Breast Cancer

Facts & Figures  2015-2016

Contents
Breast Cancer Basic Facts 1

Breast Cancer Occurrence 4

Breast Cancer Risk Factors 11

Breast Cancer Screening 18

Breast Cancer Treatment 22

What is the American Cancer Society doing about breast cancer? 26

Sources of Statistics 29

References 31

Acknowledgments
The production of this report would not have been possible without the efforts of:
Rick Alteri, MD; Tracie Bertaut, APR; Louise A Brinton, PhD; Stacey Fedewa, MPH; Rachel A Freedman, MD, MPH; Ted Gansler, MD, MPH;
Mia M Gaudet, PhD; Joan Kramer, MD; Chun Chieh Lin, MBA, PhD; Marji McCullough, SCD, RD; Kimberly Miller, MPH; Lisa A Newman,
MD, MPH; Dearell Niemeyer, MPH; Anthony Piercy; Cheri Richards, MS; Ann Goding Sauer, MSPH; Scott Simpson; Robert Smith, PhD;
Dana Wagner; and Jiaquan Xu, MD.

Breast Cancer Facts & Figures 2015-2016 is a publication of the American Cancer Society, Atlanta, Georgia.

Corporate Center: American Cancer Society Inc.
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For more information, contact:
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©2015, American Cancer Society, Inc. All rights reserved,
Rebecca Siegel, MPH including the right to reproduce this publication
Ahmedin Jemal, DVM, PhD or portions thereof in any form.

Surveillance and Health Services Research Program For written permission, address the Legal department of
the American Cancer Society, 250 Williams Street, NW,
Atlanta, GA 30303-1002.

This publication attempts to summarize current scientific information about breast cancer.
Except when specified, it does not represent the official policy of the American Cancer Society.

Suggested citation: American Cancer Society. Breast Cancer Facts & Figures 2015-2016. Atlanta:
American Cancer Society, Inc. 2015.

of cells where they originated. It is the most common type
Breast Cancer Basic Facts of in situ breast cancer, accounting for about 83% of in situ
cases diagnosed during 2008-2012. DCIS may or may not
progress to invasive cancer; in fact, some of these tumors
What is breast cancer? grow so slowly that even without treatment they would not
affect a woman’s health. Long-term studies of women whose
Cancer is a group of diseases that cause cells in the body to
DCIS was untreated because it was originally misclassified as
change and grow out of control. Most types of cancer cells even-
benign found that 20%-53% were diagnosed with an invasive
tually form a lump or mass called a tumor, and are named after
breast cancer over the course of 10 or more years.1-5 Since
the part of the body where the tumor originates.
there is no certain way to determine the progressive poten-
The vast majority of breast cancers begin in the parts of the tial of a DCIS lesion, surgery and sometimes radiation and/
breast tissue that are made up of glands for milk production, or hormonal therapy is the usual course of action following
called lobules, and ducts that connect the lobules to the nipple. a diagnosis of DCIS. Identifying molecular characteristics
The remainder of the breast is made up of fatty, connective, and of DCIS that predict recurrence or progression to invasive
lymphatic tissues. cancer is an active area of research.6
Breast cancer is typically detected either during a screen- •  Lobular carcinoma in situ (LCIS, also known as lobular
ing examination, before symptoms have developed, or after a neoplasia) refers to cells that look like cancer cells growing
woman notices a lump. Most masses seen on a mammogram within the lobules of the breast. LCIS is generally not thought
and most breast lumps turn out to be benign; that is, they are to be a precursor of invasive cancer. Instead, it is considered a
not cancerous, do not grow uncontrollably or spread, and are marker for increased risk for developing invasive cancer. LCIS
not life-threatening. When cancer is suspected, microscopic is much less common than DCIS, accounting for about 13% of
analysis of breast tissue is necessary for a definitive diagnosis female in situ breast cancers diagnosed during 2008-2012.
and to determine the extent of spread (in situ or invasive) and •  Other in situ breast cancers have characteristics of both duc-
characterize the type of the disease. The tissue for microscopic tal and lobular carcinomas or have unknown origins.
analysis can be obtained via a needle or surgical biopsy. Selec-
See page 12 for additional information on DCIS and LCIS. More
tion of the type of biopsy is based on individual patient clinical
information can also be found in the Cancer Facts & Figures 2015,
factors, availability of particular biopsy devices, and resources.
Special Section: Breast Carcinoma In Situ.
In situ
Invasive
•  Ductal carcinoma in situ (DCIS) refers to a condition where
Most breast cancers are invasive, or infiltrating. These cancers
abnormal cells replace the normal epithelial cells of the
have broken through the walls of the glands or ducts where they
breast ducts and may greatly expand the ducts and lobules.
originated and grown into surrounding breast tissue.
DCIS is considered a noninvasive form of breast cancer
because the abnormal cells have not grown beyond the layer The prognosis of invasive breast cancer is strongly influenced
by the stage of the disease – that is, the extent or spread of the
cancer when it is first diagnosed. There are two main staging
Table 1. Estimated New Female Breast Cancer systems for cancer. The TNM classification of tumors uses infor-
Cases and Deaths by Age, US, 2015* mation on tumor size and how far it has spread within the breast
and to adjacent tissues (T), the extent of spread to the nearby
Age In Situ Cases Invasive Cases Deaths
lymph nodes (N), and the presence or absence of distant metas-
<40 1,650 10,500 1,010
tases (spread to distant organs) (M).7 Once the T, N, and M are
40-49 12,310 35,850 3,690
determined, a stage of 0, I, II, III, or IV is assigned, with stage 0
50-59 16,970 54,060 7,600 being in situ, stage I being early stage invasive cancer, and stage
60-69 15,850 59,990 9,090 IV being the most advanced disease. The TNM staging system is
70-79 9,650 42,480 8,040 commonly used in clinical settings.
80+ 3,860 28,960 10,860
The Surveillance, Epidemiology, and End Results (SEER) Sum-
All ages 60,290 231,840 40,290
mary Stage system is more simplified and is commonly used in
*Rounded to the nearest 10.
reporting cancer registry data and for public health research
American Cancer Society, Inc., Surveillance Research, 2015
and planning.8

Breast Cancer Facts & Figures 2015-2016  1

•  Luminal A (HR+/HER2-). Most (74%) breast cancers express
Figure 1. Age-specific Female Breast Cancer the estrogen receptor (ER+) and/or the progesterone receptor
Incidence and Mortality Rates, US, 2008-2012 (PR+) but not HER2 (HER2-). These cancers tend to be slow-
growing and less aggressive than other subtypes. Luminal
500 A tumors are associated with the most favorable prognosis,
Incidence:
Non-Hispanic White particularly in the short term, in part because expression of
hormone receptors is predictive of a favorable response to
400
Incidence: hormonal therapy (see page 24).15, 19
Black
•  Triple negative (HR-/HER2-). Overall, about 12% of breast
Rate per 100,000

