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Breast cancer is a major health concern for many women; one in nine will face the diagnosis in her lifetime. It follows lung cancer as the second leading cause of cancer death in women in our country and accounts for 25% of all female cancers.

Who is at risk? Several factors have been identified. The first is increasing age; two-thirds of women diagnosed with breast cancer are older than age 50. Many have a family history. If a woman’s sister, mother or daughter (a first-degree relative) has been diagnosed, her risk is two to three times greater. If she has two first-degree relatives affected, her risk may be as high as 50%, especially if the relatives were diagnosed before menopause. Risk increases further if the relative’s cancer affected both breasts.

Women who have never had a child or whose first child was born after age 30, are at higher risk. There is, however, some protective benefit from breastfeeding, which increases with a longer duration of nursing.

Some proposed factors have a possible increased risk but the available data are not conclusive. These include estrogen replacement therapy, a high-fat diet and a higher socioeconomic status. Drinking alcohol also increases the risk, with higher intake leading to higher risk. But only 25% of breast cancer cases occur in the defined risk groups making screening programs for all women an important health priority.

Screening programs for early detection have three steps: clinical breast exams, monthly breast self-exams, and regular mammograms beginning by age 40. The clinical breast exam should be done by a physician, nurse-midwife or nurse practitioner at least every three years after age 20 and annually after age 40. Your health care provider will teach you the proper technique for a breast self-exam.

Your self-exam should be done monthly to remain familiar with what your normal breast contours feel like. Using the pads of your fingers, begin in the armpit and check each breast all over, either up and down or in a spiral motion. Also, look in the mirror for any changes in the skin or in the size or shape of your breasts. If you notice changes, contact your physician.

The mammogram is a breast x-ray that is quick, easy and safe, using less radiation than a dentist’s x-ray. Although a pea-sized lump may be felt with the fingers, a pinhead-sized lump can be seen on an x-ray up to two years before it can be felt. Mammography has been credited with decreasing mortality from breast cancer by up to 30%. The American Cancer Society recommends a first mammogram against which future mammograms can be compared by age 40. Women in their 40’s should have a repeat mammogram at least every two years and annually after age 50. If risk factors are present, your physician may recommend more frequent clinical exams and mammograms.

Although early screening is the standard for breast cancer prevention, current research trials using an anti-estrogenic hormone called tamoxifen appear promising. Currently this medication is used for therapy after a breast cancer diagnosis and it is possible that cancer prevention may be an indicated use for tamoxifen in high-risk women in the future.