One out of nine women will develop breast cancer sometime in her life. Women with a family history of breast cancer have two to 10 times higher incidence of breast cancer than the general female population.

In the United States, an estimated 182,000 women will be diagnosed with breast cancer in 1997. Of them, 43,900 will die of the disease. This type of cancer is more common in older women, but can strike women of any age. Twenty-five percent of cancers in the breast were reported in women age 40-50

Fortunately, 90% of breast cancers that are detected early -- with a mammogram while they're too small to be felt -- are curable, meaning the woman lives for five or more additional years after treatment.

Many women are frightened by the incidence of breast cancer, so it's important to put it in perspective. The majority of breast tumors are benign, or non-cancerous. They include cysts, firm tumors called fibroadenomas, and fibrocystic changes that are associated with aging.

Two-thirds of newly diagnosed breast cancers are localized -- they have not spread to other parts of the body. This often means that the women can choose a surgical procedure that removes only the cancer -- a lumpectomy -- rather than the entire breast -- a radical mastectomy.

No one knows why women develop most breast cancers or why the incidence is increasing. Perhaps the incidence increase is only because the greater use of mammography screening beginning in the early 1980s, especially in young women, has revealed some cancers sooner. Another possibility is that women are living longer, so that cancer's decades-long development finally catches up with them. The role of diet, drugs or the environment in the development of breast cancer has not yet been determined.

Who Is At High Risk of Developing Breast Cancer?
It has been suggested that if a woman's mother or sister has had breast cancer, she is at higher-than-normal risk of developing the disease.

Other circumstances correlated with higher risk include being Caucasian, being older than 50 years of age, not having given birth to a child, and becoming a mother for the first time when over the age of 30. Others at higher risk include women who entered menopause very late (over age 55) and very obese women.

Most importantly, the message is, WOMEN NEED TO TAKE CARE OF THEMSELVES.

A word of caution: Breast cancer is not only a women's disease. It occurs in men, although at a lower percentage rate. Some 1,400 men will be diagnosed with breast cancer this year, 290 of whom will die of the disease. Men should also check their chests periodically for lumps. If one is discovered, it should warrant immediate attention.

Estrogen-Replacement Therapy and the Breast
A controversy surrounds the pros and cons of hormone-replacement therapy. In certain women with breast cancers, the tumors are sensitive to and stimulated by feminine hormones (estrogen and progesterone). Some studies show a 21% increase in the risk of developing breast cancer for estrogen users (especially those taking large doses of the hormone).

Yet women in general who take estrogen for any number of medical reasons have experienced extra benefits from the estrogen therapy. One such benefit is a 48% decrease in the incidence of heart disease (the leading cause of death for women).

Another benefit is prevention of osteoporosis (bone thinning). Taking estrogen also reduces menopausal symptoms such as lowered libido (sex drive), hot flashes, vaginal dryness and urinary discomfort. See Step 10, Estrogen Therapy, for more information.

Before beginning estrogen-replacement therapy, discuss your health profile and the pros and cons of such therapy carefully with your health-care provider.

The large picture should be looked at as well:

In women age 50-94, the risk of death from heart disease is 31%, while the risk of death from breast cancer is only 2.8%.

Reducing a great risk by half and increasing a relatively small risk by one-fifth may be acceptable to you.

On the other hand, if your female relatives have a history of breast cancer, taking estrogen may not be wise for you.

What Can a Woman Do to Detect Breast Cancer Early?

1. You should perform a breast self-exam regularly and note any change in the breast -- a mass, skin changes or abnormal nipple discharge. If you note such a change, make an appointment with your health-care provider as soon as possible. (If you have a teenage daughter, be sure she learns how to do a breast self-exam, too.)
   
   
2. Have your health-care provider perform an annual checkup.
   
   
3. Have mammograms as recommended by your health-care provider.

Why Should a Woman Perform A Breast Self-Examination?
Every woman should start to examine her breasts as soon as they start to develop. Of course, it might be a little difficult in a young woman because youthful breasts are very fibrous. But the self-exam familiarizes the woman with the structure of her breasts. This knowledge will make it easier to notice any sudden change.