300
cancers are triple negative, so called because they are ER-,
PR-, and HER2-; however, these cancers are nearly two times
200
more common in black women than white women in the US.
Mortality: They are also more common in premenopausal women and
Black
those with a BRCA1 gene mutation.20 The majority (about 75%)
100 of triple negative breast cancers fall in to the basal-like sub-
Mortality: type. Triple negative breast cancers have a poorer short-term
Non-Hispanic White
0
prognosis than other breast cancer types, in part because
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ there are currently no targeted therapies for these tumors.19, 21
Age
•  Luminal B (HR+/HER2+). Like luminal A breast cancers,
Sources: Incidence: North American Association of Central Cancer Registries
luminal B breast cancers are ER+ and/or PR+ and are further
(NAACCR), 2015. Mortality: US mortality data, National Center for Health defined by being highly positive for Ki67 (indicator of a large
Statistics, Centers for Disease Control and Prevention.
proportion of actively dividing cells) or HER2. About 10% of
American Cancer Society, Inc., Surveillance Research, 2015
breast cancers are ER+ and/or PR+ and HER2+. Luminal B
breast cancers tend to be higher grade and more aggressive
than luminal A breast cancers.22
According to the SEER Summary Stage system:
•  HER2-enriched (HR-/HER2+). About 4% of breast cancers
•  Local stage refers to cancers that are confined to the breast
produce excess HER2 and do not express hormone receptors.
(corresponding to stage I and some stage II cancers in the
These cancers tend to grow and spread more aggressively than
TNM staging system).
other breast cancers and are associated with poorer short-term
•  Regional stage refers to tumors that have spread to surround- prognosis compared to ER+ breast cancers.19 However, the recent
ing tissue or nearby lymph nodes (generally corresponding widespread use of targeted therapies for HER2+ cancers has
to stage II or III cancers, depending on size and lymph node reversed much of the adverse prognostic impact of HER2 over-
involvement). expression. For more information about the treatment of HER2+
•  Distant stage refers to cancers that have metastasized (spread) breast cancers, see the section on targeted therapy on page 25.
to distant organs or lymph nodes above the collarbone
(corresponding to some stage IIIc and all stage IV cancers). What are the signs and symptoms of
Although we generally refer to breast cancer as a single disease, breast cancer?
it is important to note that it is distinguished by up to 21 distinct Breast cancer typically produces no symptoms when the tumor is
histological subtypes and at least four different molecular sub- small and most easily treated. Therefore, it is very important for
types, which are biologically variable in presentation, response to women to follow recommended screening guidelines for detecting
treatment, and outcomes, and also associated with distinct risk breast cancer at an early stage. When breast cancer has grown to
factors.9-14 Gene expression profiling techniques have allowed us a size that can be felt, the most common physical sign is a painless
to better understand the genetic variability among tumors; how- lump. Sometimes breast cancer can spread to underarm lymph
ever this is a costly and complicated process and is not currently nodes and cause a lump or swelling, even before the original breast
standard practice. More convenient approximations of molecular tumor is large enough to be felt. Less common signs and symptoms
subtypes have been identified using routinely evaluated biological include breast pain or heaviness; persistent changes to the breast,
markers, including the presence or absence of hormone (estro- such as swelling, thickening, or redness of the breast’s skin; and
gen or progesterone) receptors (HR+/HR-) and excess levels of nipple abnormalities such as spontaneous discharge (especially
human epidermal growth factor receptor 2 (HER2+/HER2-), a if bloody), erosion, or retraction. It is important to note that pain
growth-promoting protein.15-18 The four main molecular sub- (or lack thereof) does not indicate the presence or the absence of
types are described above. breast cancer. Any persistent change in the breast should be evalu-
ated by a physician as soon as possible.

2  Breast Cancer Facts & Figures 2015-2016

1 † 68.9 9.6 † † 65.3 94.6 25.7 15.2 121.5 88.4 21.6 † 90.3 14.1 133.5 † † † Nebraska 123.0 83.2 † Oregon 130. American Cancer Society.6 11.7 24.7 15.9 Massachusetts 141.8 9.3 35.7 124.9 111.8 20.1 90.3 † † 134.4 86.2 28.0 91.7 20.Table 2.7 65.1 31.5 82.4 † 66.4 109.9 † Maine 125. ‡This state’s registry did not achieve high-quality data standards for one or more years during 2008-2012.9 14.0 34. Mortality: US mortality data.5 16.7 115.0 † District of Columbia 164.2 Hawaii 138.1 64.0 33.7 108.1 † California 140.7 † Arizona 118.7 20.9 72.9 124.4 *Rates are per 100.7 Utah 115.9 Washington 139.4 19. †Statistics not displayed due to fewer than 25 cases or deaths.4 † † 79.6 122.3 7.0 128.1 † South Dakota 128.6 129.9 Colorado 127.1 11.8 31.0 † 125.0 100.2 141.1 Pennsylvania 129.5 Michigan 121.9 75.5 97.6 22.6 18.2 22.4 Iowa 124.2 32.5 94.6 8.0 68.9 130.2 19.8 13.4 73.9 15.4 11.3 44.2 9.2 12.6 103.5 24.0 96.7 † Alaska 126.2 22.7 33.9 59.1 33.7 8.000 and age adjusted to 2000 US standard population.1 122.7 † 81.0 74.9 † † † † † † Tennessee 120.9 134.8 86.3 33.7 78.7 21.9 † 68.7 12.3 31.6 22.1 104.9 115.8 † 96.5 † Illinois 133.5 83.1 130.5 94.2 Indiana 119.0 105.3 109.7 134.9 † Florida 120.3 123.2 29.2 21.1 29.7 87.6 8.2 124.8 10.6 21.0 12.7 60.0 7.9 30.3 77.2 92. Female Breast Cancer Incidence and Mortality Rates* by Race/Ethnicity and State.9 Idaho 120.9 19.1 11.5 8.7 † † † † † † Virginia 127.2 † 82.6 22.2 20.7 87.0 13.8 21. 2015 Breast Cancer Facts & Figures 2015-2016  3 .6 135.9 13.7 52.3 † 43.1 † 75.3 † 125.8 21.4 32.1 29.5 22.4 89.9 34.1 87.2 Montana 123.3 131.3 127.2 33.8 † 85.0 89.7 21.7 88.1 † Vermont 129.9 10.4 † 80.2 25.7 105..0 21.4 21.2 20.4 104.4 Delaware 126.6 9.7 28.4 † Wisconsin 126.7 8.1 8.2 Oklahoma 116.9 † † 99.9 New Hampshire 136.5 10.5 20.0 32.5 22.9 21.4 124.0 20.5 North Dakota 122.3 9.6 † 96.2 26.1 120.9 23.3 10.3 New Mexico 125.1 21.8 85.5 121.8 11.2 † † † † 84.1 120.8 83.7 93.9 North Carolina 128.3 † Texas 124.4 24.1 125.1 87.7 11.1 89.3 25.6 131.8 West Virginia 111.2 30.0 Minnesota‡ 131.8 28.4 106.6 123.5 15.2 129.9 95.1 16.4 63.2 99.1 23. 2008-2012 Non-Hispanic White Non-Hispanic Black Hispanic Asian/Pacific Islander State Incidence Mortality Incidence Mortality Incidence Mortality Incidence Mortality Alabama 117.8 71.9 126.9 Georgia 125.1 11.0 22.2 † 54.0 16. Inc.2 29.9 20.0 131.5 13.7 77.3 9.1 † South Carolina 125.9 21.4 † New Jersey 140.0 30.3 11.2 † Wyoming 113.6 † † † United States 128.5 26.3 19.9 10.5 20.9 127.8 20.5 8.7 21.0 12.8 21.1 137.4 † Louisiana 121.8 32.9 76.7 80.6 28.1 21.5 † † 120.6 85.2 80.2 Mississippi 113.1 24.1 91.5 20.3 Rhode Island 135.6 33.4 100.1 33.9 21.5 82.9 29.7 31.3 50.7 † † † † † † Ohio 121.5 84.8 86.5 113.4 125.7 126. according to NAACCR data quality indicators and are not included in the overall US incidence rate.2 † 70.2 71.0 76.6 † Kentucky 121.9 77.1 28. 2015.9 21.5 98.1 † New York 138. Centers for Disease Control and Prevention.8 9.7 Arkansas‡ 107.5 26.3 18.1 70.6 12.1 81.3 20.7 22.5 † Nevada‡ 121. National Center for Health Statistics.9 21.5 10.3 Connecticut 141. Surveillance Research.8 119.6 71.4 29.7 88.3 11.1 20.3 13.4 69.8 8.3 9.4 † 72.2 † 59.4 107.7 53.1 74.8 12.9 † Maryland 133.2 21. Sources: Incidence: NAACCR.0 † Missouri 124.1 18.8 † Kansas 123.2 30.2 126.3 9.7 78.0 23.

