Cancer Facts and Stats
Breast cancer is the most
frequently diagnosed cancer in U.S. women,
excluding cancers of the skin. If
the current rate stays the same, women born
today have about a 1 in 8 chance of developing breast
cancer at some point during their lives.1 Although mortality rates have steadily decreased over the past decades, breast cancer remains the
second leading cause
of cancer deaths in U.S. women, exceeded only by lung cancer.2
- In 2014, an estimated 232,670
new cases of invasive breast cancer will be diagnosed
in U.S. women. In addition to invasive breast cancer, an estimated 62,570
cases of carcinoma in situ (CIS) will be diagnosed.2
- In 2014, an estimated 40,000 U.S. women will die from breast cancer.2
- The risk of getting breast cancer increases
with age. Approximately 77% of women
with breast cancer are over the age of 50 at
the time of diagnosis.3
- Although overall incidence is highest for Caucasian women, African Americans have the highest mortality rate from breast cancer. Caucasian women have the second highest mortality rate, followed by American Indian/Alaska Natives, Hispanic/Latinos, and Asian American/ Pacific Islanders.4
- The breast cancer mortality rate has decreased since 1989, with larger decreases in women younger than
50. The decline is attributed to earlier detection, improved treatments, and possibly, decreased incidence as a result of declining use of postmenopausal hormone therapy.4
- When detected and treated
early, 5-year relative survival for localized
is 99%. For regional disease,
it is 84%. If the cancer has spread
to distant organs, 5-year
drops to 24%.4 Larger tumor size at diagnosis is also associated with decreased survival.4
- At this time, there are an estimated 2.8 million breast cancer survivors living in the U.S.2
- Gender: Female gender
is the most important risk factor for breast
cancer. Men can develop breast cancer, but the
risk for females is about 100 times greater.2
- Age: As women age, the risk of developing breast cancer increases. About 66% of all invasive breast cancers are diagnosed in women age 55 and older, while about 12% are diagnosed in women younger than age 45.2
- Race and ethnicity: In the U.S., Caucasian women are slightly more likely to develop breast cancer than are African-American women, although African Americans are more likely to die from this disease. Asian, Hispanic, and Native-American women have a lower risk than either Caucasian or African American women of developing and dying from breast cancer.2
- Family history of breast
is increased for women whose close relatives
have breast cancer. In general, the more biological
relatives with breast cancer, especially relatives
diagnosed before age 50, the higher a woman's
risk. Less than15% of women with breast cancer have a positive family history in a first degree relative.2
- Genetic factors: Certain gene
mutations strongly increase a
woman's risk. An estimated 5% to 10% of all breast
cancers are directly attributable to inherited
most often to mutations in the BRCA1 or BRCA2 genes. In the U.S., BRCA mutations
are more common in Jewish women of Ashkenazi origin, but they can occur in any racial
or ethnic group. Mutations in the genes ATM, TP53, CHEK2, PTEN, CDH1, STK11 also increase breast cancer risk, but these are much rarer and do not increase risk as much as BRCA genes.2
- Benign breast conditions: There is a slight to strong
increase in risk for women with certain types
of abnormalities found with a breast biopsy,
the type of abnormality. Non-proliferative lesions may have a slight effect on breast cancer risk. Proliferative lesions without atypia increase risk 1½ to 2 times normal. Proliferative lesions with atypia (i.e., ADH, ALH) increase a woman's risk by 3½ to 5 times.2
- Personal history of breast
cancer: A history of breast
cancer in one breast increases the
a new cancer
in the other breast or in another part of the same breast by 3 to 4 times.2
- Dense breasts: Compared to the same aged women with less dense breast tissue, women whose mammograms show extremely dense breast tissue
(usually defined as ≥ 75%) are at 2.1 to 2.3 times higher risk for breast cancer, while women with heterogeneously dense breasts (usually defined as 51-75%) are at a 1.2 to 1.5 times higher risk. 3 Dense
breast tissue can also make it harder to detect
cancer with mammography.5
- Reproductive history: Certain reproductive
factors slightly increase risk. These include
giving birth to a first child after
30, nulliparity (never having children),
age 12, and/or entering menopause after age 55.2 The increase in risk is likely due to a longer lifetime exposure to estrogen.6
therapy after menopause (also called hormone replacement therapy, or HRT): Using combined
hormone therapy after menopause (estrogen
and progesterone) increases breast cancer risk for
current or recent users, especially if used
for longer than 2 to 3 years. The use of estrogen alone after menopause does not appear to increase the risk of developing breast cancer; however, when used long term (> 10 years) it may increase risk for ovarian cancer per some studies. Both combined hormone therapy and estrogen therapy alone also appear to increase the risk of heart disease, blood clots, and strokes.2
- Radiation therapy
to the chest when young: Risk is strongly increased for women
treated with radiation to the chest for another
as children or young adults (as with Hodgkin's lymphoma).
