What's the disease that women fear the most? The answer is most likely to be breast cancer. And if you ask them the disease they're most likely to get, their answer would be breast cancer as well.
But they would be wrong.
Among the most lethal diseases of women in the United States, breast cancer lags behind heart disease, stroke, lung cancer, chronic lower respiratory diseases, and Alzheimer's. Women are far more likely to die of heart disease than breast cancer. Even as cancers go, breast cancer's not the deadliest form. Lung cancer kills about 40 percent more women every year as cancer of the breast.
But breast cancer does kill more women age 35 to 54 than any other disease, and therein lies one big reason why it's a woman's worst nightmare: We all know someone who has had it.
"The really compelling reason that people put breast cancer on a different scale is that everybody knows somebody with breast cancer. Many of us know someone with it in her 40s, and we don't know someone with heart disease in her 40s," says Barbara Brenner, executive director of Breast Cancer Action, an information and advocacy group based in San Francisco. "Since it is the leading killer of women in the 30-to-55 range, everybody has a tragic story, and the tragic story translates into a lot of fear... Women tend to overestimate their risk."
Breast cancer is also a disease rife with mythology. Although it gets a huge amount of media attention, a lot of what's widely circulated is wrong. Here are a few choice myths and misconceptions worth correcting:
Myth No. 1: If I get it, I'm going to die.
The number of women diagnosed with breast cancer has decreased significantly. In fact, the death rate has been steadily declining as well. Over 80 percent of women diagnosed with breast cancer are alive after five years. That's compared to 64 percent in the 1960s. And if the cancer is caught early, the number increases to 96 percent. Better treatments and early diagnosis through mammograms and regular breast exams are responsible for these improved outcomes.
Myth No. 2: All women have a 1-in-8 chance of developing breast cancer today.
The widely quoted "1 in 8" figure applies to a woman closer to the end of her lifetime. A 30-year-old, for example, has a 1-in-233 chance of developing breast cancer in the next decade. At age 40, it's 1 in 69; from 50-60, it's 1 in 38, and from 60-70 it's 1 in 27. The 1-in-8 risk is a cumulative lifetime risk of developing breast cancer if you live at least to age 85.
Myth No. 3: If my mother had breast cancer, I'll get it too.
If your mother or sister was diagnosed with breast cancer, your chances of getting the disease are doubled -- that is to say if, with no family history, you would have had a 1.5 percent chance of developing the disease in the next five years, with your history, your chance rises to just 3 percent.
Myth No. 4: I'm at astronomical risk if I test positive for gene mutations.
Only 5 to 10 percent of breast cancers are the result of BRCA1 and BRCA2 mutations in the genes. How a particular mutation influences your risk for getting breast cancer depends on what other risk factors you may already have. For example, if 10 or more people in various generations of your family have had breast cancer, a particularly dangerous BRCA1 mutation could give you as much as an 85 percent chance of developing the disease by the age of 70.
But if you've had only a few relatives with breast cancer, such a mutation probably gives you at most a 56 percent chance of a breast cancer diagnosis before you turn 70. A genetic counselor can help you sort out whether you should be tested, and your doctor can help you determine whether you have enough of a genetic predisposition to warrant taking medication as a preventative.
Myth No. 5: If I have no family history and I exercise, eat right, and don't smoke, I probably won't get breast cancer.
Unfortunately, this is not the case. About 70 percent of women who are diagnosed with breast cancer have no identifiable risk factors. It's important to exercise, eat a low-fat diet, avoid tobacco, and drink alcohol only in moderation, because all those things will certainly help guard against heart disease, diabetes, and other life-threatening conditions -- and research has shown a relationship between breast cancer and drinking more than one alcoholic beverage a day. Exercise, on the other hand, may help decrease the risk of breast cancer, according to the National Cancer Institute, but it does not confer complete protection against the disease.
Myth No. 6: In general, only white women get breast cancer.
The truth is that although white women are slightly more likely to be diagnosed with breast cancer, a greater percentage of African-American women who have the disease will die of it. Most experts attribute the difference to black women's poorer access to health care.
As a group, white, Hawaiian, and black women have the highest rates of the disease, according to the National Cancer Institute. The lowest rates occur among American Indian, Vietnamese, and Korean women. No one knows what accounts for this, although there are unproven theories that the groups with less breast cancer consume less fat. Some researchers and advocates for women with the disease say there's a correlation between breast cancer incidence and industrial pollutants.
Myth No. 7: Breast cancer is a women's disease.
Breast cancer in men is rare -- only about 2,000 men are diagnosed each year, and the disease in men accounts for less than 1 percent of all breast cancers. But breast cancer kills 22 percent of the men who develop it, largely because many men don't know they can get it, so the cancer goes untreated until it has reached a late stage.
Myth No. 8: If a lump hurts, it's not breast cancer.
Tenderness associated with a lump, particularly if it's cyclical in nature, is often a good sign. But many breast tumors that are malignant can be tender as well. It's best to have your doctor check out anything suspicious.
Myth No. 9: Mammograms catch all breast cancers.
At the moment, mammograms are one of the most important tool for finding breast tumors. They catch about 80 percent of breast tumors, but that still leaves up to 20 percent that escape detection. It's harder to spot tumors in dense glandular tissue than in fatty tissue, and some women -- particularly those who are thin, young, premenopausal or on hormone-replacement therapy -- have dense breasts (more gland tissue, less fat). For women with dense breasts or those at high risk for breast cancer, breast ultrasound or MRI may be useful along with mammography.
And while the American Cancer Society no longer stresses the importance of monthly breast self exams (after finding that they are less effective than first thought), it still emphasizes the importance of being aware of the normal look and feel of your breasts and being alert to any changes. The more attuned you are to changes in your breasts, the more likely you are to spot something dangerous. So, keeping up with those monthly self-exams couldn't hurt.
Myths and Facts, American Cancer Society; www.cancer.org/NBCAM_myths_vs_facts.html
Mayo Clinic. Womens Top Health Threats: http://www.mayoclinic.com/
National Cancer Institute. Probability of Breast Cancer in American Women. October 2006. http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer
Office of Minority Health. African American Profiles. http://www.omhrc.gov/
Centers for Disease Control. Breast Cancer Statistics. http://www.cdc.gov/cancer/breast/statistics
American Heart Association. Heart Disease and Stroke Statistics. http://www.americanheart.org/presenter.jhtml?identifier=1928
American Cancer Society. What Are the Key Statistics About Breast Cancer in Men? http://www.cancer.org/
American Cancer Society. Can breast cancer be found early?
National Cancer Institute. Screening mammograms: Questions and Answers.