3 Incidence 120 •  In 2015. accounting for 29% of as well as increases in breast cancer incidence due in part newly diagnosed cancers. 25 Incidence and death rates for breast cancer are of being diagnosed with breast cancer.1 124.4 breast cancer? 0 More than 3. 2014. the median age at the time of breast cancer ure 1.24 race and ethnicity during the most recent time period (2008- •  A woman living in the US has a 12. including the possibility that she may die from another cause before she would have been Age diagnosed with breast cancer. about 2. 4  Breast Cancer Facts & Figures 2015-2016 . menopausal hormone •  Men are generally at low risk for developing breast cancer. an estimated 231.. The decrease in incidence rates that occurs in women 80 years of age and older may reflect lower Race/Ethnicity rates of screening. Asian/Pacific in their lifetimes. Lifetime risk reflects an average woman’s a physician. Conversely.0 21. However. approximately 40. Who gets breast cancer? American Cancer Society. and/or incomplete detection. Inc. 31. risk over an entire lifetime. they should report any change in their breasts to through screening. as well as an estimated 60. Lifetime risk is often misinter- •  Breast cancer incidence and death rates generally increase preted to apply only to women who live to a very old age.1 million US women with a history of breast can. have been undergoing treatment.23 Some of these women were cancer-free. the time of diagnosis. the detection of cancers by mammography •  Between the ages of 60 and 84. †Persons of Hispanic origin may be any race. US. Breast Cancer Occurrence Figure 2. page 1).5 11. Rate per 100.25 Mortality: US mortality data. page 2). while others still had evidence of cancer and may *Rates are age adjusted to the 2000 US standard population. 2015 Sex •  Excluding cancers of the skin. page 1). This increase in rates.24.840 new cases of invasive breast Mortality cancer will be diagnosed among women. common cancer among US women.9 88. and increased detection however. 2008-2012 How many cases and deaths are estimated to 140 occur in 2015? 128.000 80 •  In 2015.350 men will be diagnosed with breast cancer 40 and 440 men will die from the disease.3 (Table 1. Centers for Disease Control and Prevention.290 women are expected to die from breast cancer (Table 1. Sources: Copeland et al. lifetime risk 2012). page 2).290 additional cases of in situ breast cancer 100 91. the rising prevalence of obesity.24 This means that half of women who rate before age 45 and are more likely to die from breast developed breast cancer were 61 years of age or younger at cancer at every age. Only lung cancer accounts 60 for more cancer deaths in women. •  In 2015. The median age of diagnosis is younger •  Figure 2 shows breast cancer incidence and death rates by for black women (58) than white women (62). National Center for Health Statistics.9 20 How many women alive today have ever had 15. Surveillance Research. to changes in reproductive patterns.0 14. or a 1 in 8. Non-Hispanic Non-Hispanic American Indian/ Hispanic/ Asian/ White Black Alaska Native Latina† Pacific Islander cer were alive on January 1. the lifetime risk of being Islander (API) women have the lowest incidence and death diagnosed with breast cancer was 1 in 11.3%. black women have a higher incidence diagnosis was 61. are markedly higher in white women than black women (Fig- •  During 2008-2012.9 91. 7 out of 8 lower among women of other racial and ethnic groups than women born today will not be diagnosed with breast cancer among non-Hispanic white and black women. In the 1970s. with age (Figure 1. breast cancer incidence rates before 80 years of age. Female Breast Cancer Incidence and Mortality Rates* by Race and Ethnicity. breast cancer is the most risk over the past 4 decades is due to longer life expectancy. use.

Figure 3.7 FL HI Blacks WA MT ND ME OR MN VT ID NH SD WI MA NY WY MI RI CT IA PA NV NE NJ OH UT IL IN DE CA CO WV MD KS VA MO DC KY NC TN AZ OK NM AR Rate per 100.23.8 .7 MS AL GA 25.1 22. American Cancer Society..000 SC 18. †Statistics not displayed for states with fewer than 25 deaths.22.6 TX LA 30.2 .21.2 .0 FL No data† † HI *Per 100.32. Centers for Disease Control and Prevention. 2008-2012 Whites WA MT ND ME OR MN VT ID NH SD WI MA NY WY MI RI CT IA PA NV NE NJ OH UT IL IN DE CA CO WV MD KS VA MO DC KY NC TN AZ OK NM AR Rate per 100.3 .2 TX LA 21. National Center for Health Statistics.30.28.000 females and age adjusted to the 2000 US standard population.25.7 .8 .20. Source: US mortality data.35.5 32. Female Breast Cancer Death Rates* by Race.2 . 2015 Breast Cancer Facts & Figures 2015-2016  5 .1 MS AL GA 20.20.7 AK 20.000 SC 20. Inc.9 .6 .3 . Surveillance Research.2 AK 28.

7 in Minnesota to 35.000 Rate per 100.3 in New Mexico and from 7. and API women. The widespread 6  Breast Cancer Facts & Figures 2015-2016 .000 women by state for non-Hispanic white. American Cancer Society. when population-based cancer sur- from 107. Among black women.26 Incidence rates reflect 1980s and 1990s (Figure 4a). largely because of increases in disease occurrence.000 women) in Arkansas to 164. which can detect breast can- well as California (Figure 3. Some of the historic increase in breast cancer incidence reflects changes in reproductive patterns.5 In situ breast cancer in Montana among Hispanic women. Incidence rates of in situ breast cancer have stabilized since non-Hispanic white women compared to black women. In addition. These trends likely reflect trends in mammography cancer death rates range from 18. respectively.4 in the veillance began in the nine oldest US cancer registries.4 in Nevada screening rates. Trends in In Situ and Invasive Female Breast Cancer Incidence Rates* by Age. black. 44.9 in Invasive breast cancer Nevada.7 in Alaska among black women. page 3 shows breast cancer incidence and death Incidence trends – women rates per 100. SEER 9 Registries. Invasive 400 400 Ages 50+ 350 350 Ages 0-49 All ages 300 300 Rate per 100. Hispanic and API women have the of prevalent cases as a result of wide-spread screening.000 250 250 200 200 150 150 100 100 50 50 0 0 1975 1980 1985 1990 1995 2000 2005 2010 2012 1975 1980 1985 1990 1995 2000 2005 2010 2012 Year Year *Rates are age adjusted to the 2000 US standard population within each age group. National Cancer Institute. page 5). In Situ b. The increase in incidence was greater routinely screened. as well as how completely the population is mammography screening. lowest breast cancer death rates. Epidemiology. and Western regions for breast cancer. which peaked in 2000 and then stabilized at a among white women and from 21. Breast women.0 in Hawaii among API women. Inc. in women 50 years of age and older than in those younger than In every US state.7 in Vermont to 25. District of Columbia among white women.7 (cases per 100. and 43.8 in Georgia to 18. and End Results (SEER) Program. breast cancer incidence rates of the US. cers earlier when they are too small to be felt. Death 2000 among women 50 and older and since 2007 among younger rates reflect both cancer incidence rates and survival. Figure 4. ranging from 7. 1975-2012 a. Breast cancer incidence rates range incidence rates since 1975.5 in North Carolina to 16. Surveillance Research..27 It may also reflect a reduced pool homa among black women. such as delayed childbear- Breast cancer mortality rates among white women tend to be ing and having fewer children. breast cancer death rates are lower among 50. 2015 Are there geographic differences in breast How has the occurrence of breast cancer cancer rates? changed over time? Table 2. Figure 4 presents trends for in situ and invasive breast cancer Hispanic.3 in Mississippi to 134. 94. Source: Surveillance. Mid-Atlantic.0 in Okla. as of mammography screening. US. the highest death rates are increased rapidly during the 1980s due largely to greater use found in some of the South Central and Mid-Atlantic states. slightly lower rate after 2005.0 in Mississippi Incidence rates of in situ breast cancer rose rapidly during the to 125. which are known risk factors highest in the North Central.0 in Minnesota to 141.