is highest for those treated during adolescence, when the breasts are still developing. The most vulnerable ages appear to be between ages 10 to 14.7
- Weight: Excess weight (as measured by body mass index) and/or weight gain after menopause is associated with a higher risk of breast cancer. In contrast, excess weight in premenopausal women has been associated with a lower risk. The reason for this observed relationship in premenopausal women is unclear.7
- Alcohol: Compared
with non-drinkers, women who drink alcoholic
beverages are at increased risk. The risk increases with the amount of alcohol consumed. Risk for those who consume 2 to 5 drinks daily is increased by about 1½ times normal.2
- Height: Height has been associated with an increased risk of breast cancer in a majority of studies. Risk is about 20% greater for women 69 inches or taller as compared with women less than 63 inches tall.7
- Other factors: Exposure to certain environmental substances
and conditions may also increase a woman's risk of developing
breast cancer. Currently there is conflicting evidence regarding the risk of environmental exposure to organochlorines (some exert a weak estrogenic effect), tobacco smoke, as well as night shift work. Research is ongoing in these and other areas of our current environment with potential for effecting breast cancer risk.2
For women at average risk, the emphasis is on regular screening and healthy lifestyle choices (e.g., low-fat diet, regular exercise, breastfeeding). Women at increased risk for breast cancer are advised to consider additional risk reduction strategies in consultation with their health care providers.
- Physical activity: Regular physical exercise has been shown to provide some protection against breast cancer, especially in postmenopausal women. The reduction in risk for physically active women compared with women who are least active may be as much as 25%.7
- Diet: A diet that is rich in vegetables, fruit, poultry, fish, and low-fat dairy products has been associated with a lower risk of breast cancer in some studies.2 There is also some evidence that soy-rich diets may reduce risk.6 Overall, however, the influence of dietary factors on breast cancer risk remains inconclusive.
- Breastfeeding: The risk reducing effect of breastfeeding has been shown in multiple studies, especially if the breast-feeding lasts 1½ to 2 years.2 For every year of breastfeeding, the reduction in relative risk has been estimated at approximately 4%.7
In its 2009 guidelines, the US Preventive Services Task Force (USPSTF) recommends that biennial screening mammography begin at age 50 for women at average risk. The Task Force states that the decision to start mammography screening before the age of 50 should be an individual one and take into account the patient's situation, including her values regarding the benefits and harms of screening. For older women, the USPSTF maintains that the current evidence is insufficient for assessing the additional benefits of screening mammography in women past age 74.
Similarly, with regard to clinical breast examination, the Task Force believes that there is insufficient evidence for assessing the additional benefits of clinical breast examination beyond screening mammography in women 40 years or older. The USPSTF recommends against clinicians teaching women how to perform breast self-examination (BSE), stating that evidence suggests that teaching BSE does not reduce breast cancer mortality.8
In 2015, the American Cancer Society (ACS) released new guidelines for screening for women with average risk. The ACS recommends that women of average risk undergo annual screening mammography between the ages of 45-54 and transition to biennial screening at the age of 55 with the option of continuing to screen annually. In addition, the guidelines suggest that women should be offered the option of beginning annual screening at the age of 40 and that screening should continue as long as women are in good health with a life expectancy of at least 10 years. The ACS does not recommend clinical breast exam for breast cancer screening for women of any age. For certain women at high risk for breast cancer, ACS recommends screening with magnetic resonance imaging (MRI) as an adjunct to mammography.9
The 2011 American College of Obstetricians and Gynecologists (ACOG) guidelines recommend annual screening mammography for women 40 years and older; beginning at age 75, women should consult with their physicians to decide whether or not to continue with mammographic screening and should consider medical comorbidities and life expectancy. ACOG supports the use of clinical breast exam as a screening tool and recommends that women 40 and older have annual CBE, while women ages 20-39 have a CBE every one to three years. ACOG is in favor of considering teaching high-risk women breast self-examination and recommends that all women be taught about breast self-awareness.10
Comparison of USPSTF, ACS, and ACOG
|Biennial screening mammography beginning at age 50.
||Annual screening mammography beginning at age 45 with an option to begin at age 40. Transition to biennial screening at age 55 with option to continue annual screening.
||Annual Screening Mammography beginning at age 40.
|Evidence is insufficient for assessing the additional benefits of screening mammography in women past age 74.
