General Considerations

In the United States, the National Cancer Institute estimates that one of every eight women (approximately 12.5%) will develop breast cancer during her lifetime. Among the malignant diseases in women, breast cancer is the most common to develop and is the second most common cancer cause of death. In 2007, it accounted for 31% of new cancer cases in American women, and 15% of cancer deaths;there were 180,510 new cases of invasive breast cancer (stages I to IV) and 40,910 related deaths in the United States (40,460 women and 450 men). Breast carcinoma in situ, a very early form of the disease, was diagnosed in another 62,030 women.

The incidence of cancer of the breast is higher in the United States than in European or Asian countries. It has been well established that women in underdeveloped nations have lower rates of breast cancer than do women from more affluent societies. Among racial/ethnic groups, white and African-American women have the highest incidence rates of breast cancer (113.2 and 99.3 per 100,000 population, respectively). Asian and Pacific Islander women and Latino women have a lower risk (72.6 and 69.4 per 100,000 population, respectively). The risk is lowest among Native Americans (33.9 per 100,000 population). The rate of mortality from breast cancer is highest in African-American women (31.4 per 100,000);the mortality rate in white women is 25.7 per 100,000. The lowest rate of mortality from breast cancer is in Asian and Pacific Islander women (11.4 per 100,000). The incidence of breast cancer continues to increase, partly because of increased screening through mammography.

Once breast cancer has occurred in a family, the risk that other women in the same family will have breast cancer is significantly higher. First-degree relatives, such as sisters or daughters, have more than twice the risk for development of breast cancer if the original patient developed cancer in one breast after menopause. Women with a family history of premeno-pausal breast cancer in one breast have three times the risk. If the original patient had post-menopausal cancer in both breasts, the first-degree relatives have more than four times the risk. First-degree relatives of patients with cancer in both breasts before menopause have nearly nine times the risk.

The age at onset of menarche and the reproductive cycle seems to play some role in the development of breast cancer. In women with menarche before the age of 12 years, the incidence of breast cancer appears to be higher. Women who had their first child at the age of 30 years or older have three times the risk of those who had their first child at a younger age.

Most breast cancers are detected as painless masses, noticed by either the patient or the examiner during a routine physical examination. The earlier the diagnosis is made, the better the prognosis is. Screening for breast cancer is best accomplished by a thorough clinical breast examination, breast self-examination, and mammography. Mammography is the most sensitive method for the detection of breast cancer and has been demonstrated to reduce the breast cancer mortality rate.

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