Data for other races/ethnicities are 3-year moving averages from the 13 SEER registries. 1975-2012 and blacks have converged in 2012.24 Asian/Pacific Islander 5 Tumor size: Figure 6.0 cm).4% per year) and API (1. Centers for Disease Control and Prevention. Trends in Female Breast Cancer Death Alaska Natives (AI/AN). breast cancer rates dropped sharply (nearly 7%). incidence data do not include cases from the Alaska 2012 (the most recent 5 years of data available). page 8 presents incidence trends by race/ethnic. 20 Alaska Native incidence rates slightly increased in whites (0.3% per year for tumors *Rates are age adjusted to the 2000 US standard population.. likely Pacific Islander Rate per 100. overall breast Native Registry. followed by a slower increase during 160 the latter half of the 1990s (Figure 4b). The percent. Rates stabilized Rates* by Race and Ethnicity. National Cancer Institute. 140 as well as rising rates of obesity and the use of menopausal hor- mones. or American Indians/ Figure 5b.1-5. by 1. and for ER+ disease.4% per year) and Hispanic/Latina APIs (0.5% per year) women. page 8 describes trends in incidence rates by tumor size for women of all races combined.24 Among older women (50+). 30 This trend may also reflect declines in mammography screening.28. This trend may reflect further increases in the prevalence of mammography screening. larger than 5. Inc. rates increased 0. National Center for Health Statistics.7% per year for women 50 years of age and older. breast cancer rates for whites Rates* by Race and Ethnicity. in the rate of tumors with unknown size since 1992. ity and stage at diagnosis. Notably.3%) women. however. Among younger women (<50). women of other races and ethnicities since 1992. Year In contrast. reflecting the slow. in women 50 60 years of age and older. but steady increase in incidence in black women and relatively stable rates 45 in white women (Figure 5a). Incidence reporting delay.3% per year for 2. US. incidence rates increased for larger tumors. Rates for American Indian/ Alaska Native are based on CHSDA counties and are 3-year moving averages. Between 2002 120 White Asian/ and 2003. For smaller 0 1975 1980 1985 1990 1995 2000 2005 2010 2012 tumors (≤ 2.8%) during 2008-2012 and were stable in other racial/ 15 ethnic groups. Incidence rates have increased during American Cancer Society. 1975-2012 between 1987 and 1994. incidence rates were stable during 2008-2012. and has since stabilized.24 0 1975 1980 1985 1990 1995 2000 2005 2010 2012 Year Race/Ethnicity: Figure 5a presents trends in invasive female *Rates are age adjusted to the 2000 US standard population and adjusted for breast cancer incidence rates by race and ethnicity.28.24 Trends by age at diagnosis 25 American Indian/ also vary by race and ethnicity. Stage: F  igure 7. 40 age of women 40 years of age and older who reported having a mammogram within the past 2 years peaked in 2000. (0. For Hispanics. Incidence data for American Indians/Alaska Natives are based cancer incidence rates increased among non-Hispanic black on Contract Health Service Delivery Area (CHSDA) counties. both of which increase breast cancer risk. 29 The decline American Indian/ Alaska Native Latina in incidence occurred primarily in white women. Trends in Female Breast Cancer Incidence they would have in the absence of screening. US.uptake of mammography screening inflated the incidence rate because cancers were being diagnosed 1 to 3 years earlier than Figure 5a. Hispanics. as provided by the Surveillance.0 cm tumors and by 2. data are available for white and black women since 1975 and for Source: Data for whites and African Americans are from the 9 SEER registries. Rates for Hispanics exclude deaths from New Hampshire and Oklahoma. 40 Black Age: Trends for invasive breast cancer by age at diagnosis are 35 shown in Figure 4b. but were stable among non-Hispanic whites. Among women under age 50. Surveillance Research. and End Results Program. declined 20 slightly. overall breast cancer incidence rates remained stable.000 time period (2008-2012). increasing trends 10 were observed only in black (0.0 cm. there has been a consistent decline Source: US mortality data. Notably.27 From 2004 to 2012. breast can- cer incidence rates were relatively stable during the most recent 30 White Rate per 100. Epidemiology.000 due to the decreased use of menopausal hormones following the 100 Black 2002 publication of clinical trial results that found higher risk 80 Hispanic/ of breast cancer and heart disease among users. 2015 Breast Cancer Facts & Figures 2015-2016  7 . During 2008.4%) and API (1.

Rates of distant-stage tumors increased in white. adherence. On the other hand.000 Rate per 100. breast can- death rates declined annually by 1. but remained unchanged among American Indians/Alaska Natives. Source: 13 SEER Registries.3%) and were stable for blacks and APIs. However.000 Rate per 100.000 Rate per 100. Surveillance Research.32-34 The racial disparity may also reflect differences in mammography screening.24 From 2003 through 2012. breast cancer death rates decreased in white women The decline in breast cancer mortality has been attributed to both in all 50 states. 2015 40 40 30 30 2008-2012 for localized breast cancers among white (0. and adjusted for reporting delay. breast cancer death rates were sta- equally from these advances.0-4. and more since 2007. including unstaged tumors declined sharply. 2010 and have since stabilized.9 cm 30 30 30 20 20 10 10 20 unknown 0 0 1992 1995 1998 2001 2004 2007 2011 1992 1995 1998 2001 2004 2007 2011 10 5+ cm Asian/Pacific Islander Hispanic 0 100 100 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 90 90 Year 80 80 *Rates are age adjusted to the 2000 US Standard population and adjusted for 70 70 reporting delay. and response Mortality trends – women to treatment. During 2003-2012. not all segments of the population have benefited Oklahoma. National Cancer Institute. In 3 states (Mississippi. 1. obesity and comorbidities. black (2.24 Trends in breast cancer death rates also vary by state. Inc. rates of ity difference likely reflects a combination of factors.. although these surveys may overestimate mammography rates. breast cancer improved. Inc. cer death rates were 42% higher in black than white women.0% in Asians/Pacific Islanders. page 7). and 1. and API (0. which likely reflects more differences in stage at diagnosis. 50 50 American Cancer Society.8%) women. Trends in Female Breast Cancer Incidence Figure 7. as well as access. Trends in Female Breast Cancer Incidence Rates* by Tumor Size.9% per 20 20 10 10 year). A striking divergence in long- ble for black women during 2003-2012. and complete staging of advanced tumors. The ilar between black and white women. age adjusted to the 2000 US standard regional stage tumors also declined in Hispanics during 2000. some studies suggest that decrease occurred in both younger and older women.000 60 60 Source: 13 SEER Registries. US. This mortal- 8  Breast Cancer Facts & Figures 2015-2016 . Rate per 100. the breast cancer death rate has been level among so for blacks than whites. 0 0 rates for regional stage tumors have decreased in white women 1992 1995 1998 2001 2004 2007 2011 1992 1995 1998 2001 2004 2007 2011 (1. the racial disparity has widened. 1992-2012 Rates* by Stage and Race/Ethnicity. National Cancer Institute. by 2012. These trends may reflect a shift American Cancer Society.4% per year) since 1975..4% in blacks. but in all four groups. Figure 6. 1992-2012 90 Localized Regional Distant Unknown 80 Non-Hispanic White Non-Hispanic Black 100 100 <2.000 60 60 50 50 50 40 40 40 <2. 1.4%). but for black women in only 27 out of 30 states improvements in breast cancer treatment and early detection.5% in Hispanics. tumor characteristics. Incidence rates for *Rates are two-year moving averages. but not Hispanics. and API women. after slowly increasing (0. black. Surveillance Research. The lack of a decline in term breast cancer mortality trends between black and white these states is likely related to variations in the prevalence and women began in the early 1980s (Figure 5b. Although findings from national Overall breast cancer death rates decreased 36% from 1989 to surveys indicate current mammography screening rates are sim- 2012. population. 2015 toward earlier stage at diagnosis in white and Hispanic women. US.8% in whites.31 with sufficient data to analyze trends.0 cm 70 90 90 80 80 60 70 70 Rate per 100. and Wisconsin).35-37 As treatment for breast cancers has women younger than 50.

