 An estimated 175,000 NEW invasive cases of breast cancer were expected to occur among women in the United States during 1999. About 1,300 new cases of breast cancer were expected to be diagnosed in men in 1999. During the 1980's the incidence of breast cancer rose by 4% per year. During the 1990's the figures have leveled off to about 110 cases per 100,000.
 An estimated 43,700 deaths (43,300 women, 400 men) in 1999; breast cancer is the second leading cause of cancer death in women. According to the most recent data, mortality rates declined significantly during 1991-1995 with the largest decreases in younger women—both white and African American. These decreases are probably the result of earlier detection and improved treatment. When detected late, prognosis is not nearly so good.
 The earliest sign of breast cancer is usually an abnormality that shows up on a mammogram before it can be felt by the woman or her health care provider. When breast cancer has grown to the point where physical signs and symptoms exist, these may include a breast lump, thickening, swelling, distortion, or tenderness; skin irritation or dimpling; and nipple pain, scaliness, or retraction. Breast pain is very commonly due to benign conditions and is not usually the first symptom of breast cancer.
 The risk of breast cancer increases with age. The risk is higher in women who have a personal or family history of breast cancer; biopsy-confirmed atypical hyperplasia; early menarche; late menopause; recent use of oral contraceptives or postmenopausal estrogens; never having children or having the first live birth at a late age; and higher education and socioeconomic status. International variability in breast cancer incidence rates appear to correlate with variations in diet, especially fat intake, although a causal role for dietary factors has not been firmly established. Additional factors that may be associated with increased breast cancer risk and that are currently under study include pesticide and other chemical exposures, alcohol consumption, weight gain, induced abortion, and physical inactivity. Exciting new research about BRCA1 and BRCA2 susceptibility genes for breast cancer is also in progress, although, general screening of the population for these genes is not yet recommended. Research is ongoing to learn more about the complex characteristics of these genes and to evaluate their contribution to the incidence of breast cancer.
A majority of women will have one or more risk factors for breast cancer. However, most risks are at such a low level that they only partly explain the high frequency of the disease in the population. Although women cannot alter some of their personal risk factors, maintaining an ideal body weight and reducing alcohol consumption may result in some reduction in breast cancer risk. Recent studies suggest that selective estrogen receptor modulators (SERMs) such as tamoxifen and raloxifene may reduce the risk of developing breast cancer. Early detection, however, provides the best opportunity to reduce mortality. The value of mammography is that it can identify breast abnormalities that may be cancer at an early stage before physical symptoms develop. Numerous studies have shown that early detection increases survival and treatment options. The American Cancer Society guidelines for early detection of breast cancer recommend that women age 40 and older have an annual mammogram, an annual clinical breast exam performed by a health care professional, and perform monthly breast self-examination. Women ages 20-39 should have a clinical breast exam performed by a health care professional every three years and should perform monthly breast self-examination.
Most breast lumps are not cancer, but only a physician can make a diagnosis. When a woman has a suspicious lump or when a suspicious area is identified on a mammogram, diagnostic mammography can help determine whether additional tests are needed and if there are other lesions that are too small to be felt in the same or the opposite breast. All suspicious lumps should be biopsied for a definitive diagnosis. Taking into account the medical situation and the patient’s preferences, treatment may involve lumpectomy (local removal of the tumor) and removal of the lymph nodes under the arm; mastectomy (surgical removal of the breast) and removal of the lymph nodes under the arm; radiation therapy; chemotherapy; or hormone therapy. Often, two or more methods are used in combination. Numerous studies have shown that, for early stage disease, long-term survival rates after lumpectomy plus radiotherapy are similar to survival rates after modified radical mastectomy. Patients should discuss possible options for the best management of their breast cancer with their physicians. Significant advances in reconstruction techniques provide several options for breast reconstruction after mastectomy. In recent years, this often has been performed at the same time as the mastectomy. High-dose chemotherapy with bone marrow transplant or stem cell rescue is a new treatment under study for special cases of breast cancer.
The 5-year relative survival rate for localized breast cancer has increased from 72% in the 1940s to 97% today. If the cancer has spread regionally, however, the rate is 77%, and for women with distant metastases the rate is 22%. Survival after a diagnosis of breast cancer continues to decline beyond five years. Sixty-nine percent of women diagnosed with breast cancer survive 10 years, and 57% survive 15 years.
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