The structure and position of the breasts change throughout a woman's life. Puberty, pregnancy, hormones, menopause, and gain or loss of weight all can cause breast changes.

Also, the two breasts aren't identical. Each has its own characteristics. (The same is true of other body pairs, such as hands, feet and eyes.)

How to Perform the Breast Self-Exam
Examining your breasts once a month is one of your most important steps in taking charge of your own health. The best time is a week after the start of your menstrual period. If you don't menstruate, choose an easy-to-remember date, such as the first of the month.

Diagram of correct breast self-examination procedure.

In front of a mirror, first with your hands on your hips and then with your arms held above your head, note any indentation or puckering in the skin of the breast or any change in its contour. (If your breasts are large and pendulous, and raising your arms does not allow you to see their undersides, do the exercise this way: Stand with your side to a mirror and bend forward from the waist. Place your hands on your hips and check the bottom contour of your breast in the mirror for puckering, indentations or any other changes. Now turn your other side to the mirror and, with your hands on your hips, check your other breast).

In the shower, raise one arm and use the fingers of the opposite hand to feel the breast for any masses or unusual thickness. Do this for each breast.

After you're out of the bath, lie down on your back with a folded towel below one shoulder. Put one hand under your head and feel the breast with the three middle fingers of the opposite hand.

Using a circular and continuous motion, examine t he whole breast, beginning around the nipple. Without lifting the fingers, enlarge the circle until you have examined the entire breast. Don't forget to check the armpit for any unusual mass.

Now perform the same sequence on the other breast.

When you have your health-care provider perform your annual exam, take the opportunity to demonstrate your self-exam technique to be sure you're doing it correctly.

What About Mammograms?
A mammogram is an exam of the breast with low-dose x-rays. Mammograms allow detection of breast cancer in a very early stage, even before you or your health-care provider can manually feel its presence.

But mammograms are not foolproof, since they may miss from 10 to 15% of cancers. That is why if a woman discovers a new lump in her breast, it should be biopsied (a sample of it removed for laboratory examination), even though her mammogram was negative.

Over 50% of women who have had a mammogram complain of some type of discomfort due to the compression of the breast by the mammography machine.

This compression is necessary in order to obtain a clear picture of the breast with the least amount of radiation. If the discomfort persists, take a mild analgesic like Tylenol. Sometimes the skin is slightly discolored following a mammogram, but this usually disappears in a few days.

Many studies have demonstrated that mammograms are the best way to detect early breast cancer.

• Each woman should have an initial or baseline mammogram beginning at age 40.
• Every other year until age 50, the woman should have a new mammogram taken.
• After age 50, a mammogram should be taken every year.
  

Though the subject remains controversial, I believe mammograms should be performed on women between the ages of 40 and 50.

Studies have shown that 25% of the cancers discovered by mammograms are among women in this age group, and my own patients in this age group have had cancers revealed by mammograms.

If these women had waited until they reached 50, their cancers would have grown and spread. Their chances for survival would have undoubtedly been much lower.

BE SURE THAT WHOEVER PERFORMS YOUR MAMMOGRAM IS CERTIFIED TO DO SO.

Unfortunately, very few women do breast self-exams or have mammogram screening as recommended.

In one 1992 study, less than 17% of women over age 65 had mammograms, and only 49% had a breast exam the year before. Of 3,000 women who had a relative with breast cancer, 92% never had a mammogram.

If women over 50 had yearly mammograms, it has been estimated that breast-cancer deaths would be reduced 30 to 35%.

Early discovery of breast cancer increases the probability of a cure. DON'T BE AFRAID. ACT!! Do your breast self-exam every month. Have your health-care provider examine your breasts every year and perform the required diagnostic tests.

Stay informed. Share with your friends and family the importance of breast care.