It differs from observed survival in that it accounts •  89% at 5 years after diagnosis for deaths from other causes by comparing survival among can. accounting for approxi. from 1. Men are more likely than women to be 0.000 men during 1975-1979 to 1. testicular disorders.8 diagnosed with advanced-stage breast cancer. 1975-2012 Incidence and mortality trends – men 1. felter syndrome. since 1975. Inc. Breast cancer in men is rare.0 1.4 of male breast cancer increases with age. Similar to female breast cancer. Stage distribution percents may not sum to 100 due to rounding.38 However. Risk factors include radiation exposure.39 The death rate for male breast cancer has decreased 1. unlike female breast cancer. the incidence rate has increased 0. Kline.0 case per 100. Five-year Relative Survival Rates (%) by Stage b.2 year from 2000 to 2012. Source: Howlader et al. gynecomastia (enlarged breasts). 2015 Breast Cancer Facts & Figures 2015-2016  9 .6 mammography is not recommended for men because of the rar- ity of the disease.3 cases per 100.000 Rate per 100.4 Figure 8 presents incidence and mortality trends for male breast Incidence cancer. much less is 1975-79 1980-84 1985-89 1990-94 1995-99 2000-04 2005-08 2009-12 Year known about the disease than female breast cancer. 2005-2011 a. Control and Prevention. Mortality: US mortality data. 41 American Cancer Society. BRCA 1/2 gene mutations. Trends in Male Breast Cancer Incidence and Mortality Rates. Surveillance Research.8% annually.24 American Cancer Society.quality of mammography screening and access to high-quality medical treatment.8% per 0.0 Due to the infrequency of male breast cancer. incidence rates are similar in blacks and whites. however. Figure 9. US. •  83% after 10 years cer patients to survival among people of the same age and race •  78% after 15 years who have not been diagnosed with cancer.. National Cancer Institute.2 mately 1% of breast cancer cases in the US. Screening 0.. Stage Distribution (%) by Race at Diagnosis and Race 94 53 Localized 99 Localized 62 99 61 75 37 Regional 86 Regional 31 85 32 17 9 Distant 27 Distant 5 Black 26 6 White 51 2 All Races Unstaged 49 Unstaged 2 52 2 0 25 50 75 100 0 25 50 75 100 *Survival based on patients diagnosed between 2005-2011 and followed through 2012. 2015 Breast cancer survival and stage at diagnosis Relative survival rates are an estimate of the percentage of Based on the most recent data. Female Breast Cancer Survival Rates* and Stage Distribution.* US. family history of male or Sources: Incidence: 9 SEER Registries. Surveillance Research.40. National Center for Health Statistics. relative survival rates for women patients who will survive for a given period of time after a cancer diagnosed with breast cancer are: diagnosis. which likely reflects decreased awareness and delayed detection. *Rates are age adjusted to the 2000 US standard population. the incidence 0. Centers for Disease female breast cancer.000 men during 2008-2012. 0. Figure 8. diabetes. and obesity. Mortality 1. Inc.

1990. among women with regional disease. the 5-year rela. tumor characteristics that influence breast cancer survival are Table 3 presents 5-year cause-specific breast cancer survival not taken into account.1-5. 1984.24 The racial disparity in they are based on the average experience of all women and do survival reflects both later stage at diagnosis and poorer stage- not predict individual prognosis because many patient and specific survival in black women (Figure 9. page 9). through 2012.1999. Chinese and Japanese women (among Asians Survival is lower among women with a more advanced stage of known origin) have the highest breast cancer survival rates. Second. For Poverty. 1981.43-45 Breast cancer tive survival is 95% for tumors less than or equal to 2. Inc. 2002. 85% for regional group. associated with lower breast cancer survival. Surveillance Research. Inc. Pakistani 91 60 Chinese 93 Percent 50 Filipino 90 40 Japanese 93 Korean 92 30 Vietnamese 91 20 Other Asian 93 10 Pacific Islander 87 Hawaiian 90 0 1975. at diagnosis (Figure 9a. less education. disease... tancy are not available for most racial groups. 1996. never- theless. Source: Howlader et al.0 cm. page 9). long-term survival rates are rates by race and ethnicity. Cause-specific Stage at diagnosis survival is the probability of not dying of breast cancer within 5 years of diagnosis. 1975-2011 Survival Rate* by Race/Ethnicity. First.0 cm. 2015 American Cancer Society. the breast cancer 5-year relative survival rate has increased significantly for both black and white women. the 5-year relative survival rate was 81% for 10  Breast Cancer Facts & Figures 2015-2016 . Cause-specific survival instead of based on the experience of women diagnosed and treated many relative survival is used to describe the cancer experience of years ago and do not reflect the most recent improvements in racial and ethnic minorities because estimates of life expec- early detection and treatment. 1978. and a lack of health insurance are also example.0 cm. and 70% for tumors greater than 5. 84% patients who reside in lower-income areas have lower 5-year for tumors 2. Figure 10. In the most recent period.24 Larger tumor size at diagnosis is also associated with decreased survival. Considering all races. there remains a substantial racial gap (Figure 10). Trends in Female Breast Cancer 5-year Table 3.24 Source: Howlader et al. 1987. 2005. 2005-2011 Survival 100 White Black Rate (%) Non-Hispanic White 89 90 Black 80 80 American Indian/Alaska Native 85 70 Asian 92 Asian Indian. 2015 Relative survival rates should be interpreted with caution.46 Race/ethnicity and socioeconomic factors Since 1975. 1993. Surveillance Research.24 American Cancer Society.42 survival rates than those in higher-income areas at every stage of diagnosis. Five-year Cause-specific Breast Cancer Relative Survival Rates* by Race. 5-year Black women have the lowest survival rate of any racial or ethnic relative survival is 99% for localized disease. black women and 92% for white women. Other Pacific Islander 82 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2011 Year Hispanic 88 *Survival based patients diagnosed between 2007-2011 and followed *Survival based on patients diagnosed between 2005-2011 and followed through 2012. and 26% for distant-stage disease.

