Enlargement:

A normal duct cells

B basement membrane

C lumen (center of duct)

Image - Axillary Lymph Nodes

Lymph node areas adjacent to breast area.

A pectoralis major muscle

B axillary lymph nodes: levels I

C axillary lymph nodes: levels II

D axillary lymph nodes: levels III

E supraclavicular lymph nodes

F internal mammary lymph nodes

Lower Your Risk

2008-04-12T11:49:00.000-07:00

A tremendous amount of promising research is under way to determine the cause of breast cancer and to establish effective ways to prevent it. Still, doctors can't always explain why one woman develops breast cancer and another doesn't.

Everyone seems to know someone with breast cancer, and we wonder whether we, too, will be affected during our lifetime. All of us want to do everything we can to reduce the risk of ever getting the disease. Right now, though, we just don't know enough about what causes breast cancer and we haven't yet figured out how to keep it from happening—so we can't say that we can “prevent” it.

However, researchers are working to learn how our “external” and “internal” environments may work separately and together to affect our health and possibly the risk of developing breast cancer. “Internal environment” means the things inside our bodies that influence our health, such as genetics (the genes you got from your mother and father), hormones, illnesses, and feelings and thoughts. “External environment” refers to the things outside of our bodies that influence our health, such as air, water, food, danger, music, noise, people, and stress. Also, the external environment enters our internal environment every day—think of the food you eat, water you drink, air you breathe (including whether you smoke or not), and medicines you take. More subtlely, there's the way you “breathe in” or absorb your environment, such as your home or workplace, and the way you take in energy from the people you spend time with.

Some of these factors, such as your genetic makeup and the medicines that you take, have a very direct effect on your breast health. The impact of other, indirect factors, such as air quality, exercise, meditation, and spending time with friends, is less well understood.

Anything that INCREASES your chance of developing breast cancer is called a risk factor. Anything that REDUCES your risk of developing breast cancer is called a protective factor.

You can control some risk factors. For example, if you are overweight, you can seek to lose excess pounds, which may reduce your risk of breast cancer. You can also make informed choices about the medicines you take.

But other factors are beyond your control. For instance, you can't change your gender. Women are much more likely than men to have breast cancer. This is mostly because women have more estrogen and progesterone in their bodies. These hormones stimulate breast cell growth—both normal and abnormal. Also, you can't stop growing older. Aging is the biggest risk factor for breast cancer (besides being a woman).

Risk reduction means making choices to avoid or minimize any possible risk factors that you can. It also means increasing the protective factors in your life so your chances of developing breast cancer are lower.

Although you can control many risk factors, remember that doing so does not guarantee zero risk. It is also important to keep in mind that many women who have a particular risk factor for breast cancer never develop it.

Knowledge is power. Instead of living under the shadow of myths and misunderstandings, KNOW your own realistic level of risk. Then you can talk to your doctor about ways to lessen controllable risk factors and boost your protective factors.