Here are a few basic questions and answers about breast cancer based on current statistics, education and awareness programs.

Q. What is breast cancer?
A. Breast cancer is a type of cancer where cells in the breast divide and grow without normal control. Between 50 and 75 percent of breast cancers begin in the ducts, 10 to 15 percent begin in the lobules and a few begin in other breast tissues.

Q. How common is breast cancer?
A. Breast cancer is the second most common cancer diagnosed in women, after non-melanoma skin cancer. This year, approximately 300,000 women will be diagnosed, and close to 40,000 women will die of breast cancer.

Q. Is a lump the primary, or first sign of breast cancer?
A. Because of mammography and better screenings, many of those diagnosed with breast cancer are diagnosed early, and have no noticeable lumps, pain, or other indications of a problem in their breasts. And among lumps that are detected, 80 to 85% are benign (usually cysts or noncancerous tumors). Lumpiness throughout the breasts is more likely to be normal breast tissue, while lumps that feel harder or different from the rest of the breast or that feel like they have changed are a concern. Of course, any lump or breast symptom that does not go away should be checked by a doctor.

More common signs of breast cancer may be a change in size, feel, look or shape of the breast or nipple (dimpling, puckering, pulling in, darkening, swelling, warmth) , nipple discharge that starts suddenly, or new pain that doesn’t go away.

Q. Is breast cancer primarily genetic?
A. Just 5 to 10% of cases are linked to inherited genetic mutations in breast cancer genes BRCA1 and BRCA2. However, women who are diagnosed at younger ages may be more likely to have the BRCA1 or BRCA2 genetic mutation. Women who carry one of these gene mutations have an increased risk of both breast and ovarian cancers.

But overall, even in women who have a family history, many cases are due not to specific gene mutations, according to the American Cancer Society, but, rather, to a combination of shared lifestyle factors and genetic susceptibilities.

Q. What is the biggest risk factor for breast cancer?
A. Age. As women get older, their likelihood of cancer increases. Only five percent of all breast cancers occur in women under age 40 and women under 50 account for 25% of all breast cancer cases; most breast cancers and breast cancer deaths occur in women aged 50 and older.
However, even though risk increases with age, there are is some good news for older women. Mammograms may be more effective as you reach your 60s and beyond, because your breasts are less dense, making cancer easier to spot on an x-ray. And, the cancer progresses less quickly. It takes 2.1 years for tumors to double in size among women in their 60s, compared with 1.4 years for women in their 50s.

Q. Is there anything I can do to reduce my risk?
A. Three lifestyles steps can have a significant impact on reducing your risk: regular exercise, maintaining a healthy weight, and limiting or reducing alcohol intake. According to a recent study, together they can reduce breast cancer risk by up to 26%. See Dr. Cherry on Breast Cancer for more information on the research.

Looking at these factors independently, one study found that women who gained 55 pounds or more after age 18 had an almost 50% higher risk of breast cancer compared to those who maintained their weight. And according to a meta-analysis of more than 40 studies, having just two drinks a day boosts your breast cancer risk by 21%, even a modest three to 14 drinks a week could raise your risk. If you choose to drink, limit yourself to one per day. And lastly, there is strong evidence that physical activity is associated with reduced risk of breast cancer.

Q. What about nutrition?
A. According to research, a plant-based diet high in fruits, vegetables, seeds/nuts, and whole grains while low in refined grains, processed meats and saturated fats may be the most beneficial. Trans fats have been linked to higher rates of breast cancer, so those should be eliminated or avoided as much as possible.

Dr. Cherry recommends the following foods, nutrients and natural extracts:
Tofu/soy products (soy isoflavones); red clover extract; cold-water fish (omega-3 fatty acids); kiwi fruit (vitamin C); almonds (vitamin E); prunes; oranges (citrus compounds); psyllium and high-fiber foods; cabbage and broccoli (sulforaphane); yogurt (calcium, probiotics); green tea/extract, vitamin D and vitamin A.

Q. Does hormone use affect breast cancer risk?
A. Hormone replacement therapy, which usually contains estrogen plus progestin, increases the risk of both developing and dying from breast cancer. When women take these hormones, their risk of having an abnormal mammogram increases within the first year of use, and their risk of breast cancer increases within the first five years of use. For each year that a woman takes estrogen plus progestin, her risk of breast cancer goes up slightly; one large study found that women who use estrogen plus progestin for five or more years (and are still taking it) more than double their breast cancer risk. When women stop taking these hormones, their risk of breast cancer starts to decline and returns to that of a woman who has never used hormones in about five to 10 years. Because of these and other health risk, postmenopausal hormones are no longer used to prevent chronic disease and are usually approved for the short-term relief of menopausal symptoms.

Q. Can men get breast cancer?
A. Yes. While it is rare, it does happen.

Q. What are the current screening recommendations?
A. Getting regular screening tests is the best way for women to lower their risk of dying from breast cancer. Screening tests can find breast cancer early, when it's most treatable. And, for quite a while the standard recommendation was annual mammograms for women starting at age 40. However, there has been some debate recently as to whether that should change to screenings every other year, and only for women age 50-74, unless there are high risk factors.

For women ages 50 to 69, the life-saving benefits of mammography are clear, and there is little dispute other than the frequency (every year vs. every other). For women ages 40-49, the benefits, compared to the higher rate of false positives in this age group, has been questioned.
Most major health organizations, including Susan G. Komen for the Cure®, the American Cancer Society and the National Cancer Institute, feel the modest survival benefits of mammography in women ages 40 to 49 outweigh the risks of false positive results. All recommend regular mammograms for women aged 40 to 49.

However, the U.S. Preventive Services Task Force recommends routine mammography screening begin at age 50. The Task Force encourages women ages 40 to 49 to discuss the pros and cons of mammography screening with their health care providers. Then, together, they should make a decision on when to start mammography. The American College of Physicians also recommends women ages 40 to 49 and their providers together make decisions about mammography. Decisions should be guided by a woman's breast cancer risk profile as well as her own preferences based on the potential benefits and risks of mammography screening.