an estimated menopause. page 15).51 mone therapy should be considered when evaluating treatment In addition. Breast Cancer Facts & Figures 2015-2016  11 . Factors associated with an increased or decreased risk of breast cancer are discussed below. Compared to women without a family history. tubal. brother. page 12) are not modifiable.53-55 Mutations in Strategies that may help reduce the risk of breast cancer include PALB2.50. breast cancer. tests are not available for all of the father. risk is higher with more than one affected first-degree Recently updated recommendations from the US Preventive Ser- relative. late account for 5%-10% of all female breast cancers. For more have a family history of the disease. however.58 It is not yet possible to predict if or when Women (as well as men) with a family history of breast cancer. the interpretation of these tests and treatment deci- Family history sions is complex. 51 These mutations are very rare (much less than 1%) thereby increasing the likelihood of DNA damage.org to see the American Cancer Society document called Genetic Testing: What You Need to Know. 52 time between menarche and first pregnancy may be particu- Compared to women in the general population who have a 7% larly critical.or basal-like breast cancers. Hormones are thought 5%-20% of male breast cancer.57 Mutations and genetic variants can be inherited from among women at high risk (see page 17 for section on chemo- either parent and by sons or daughters. women who carry a particular genetic abnormality will develop especially in a first-degree relative (mother. A family history of ovarian cancer is also associated with Breast Cancer Risk Factors increased breast cancer risk in both men and women. as well as many of the family cancer Personal and family history syndromes responsible for inherited forms of breast cancer. daughter. between 57%-65% and 45%-55%. low-risk variations in the genetic code may affect options for menopausal symptoms. Furthermore. and minimizing alcohol intake (see American Cancer Other inherited conditions associated with a smaller increase Society guidelines. and breastfeeding. Many breast cancer risk factors affect life- the most well-studied breast cancer susceptibility genes. but occur slightly more often in cer- promoting cancer growth.56 activity. information. Although breast cancer risk accu- tain ethnic or geographically isolated groups. early menarche. cancers. prevention).48 The increased risk of breast in breast cancer risk include the Li-Fraumeni and Cowden syn- cancer associated with the use of combined menopausal hor- dromes and a number of more common genetic mutations. as well as in the general population. It is important to note that the majority of women with one is strongly encouraged to talk with a genetic counselor before or more affected first-degree relatives will never develop breast making a decision so that the benefits and potential conse- cancer and that most women who develop breast cancer do not quences can be understood and carefully considered. sister. or perito- times higher for women with two relatives. risk vices Task Force encourage primary care providers to routinely of breast cancer is about 2 times higher for women with one collect and update family history information and to screen first-degree female relative who has been diagnosed. and late menopause. genetic predisposition to cancer. ovarian. Treatment with interaction between lifestyle factors and these low-risk varia- tamoxifen or raloxifene can also reduce the risk of breast cancer tions. Women who choose to breast cancer risk. engaging in regular physical risk similar to BRCA2 mutations. research suggests that the Ashkenazi (Eastern European) Jewish descent (about 2%). cancer. obesity.50. time exposure of breast tissue to hormones (early menarche. a different gene that works with BRCA2. use of combined estrogen Genetic predisposition and progestin menopausal hormones. nearly 3 women with a family history of breast. or son) are at increased risk of developing breast genetic variants that affect breast cancer risk.49 Risk is further to determine if there is a need for in-depth genetic counseling increased when the affected relative was diagnosed at a young to consider BRCA testing. Molecular tests are commercially available to identify some of the BRCA mutations. Scientists believe that much of the occur- breastfeed for an extended period of time (studies suggest a year rence of breast cancer clustered in families results from the or more) may also lower their breast cancer risk. such as those of mulates throughout a woman’s life. visit cancer. less risk for BRCA1 and BRCA2 mutation carriers is estimated to be is known about risk factors for ER. and 15%-20% of all familial breast to influence breast cancer risk by increasing cell proliferation. and nearly 4 times neal cancer with one of several brief screening questionnaires higher for women with three or more relatives. the average are specifically associated with ER+/luminal breast cancer. such as age. Inherited mutations (genetic alterations) in BRCA1 and BRCA2. family history. respectively. alcohol consumption. appear to confer avoiding weight gain and obesity. and hormone use).47 Many established risk factors for breast cancer risk of developing breast cancer by 70 years of age.59 Anyone who is considering testing age. Factors that are modifi- able include postmenopausal obesity. Women with a history of breast or ovarian cancer in their immediate family or in either parent’s extended family should discuss this Many factors known to increase the risk of breast cancer (Table with their physician because it may signal the presence of a 4.

such as mutations in BRCA1 and BRCA2 genes. it is a strong Table 4.63 Risk Factor >4.61 Many women have dense breasts. screening.60 The risk is is further reduced by pregnancy and menopause.3 times. with risk increasing with the level of mammo- graphic breast density. Women with LCIS are 7 to 12 times more likely to for Breast Cancer in Women develop invasive cancer in either breast than women without Relative LCIS.1-2. and counseling for chemoprevention and other • Personal history of breast cancer (40+ years) risk-reduction strategies. • Two or more first-degree relatives with breast cancer •  Nonproliferative lesions are not associated with overgrowth diagnosed at an early age 2. About 40%-50% of women Ductal or lobular carcinoma in situ undergoing screening mammography have heterogeneous or DCIS is considered a precursor to invasive cancer. • Ductal carcinoma in situ proliferative lesions without atypia (abnormal cells or patterns • Lobular carcinoma in situ • Personal history of early-onset (<40 years) breast cancer of cells). Women with a history of DCIS are 8 to 10 times more greater breast density have about a 1. particu- density). Although LCIS seldom becomes invasive cancer. hyperplasia. although risk increases across all Benign breast disease ages until age 80) • Biopsy-confirmed atypical hyperplasia Some types of benign breast conditions are linked to breast can- • Certain inherited genetic mutations for breast cancer cer risk. ovary.68 larly among women diagnosed at a young age. or colon cancer • Recent and long-term use of menopausal hormone therapy containing estrogen and progestin Breast density • Recent oral contraceptive use Breast tissue density (a mammographic indicator of the amount of the breast’s glandular and connective tissue relative to its fatty tissue) has been shown to be a risk factor for the development Personal history of breast cancer of breast cancer. simple cysts.0 • Alcohol consumption small increase in the risk of breast cancer (1.5 to 2 times • A shkenazi Jewish heritage the risk of those who do not have one of these lesions) and • Diethylstilbestrol exposure • Early menarche (<12 years) include non-atypical (or usual) ductal hyperplasia and • Height (>5 feet 3 inches) fibroadenoma.64 • High socioeconomic status •  Proliferative lesions with atypia are associated with the • Late age at first full-term pregnancy (>30 years) greatest breast cancer risk – about 4 to 5 times higher than • Late menopause (>55 years) • Mammographically dense (26%-50%) breasts compared to average risk.5-fold because of the higher proportion of fatty tissue. mam- women without DCIS.70 Perhaps more importantly.60 Genetic predisposi- also affect breast density.5 times more likely to develop a new breast cancer. those with 26%-50% or >50% or cancer.65 Although breast density is influenced Compared to women who have never been diagnosed with by genetics. It 1. but also extremely dense (>50% density) breasts. <65 years. it is also affected by a number of other factors.69 Compared to women increases a woman’s risk for developing a new invasive breast with 11%-25% breast density. reflecting the degree of risk: nonproliferative lesions. Women diagnosed sity is generally lower among women with higher body weight with early onset breast cancer (age <40) have almost a 4.6 or 2. • Non-atypical ductal hyperplasia or fibroadenoma • Never breastfed a child Women should keep detailed records of any benign breast • No full-term pregnancies biopsy results.65 Breast den- higher if the diagnosis was at a younger age.62 mographic detection of breast cancer is impaired in areas of 12  Breast Cancer Facts & Figures 2015-2016 . women with a history of breast cancer are about most women. • Personal history of endometrium. pared to less dense (11%-25%) • One first-degree relative with breast cancer •  Proliferative lesions without atypia are associated with a 1. and mild • Mammographically extremely dense (>50%) breasts com.64 These include atypical ductal hyperplasia less dense (11%-25%) (ADH) and atypical lobular hyperplasia (ALH).67 Alcohol may also increase breast density.0 • High endogenous estrogen or testosterone levels of breast tissue and have little to no effect on breast cancer (postmenopausal) risk. contribute sity) and combined menopausal hormone therapy (increases to some of the excess risk of subsequent breast cancers.0 • Age (65+ vs. Factors That Increase the Relative Risk risk factor. Examples of nonproliferative lesions include fibrosis • High-dose radiation to chest (also known as fibrocystic changes). including tamoxifen (decreases den- tion. respectively.1-4. In breast cancer. and proliferative lesions with atypia. likely to be diagnosed with an invasive breast cancer than higher risk of breast cancer. decreasing with age. as that information is valuable for risk assess- • Obesity (postmenopausal)/adult weight gain ment. it will change over time.66 Some drugs increased risk of subsequent breast cancer. Doctors often categorize these conditions into 3 general (BRCA1 and/or BRCA2) groups.