||Continue biennial screening mammography for as long as a woman is in good health and a life expectancy of has at least 10 years.
||Women aged 75 years and older should consult with their physicians to decide whether or not to continue screening mammography.
|Recommends against clinicians teaching women how to perform breast self-examination.
||Recommends against clinicians teaching women how to perform breast self-examination.
||Consider breast self-examination instruction for high-risk patients. Breast self-awareness should be encouraged and can include breast self-examination.
|Evidence is insufficient for assessing the additional benefits of clinical breast examination beyond screening mammography in women 40 years and older.
||CBE not recommended for average risk women at any age.
||CBE should be performed annually for women aged 40 and older. For women 20-39 years of age, CBE recommended every 1-3 years.
|Evidence is insufficient for assessing the additional benefits and harms of MRI as a screening method for breast cancer.
||In addition to screening mammography, annual MRI screening is recommended for women with greater than 20% lifetime risk of breast cancer.
||MRI not recommended for average risk women. For those women who have BCRA1 or BRCA2 mutations and for those women with greater than 20% lifetime risk of breast cancer, enhanced screening should be offered.
Information for Every Woman Counts (EWC) Providers
Every Woman Counts pays for screening mammograms for women starting at age 40 once a year. EWC recommends that every EWC beneficiary discuss screening guidelines with her physician. Together, they should make an individual decision about the age of initiation and frequency of screening based on the woman’s risk of breast cancer and her personal beliefs about the risks and benefits of screening.
on cancer screening services for medically underserved
Breast and cervical cancer screening services are
available to medically underserved women living in
the United States through the National
Breast and Cervical Cancer Early Detection Program (NBCCEDP).
This national program is sponsored by the Centers
for Disease Control and Prevention (CDC) and
provides access to free or low-cost screening for
In California, the Every Woman Counts (EWC) program assists low income, uninsured, underserved women in obtaining high quality breast and cervical cancer screening and follow-up services. The program is funded through the California Department of Health Care Services (DHCS), from federal grant monies, and State of California funds: The Breast Cancer Control Account (BCCA), Proposition 99, and the General Fund.
Women who would like to find out if they qualify
for the program may call 1-800-511-2300 Monday -
from 8:30 AM to 5 PM. The EWC representative for your area may know
of other low-cost screening programs that might be
available to you. Regional Contractors are also your
link to support groups, advocacy groups and the latest
information on what's happening in your community.
Institute (NCI). (2012, Sep. - Last reviewed). Breast cancer risk in American women. Accessed Jul. 2, 2014,
Society (ACS). (2014, Jan. - Last revised). Breast
cancer: detailed guide. Accessed Jul.
2, 2014, from http://www.cancer.org/cancer/breastcancer/detailedguide
3 U.S. Department
of Health and Human Services (USDHHS). (2008,
Aug. - Last revised). Preventing chronic
diseases: Investing wisely in health - screening
to prevent cancer deaths. Accessed Jul. 2, 2014, from http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/cancer.pdf
4American Cancer Society (ACS).
cancer facts & figures 2013-2014. Accessed
Jul. 8, 2014, from http://www.cancer.org/research/cancerfactsstatistics/breast-cancer-facts-figures
5 Wang, A.T., Vachon, C.M., Brandt, K.R., Ghosh, K. (2014). Breast density and breast cancer risk: a practical review. Mayo Clinic Proceedings, 89(4):548-557.
6Chen, W.Y. (2013, Jan. - Last updated). Patient information: factors that modify breast cancer risk in women (Beyond the Basics). Accessed Jul. 3, 2014, from http://www.uptodate.com/contents/factors-that-modify-breast-cancer-risk-in-women-beyond-the-basics
7Chen, W.Y. (2013, Oct. - Last updated). Factors that modify breast cancer risk in women. Accessed Jul. 3, 2014, from http://www.uptodate.com/contents/factors-that-modify-breast-cancer-risk-in-women
Services Task Force (USPSTF). (2009). Screening
for breast cancer: U.S. preventive services task
Intern Med, 151:716-726.
9Oeffinger, K. C., Fontham, E. T. H., Etzioni, R., Herzig, A., Michaelson, J. S., Ya-Chen, T. S.,…Wender, R. (2015). Breast cancer screening update for women at average risk. 2015 guideline update from the American Cancer Society. JAMA, 314(15): 1599-614.doi: 10.1001/jama.2015.12783
10The American College of Obstetricians and Gynecologists. (2011, August). Practice bulletin no. 122: breast cancer screening. Obstetrics & Gynecology, 118 (2 Pt 1): 372-82. doi: 10.1097/AOG.0b013e31822c98e5
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Last updated: November 5, 2015