Empower
The Breast Cancer Epidemic
Breast cancer is the most common form of cancer in women today with the exception of nonmelanoma skin cancer. One in every eight women born in the United States today will develop breast cancer at some point in their lives. It is estimated in this year alone that 182,460 women will be diagnosed with invasive breast cancer, and 40,480 will succumb to it. Additionally, an estimated 67,770 cases of carcinoma in situ (CIS) will be diagnosed in 2008. CIS is non-invasive and is the earliest form of breast cancer. Millions more will be affected by breast cancer as it afflicts their mothers, sisters, daughters, and wives. This epidemic also targets men, with almost 2,000 predicted cases of male breast cancer in the United States this year.
All Women are at Risk for Breast Cancer.
While a minority of cases can be directly linked to family genetic history, the vast majority are sporadic with no single identifiable cause. There are, however, a number of risk factors that increase the probability of developing breast cancer. Known risk factors and personal characteristics include personal or family history of breast cancer, high breast tissue density, earlier onset of menstruation (12 years or younger), later menopause (55 years or older), late first-term pregnancy (30 years or older), no children or no breast-feeding, early or recent use of oral contraceptives, more than four years use of hormone replacement therapy, post-menopausal obesity, alcohol consumption, exposures to secondhand cigarette smoke and exposure to ionizing radiation. Many of these risk factors may relate to a woman’s lifetime exposure to the female hormone estrogen. Additionally, a healthy lifestyle significantly reduces the risk of developing breast cancer, as obesity, diet, and alcohol/cigarette consumption have all been identified as increasing cancer risk.
Breast Cancer is Life-Threatening
Breast cancer is the leading cause of cancer death among U.S. women aged 20 to 59. Young women with breast cancer face unique issues: delayed diagnosis, aggressive disease, fertility and pregnancy issues and possibly early menopause. Delayed diagnosis combined with more aggressive tumors results in high mortality rates in young women. Most research on breast cancer is focused on women who are 45 or older, thus young women are excluded from this research.
Incidence and mortality rates for breast cancer increase with age. While the chance of developing breast cancer by age 30 is only 1 in 229, by age 60 the probability has jumped to 1 in 26. The total lifetime probability is 1 in 8.
African American women have the highest death rate from breast cancer (14 percent higher than white women), although white women have the highest
incidence of breast cancer (12 percent higher than African American women). African American women also tend to be diagnosed with breast cancer at a more advance stage, highlighting the importance of early detection and the need for more readily available screening technology. Breast cancer is the most commonly diagnosed cancer among Latinas; an estimated 11,000 Latinas were diagnosed with breast cancer in 2003. Unlike white women, breast cancer is the leading cause of cancer death among Latinas. The lowest rates of breast cancer are in East Asian nations such as China and Japan (18.7 and 32.7 per 100,000 respectively compared to 101.1 per 100,000 for the United States). Similarly, Asian Americans have a lower rate of breast cancer incidence than any other ethnic group in the United States with the exception of Native Americans. However, the breast cancer rate has been seen to increase significantly in first-generation American descendents of Asian immigrants as they shift from a low-risk environment to a high-risk environment.
The Environmental Links to Breast Cancer
All women are at risk for breast cancer, regardless of hereditary factors. In fact, 85 to 90 percent of breast cancer incidences cannot be explained by known inherited genetic predisposition markers.
When all known risk factors and characteristics are added together including genetics and family history, as much as 50 percent of breast cancer cases remain unexplained.
Although environmental exposures are not generally cited as risk factors for the disease (except for diet, pharmaceuticals and radiation), a substantial and growing body of evidence indicates that exposures to certain toxic chemicals and hormone-mimicking compounds contribute to the development of breast cancer.
One example is bisphenol A, a component of many consumer plastics has been shown to act as an estrogen receptor agonist, mimicking the effects of the hormone estrogen in the body and potentially increasing a woman’s lifetime breast cancer risk. As the result of work by the Breast Cancer Fund and others, federal and state governments have been increasingly adopting or moving toward legislations banning or restricting the use of bisphenol A in sensitive products such as baby bottles. On April 18, 2008 it was announced that Canada intends to ban the import, sale, and advertising of polycarbonate baby bottles containing bisphenol A over concerns of the safety of bisphenol A. Around the same time, Wal-Mart announced that it was immediately ceasing sales in all its Canadian stores of food containers, water and baby bottles, sippy cups, and pacifiers containing bisphenol A, and that it would phase out baby bottles made with it in U.S. stores by early 2009. Nalgene also announced it will stop using the chemical in its products, and Toys-R-Us said it too will cease selling baby bottles made from it.
Progress in the Fight Against Breast Cancer
Breast cancer incidence rates climbed steadily for much of that last 50 years, with the lifetime risk of breast cancer nearly tripling in that time span. However, starting around 2001, breast cancer rates began to drop significantly. Between 2001 and 2004 the incidence rate dropped by 3.5% per year with a cumulative decrease of approximately 10%. Multiple factors have contributed to the decline, including improved screening and preventative care, as well as the discontinuation of hormone replacement therapy (HRT) for menopausal women after the results of the Women’s Health Initiative were published in 2002. Mortality rates from breast cancer have also shown a steady decrease since approximately 1990, with larger decreases in women under 50 (3.3% per year) than in those over 50 (2.0% per year). This decrease in breast cancer mortality represents progress in both early detection and improved treatment.
While these developments are encouraging, the fight against breast cancer is far from over. Early detection via mammography has saved many lives; however, mammograms fail to detect as much as 20 percent of breast cancer in women over 50, and as much as 40 percent in younger women. Furthermore, since mammography involves exposing the breast to low-doses of radiation it is not generally recommended for asymptomatic women under 40 years of age. Above this age it has been demonstrated that the benefits of mammography in relation to early detection of breast cancer out way the potential risk from radiation exposure. Better screening methodologies need to be developed to catch breast cancer in its earliest, most treatable stage. Several currently being researched include magnetic resonance imaging (MRI), ultrasound, and breast thermography. The 5-year survival rate for advanced, metastatic breast cancer is only 27.1%. Improved therapies will help to decrease this distressingly high mortality rate. Simultaneously, further understanding of the underlying causes of breast cancer, including exposure to environmental toxins, should help us to continue bringing the breast cancer incidence rate down.
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