was not associated with breast cancer risk. however.100-102 Studies of the Breast Cancer Facts & Figures 2015-2016  13 .72-74 clomiphene. It is less clear if newer. In a review of 47 studies in 30 who experience menopause at age 55 or older have about a 12% countries. first child before 20 years of age have a 50% reduced lifetime risk ing that mammography reports include information about of breast cancer compared to women who have not had children. Pregnancy Some. a recent large review found that high levels of circu- never used fertility drugs. breast cancer risk is about protective effect may be stronger for or even limited to triple 20% higher among girls that begin menstruating before age negative cancers.dense breast tissue. Menstrual cycles Breastfeeding Breast cancer risk increases slightly for each year earlier men- Most studies suggest that breastfeeding for a year or more struation begins (by about 5%) and for each year later menopause slightly reduces a woman’s overall risk of breast cancer. studies have found recent use of the inject- Not having children or having children later in life is associated able progestin-only contraceptive depot-medroxyprogesterone with increased risk of breast cancer. if any. but a marker for cumulative estrogen begin use before 20 years of age or before first pregnancy. including ing breast cancer compared to women with the lowest levels. estrogen formulations.90 More research is needed on the rela- lating estrogens and androgens are also associated with a small tionship between breast cancer risk and the long-term effects of increased risk of breast cancer in premenopausal women. but not all. should be done in addition to mammograms to years of age remain at higher risk of breast cancer compared screen for breast cancer in women with dense breasts. 24 states have laws requir.95-99 exposure. it is similar to those who have never taken bone density indicates absence of osteoporosis). women who have a prior use (5 or more years ago) of the drug.79-83 Bone density does not appear to be an independent risk increase in breast cancer risk.87. breast density.91 The begins (by about 3%). no association has been found with associated with decreased risk.76 ovulation-stimulating drugs. risk appears to be most strongly related to ER+ dis- bined estrogen and progesterone pill) is associated with a small ease.77 Likewise. the risk of breast cancer was reduced by 4% for every higher risk compared to those who do so between ages 50-54. low-dose estrogen formulations Reproductive factors increase breast cancer risk. such as ultrasound or MRI. thus reproductive hormones and has been more strongly linked to reducing the lifetime number of menstrual cycles.78 possible explanation relates to structural changes that occur in Bone mineral density the breast following lactation and weaning. at this time there is no expert consensus about what other ies also suggest that women who have their first child after 35 tests.71 As of June 2015.75 at 5 US fertility clinics also found no association with ever use of clomiphene or gonadotropins. and gonadotropin-releasing hor- High circulating hormone levels are associated with and may mones. whereas having a first child acetate (Depo-Provera) to be associated with increased risk at a younger age and having a greater number of children is of breast cancer. studies.84-86 Stud- ever.77 12 months of breastfeeding. risk of invasive breast It is harder to study the relationship of hormones in premeno- cancer was increased among women who underwent more than pausal women because levels vary across the menstrual cycle. and sured to identify women at increased risk for osteoporosis (high after about 10 years. How. Most of this research considered high-dose helpful for identifying women at increased risk for breast cancer. particularly among women who factor for breast cancer. supplemental imaging tests. to women have not had children.94 Another ER+ breast cancer than other subtypes. 12 clomiphene treatment cycles compared to women who had however. 92 Breastfeeding for a longer duration is asso- 11 compared to those that begin at age 13.83 However. A review of 23 studies found that use of fertility drugs.91 High bone mineral density in postmenopausal women has been Hormonal birth control associated with increased risk for breast cancer in many. which were more commonly used in the past. For example.78 Endogenous hormone levels Postmenopausal women with naturally high levels of certain Fertility drugs endogenous sex hormones have about twice the risk of develop.91.93 One possible explanation for this The increased risk may be due to longer lifetime exposure to effect may be that breastfeeding inhibits menstruation. because bone density is routinely mea- Risk appears to diminish when women stop taking the pill. particularly among women who are older at first birth. women ciated with greater risk reduction. it also may be oral contraceptives.89 Recently reflect the effects of other breast cancer risk factors. such as published results of a long-term follow-up study of women seen postmenopausal obesity and alcohol use. but not Studies suggest that recent use of oral contraceptives (com- all. gonadotropins.69 Many states with these laws also require that There also appears to be a transient increase in breast cancer women with dense breasts be told that they may benefit from risk (lasting about 10 years) following a full-term pregnancy. 88 Reproductive risk factors seem to be more strongly related to ER+ breast cancers.77 For example. however.

however. This association might also be explained by the higher levels of insulin among obese women.5 times higher in overweight women and about to secondhand smoke and breast cancer risk. For important to note that the overall breast cancer risk is low in example. diet.109 this example. Therefore. 115 Conflicting results may therapy. In which were not controlled for in the observational studies.112.103-105 Depo-Provera and Mirena What is the difference between absolute.124. ticularly for premenopausal breast cancer.123 Obesity and weight gain The association between breast cancer and secondhand smoke Obesity increases the risk of postmenopausal breast cancer.87 While relative risks are useful for comparisons. of discontinuation of hormone use. par.000 women of the same ages who never may slightly increase breast cancer risk. of every 44 women who are 50 years old will be diagnosed with breast cancer by the age of 60. ple. page 17). 111 Relative risk: Relative risk compares the absolute risk of The effects of estrogen-only therapy on breast cancer risk is less disease among people with a particular risk factor to the clear. 14  Breast Cancer Facts & Figures 2015-2016 . 30 cases would be expected heavy smoking and among women who start smoking before over the same period.108.2 years. 126. with higher risk associated with longer use. Postmenopausal hormones Lifetime risk: Lifetime risk is the absolute risk of being diag- Recent use of menopausal hormones (also referred to as hor.129 Breast some studies suggest secondhand smoke may increase risk. the risk for a 50-year-old cancer-free woman of being younger women and most studies suggest that any elevation in diagnosed with breast cancer over the next 10 years is 2% breast cancer risk is temporary and diminishes after discontin. 10. the 26% increased relative their first pregnancy. then risk is higher among those with the the use of estrogen alone is associated with reduced risk of breast risk factor than among those without the factor. 38 breast cancers would be expected to be Tobacco diagnosed among 10. (Table 5.26.116. thus more studies with lifetime. particularly among lean women and those who begin risk compared to women who have not used hormone therapy soon after menopause. and physical activity the risk of breast cancer. 110. have only been in use since the 1990s. or a 26% increased apy users.116-122 A recent review by American Cancer risk results in a total of 8 additional breast cancer cases per Society researchers found that women who initiated smok. Another way to say this is that 1 out of every 8 the onset of menopause compared to those who begin use women will be diagnosed with breast cancer in her lifetime later. which found that women who used estrogen-only exposure and the disease. It is also diagnosed with cancer over a certain period of time. The US Preventive Services Task Force has concluded that risk among people without that risk factor.000 women over a period of 5.118 The 2014 US Surgeon General’s report on smoking concluded that there is “suggestive but not sufficient” evidence that smoking increases Obesity. of developing breast cancer of 1.levonorgestrel-releasing intrauterine device (Mirena) have also produced conflicting results.108. A woman living in the US has a 12% chance of cancer. one study found current users of combined estrogen ing breast cancer. 107 Risk is being diagnosed with breast cancer in her lifetime (Table 5. For exam- therapy for an average of 6 years had a 23% lower risk of develop. in part. nosed with cancer over the course of a lifetime from birth mone therapy or hormone replacement therapy) with combined to death.108. Among 10. 111.0 reflect an inverse association between the domized trial.2 years (that is the absolute risk among this Limited but accumulating research indicates that smoking group).128 is unclear. 114. 125 However. 2 times higher in obese women than in lean women.000 women who use estrogen and progestin for 5. If the relative risk is above 1. used menopausal hormones. Relative cancer based on results from the Women’s Health Initiative ran- risks below 1. reflect higher rates of screening in menopausal hormone users. and relative risks? additional years of follow-up data are needed to confirm if use Absolute risk: Absolute risk is the likelihood of being of these drugs is associated with breast cancer risk. some observational and progestin menopausal hormones have a relative risk studies have found a slight increase in risk among estrogen ther.106. 127 to high estrogen levels because fat tissue is the largest source of estrogen in postmenopausal women. Another way to say this is that 1 out uation of hormonal birth control. particularly long-term. or a protective effect.0. Most studies have not found a link between exposure Risk is about 1. 109 The increased risk appears to diminish within 5 years (Table 5. Lifetime risk of breast cancer reflects the average estrogen and progestin increases the risk of developing breast probability of a female being diagnosed with breast cancer in the US. page 17). ing before the birth of their first child had a 21% higher risk of breast cancer than did women who never smoked. 113 In contrast. cancer risk associated with excess weight is likely due. also greater for women who start hormone therapy soon after page 17). they do not provide information about the absolute amount of additional risk experienced by the exposed group.

