Discuss the risk factors, common presentation and physical exam findings of breast cancer. 

Discuss the risk factors, common presentation and physical exam findings of breast cancer.  Discuss the most recent American Cancer Society guidelines for breast cancer screening

 

Breast cancer is the most common cancer among women, it is estimated that one in eight women will be diagnosed with breast cancer in their lifetime in the United States (Goolsby & Grubbs, 2019). Women under the age of 45 account for approximately 11% of all breast cancer diagnosis in the United States (Daly et al., 2021). Breast cancer is a multifactorial disease with various contributing factors. There are some modifiable and non-modifiable risk factors for developing breast cancer. Modifiable risk factors include alcohol consumption, smoking, weight, physical activity, hormone contraceptive use, menopausal hormonal therapy, and pregnancy and parity (Daly et al., 2021). Alcohol consumption increases the risk of breast cancer in young and premenopausal women. Those who drink 14 or more alcoholic drinks per week have the highest risk in comparison to non-drinkers. Smoking increases the risk in premenopausal women. Women who commence smoking at a young age seem to have a higher lifetime breast cancer risk than those who take up smoking later in life (Daly et al., 2021). Being overweight after menopause increase breast cancer risks. Women who are overweight also tend to have higher blood insulin levels. Higher insulin levels have been linked to some cancers, including breast cancer (American Cancer Society, 2022). Recent evidence suggests that physical activity and exercise may be a key in reducing premenopausal risks of breast cancer (Daly et al., 2021). Studies have shown that women who use oral contraceptives have a slightly higher risk of breast cancer in comparison to those who never used them (Daly et al., 2021).  The risk associated with the use of hormone replacement therapy after menopause applies to current and recent users. The risk goes back down within 5 years of stopping treatment (American Cancer Society, 2022). Breast cancer risk is higher among women who start having children after the age of 35 years and those who do not have children. The risk is 50% lower for women how start having children at age 20 year or younger (Daly et al., 2021).

There are also numerous non-modifiable risk factors associated with breast cancer. The first is gender, men can get breast cancer, but it is much more common in women than in men (American Cancer Society, 2022). Age is another non-modifiable risk factor. As a woman gets older, the risk increases. Most breast cancers are found in women aged 55 year and older (American Cancer Society, 2022). Inheriting certain genes such as BRCA1 and BRCA2, having a first degree relative with history of breast cancer, and having a personal history of breast cancer are all factors that increase the risk of developing breast cancer (American Cancer Society, 2022). Race and ethnicity are other factors to consider, white women are slightly more likely to develop breast cancer than African American women. However, in women younger than 40 years, breast cancer is higher in African Americans. Asian, Hispanic, and Native American women have a lower risk of developing breast cancer (American Cancer Society, 2022). Other non-modifiable risk factors are being taller, having dense breast tissues, having benign breast conditions, starting menstruation period before age 12, going through menopause later, and having radiation to the chest (American Cancer Society, 2022).

Common Presentation and Physical Exam Findings of Breast Cancer

Early breast cancer is often asymptomatic. A breast lump is the most common complaint and usually the only complaint (Goolsby & Grubbs, 2019). Other possible signs and symptoms of breast cancer are change in breast size or shape, skin dimpling or other skin changes such as thickening, redness, or swelling, and recent nipple inversion or retraction (Chalasani, 2022). Physical examination may reveal axillary lump, blood-stained nipple discharge, skin tethering, dilated veins, ulceration, and Mammary Paget disease. Upon assessment features such as hardness, irregularity, focal nodularity, asymmetry with other breast, and fixation of lump to skin or muscle might be evident (Chalasani, 2022). In advanced cases, the patient may present with fatigue, weight loss, and bone pain (Goolsby & Grubbs, 2019).

American Cancer Society Guidelines for Breast Cancer Screening

The American Cancer Society has screening and early detection guidelines for women with average and high risk for breast cancer. Early detection is important because it can improve the prognosis of the disease. A woman with average risk of breast cancer is someone with no personal history of breast cancer, no strong family history of breast cancer, does not have a genetic mutation known to increase breast cancer such as a BRCA gene, and has not had chest radiation before the age of 30 (American Cancer Society, 2022). The American Cancer Society recommends optional yearly mammogram screening for women ages 40 to 44. Women ages 45 to 54 should get yearly mammograms. Women aged 55 and older can choose to switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years (American Cancer Society, 2022). The American Cancer Society does not recommend clinical breast exams as a screening tool for women with average risk.

Women at high risk for breast cancer includes having  a lifetime risk of 20% to 25% or higher, have a known BRCA1 or BRCA2 gene mutation, first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves, had radiation to the chest between the ages of 10 to 30 years, and those with Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes (American Cancer Society, 2022). The American Cancer Society recommends that such women begin screening with MRI and mammogram at the age of 30 years and continue annually as long as they are in good health (American Cancer Society, 2022).