132.000 breast cancer cases. with an emphasis menopausal than premenopausal women. The increased risk was only observed among women who did not •  Children and adolescents should get at least 1 hour of use menopausal hormones. and whether risks differ by meta-analysis showed that soy intake was inversely associated tumor hormone receptor status.130.Obesity is a risk factor for type II diabetes. However. specific dietary components. 133 Adopt a physically active lifestyle.000 postmeno. a recent meta-analysis of animal fat intake and breast cancer. con. which included more than 20.140 The •  Eat at least 2½ cups of vegetables and fruits each day. Although some studies have found moderate. but foods and drinks. as find. and energy balance.142 If you drink alcoholic beverages.147 It has been suggested that The effect of diet on breast cancer risk remains an active area of soy consumption may reduce breast cancer risk. sistent.149 These findings are supported by ings from the Nurses’ Health Study showed that a high-fat diet studies linking lower breast cancer risk to higher blood levels of during adolescence was associated with a moderate increase in carotenoids (micronutrients found in fruit and vegetables). •  Choose foods and beverages in amounts that help achieve pausal women found that breast cancer risk was 14% lower and maintain a healthy weight. results are incon. 151 premenopausal breast cancer risk. lying down. dairy. Physical activity •  Doing some physical activity above usual activities. Cancer Society study that included more than 73. 131 American Cancer Society Guidelines for A recent review of 40 studies concluded that breast cancer risk Nutrition and Physical Activity for Cancer was 16% higher in women with type II diabetes independent of Prevention48 obesity. For those who are risk for developing breast cancer was about 14% lower in over.146 Similarly. to women who are inactive. Breast Cancer Facts & Figures 2015-2016  15 . vegetable consumption may reduce the risk of hormone recep- However. the •  Avoid excess weight gain at all ages.150. and other forms of screen-based entertainment. meat. to women who were normal weight. and fruits and vegetables) and breast cancer with mixed results. with stronger evidence for post. can have many cal activity have a 10%-25% lower risk of breast cancer compared health benefits.131 Achieve and maintain a healthy weight throughout life. 139-141 An American on plant foods. being underweight. A sure. benefit may be due to the effects of physical activity on body •  Choose whole grains instead of refined-grain products. losing even a small amount of weight women and about 26% lower in obese women compared weight has health benefits and is a good place to start.or vigorous activity each day. Many studies have looked at whether the timing of weight gain •  Adults should get at least 150 minutes of moderate- influences breast cancer risk. Consume a healthy diet. the timing of the exposure may be important. among women who reported walking 7 or more hours per week •  Limit consumption of processed meat and red meat. studies have found that obesity protects against •  Be as lean as possible throughout life without developing breast cancer before menopause. in part because research. perhaps because Asian women both consume more soy products cluded there was no association.13.128. loss on breast cancer because weight loss is often not sustained. soy. mass. A large meta-analy. sis found that among women between 40 and 49 years of age. or an equivalent combination. no matter what the level of activity. with breast cancer risk in Asian but not Western populations. fiber. Diet •  Drink no more than 1 drink per day for women or Numerous studies have examined the relationship between food 2 per day for men. intensity activity at least 3 days each week. with vigorous- weight loss to be associated with reduced risk.143-145 Early diet and breast cancer studies focused on fat intake. the protective effect may be limited to ER+ breast cancers.95 The underlying mecha.134 throughout the week. Growing evidence suggests that women who get regular physi. tor-negative breast cancer. preferably spread increases the risk of postmenopausal breast cancer by 11%. limit consumption. A large meta-analysis recently con. consumption (including fat. intensity or 75 minutes of vigorous-intensity activity each cluded that each 5 kg (about 11 pounds) gained during adulthood week. overweight or obese. watching television. with studies particularly focusing on timing of expo- of historically low breast cancer rates among Asian women. •  Get regular physical activity and limit intake of high-calorie nisms for this inverse relationship are not well understood. reducing dietary and begin at an earlier age than women in Western popula- fat in postmenopausal women did not affect risk of breast tions.135-138 It is more difficult to examine the effect of weight •  Limit sedentary behavior such as sitting. hormones. compared to women who walked 3 or less hours per week. In contrast. which has also been linked to increased risk for postmenopausal breast cancer.148 There is growing evidence that high levels of fruit and cancer in the Women’s Health Initiative dietary intervention.

178 16  Breast Cancer Facts & Figures 2015-2016 . there is presently In general.168 antiperspirant use has been less well-studied. Most studies of demonstrated in studies of atomic bomb survivors and women nurses who work night shifts and flight attendants who experi- who have received high-dose radiation therapy to the chest. such as adolescence. a review by a panel of experts convened by the National Cancer studies to date have found no association between increased Institute in 2003. and much of the population From the 1940s through the 1960s. the use of antiperspirants.org to see the American Cancer strated that prolonged. high-dose exposure to many industrial Society document called Is Abortion Linked to Breast Cancer?.177.164-167 Although animal studies have demon.163 There are persistent claims that women who have had an abor- tion are at increased risk for developing breast cancer based on Environmental pollutants early studies that have since been deemed methodologically Some have suggested that rising breast cancer incidence in the flawed by the American College of Obstetricians and Gynecol- latter half of the 20th century may have been caused by environ.175 For breast cancer risk. a large body of solid scientific evidence.159 that night shift work increases breast cancer risk by 40%.breast cancers. and con. such as for Hodgkin lymphoma humans and animals. a hormone that regulates childbirth. An asso- for each 10g (roughly one drink) of alcohol consumed per day ciation between environmental exposures and breast cancer on average. 157 A few occupations have been linked to breast cancer risk. These women have an increased Factors that are not associated with breast risk (about 30% higher) of developing breast cancer compared cancer risk to women who have not taken DES. particularly at night.Alcohol although these studies have had limited capability to study Numerous studies have confirmed that alcohol consumption effects on population subgroups or to quantify exposures at increases the risk of breast cancer in women by about 7%-10% potentially critical periods of life.162 Some studies also suggest that women whose mothers took DES during pregnancy have a Abortion slightly higher risk of breast cancer. 152-154 Women who have 2-3 alcoholic drinks per day may be difficult to quantify because it may reflect an indirect have a 20% higher risk of breast cancer compared to non-drink. given the drug diethylstilbestrol (DES) because it was thought to lower the risk of miscarriage.169 This chemical has been shown to cause Radiation breast cancer in animal studies.158. One study found an increased risk among women employed in com- mercial sterilization facilities who were exposed to high levels Environmental and other risk factors of ethylene oxide.. visit cancer.173 A recent meta-analy- after radiation treatment and continues to be elevated for more sis concluded that evidence from high-quality studies suggests than 25 years. Night shift work has also been The link between radiation exposure and breast cancer has been associated with increased breast cancer risk. it is difficult to determine whether exposure to much lower concen. among women with such exposure starts to rise about 8 years was probably carcinogenic to humans. 159 time zones have found increased risks of breast cancer associ- This may be because breast tissue is most susceptible to car. no convincing scientific evidence that links breast cancer risk to tionships between environmental pollutants and breast cancer.161 Breast cancer risk Cancer concluded in 2007 that shift work.174 Indeed. epidemiological studies have not found clear rela.170. established tumors and prevent new Girls and women treated with high-dose radiation to the chest tumors from developing. including mental pollutants such as organochlorine pesticides. However. an effect of these exposures on early onset puberty ers.172 Based on the results of studies in between 10 and 30 years of age. breast cancer is by increasing estrogen and androgen levels.160 sleep. the International Agency for Research on are at increased risk for breast cancer. pathway (e.156. more information. ogy. ated with long-term employment. One of the mechanisms by which alcohol increases risk of and menstruation). drinking water.155 Occupational exposures Alcohol use has been more strongly related with increased risk for ER+ than ER.47. which occurs with first disrupts the production of melatonin. confirms that there is no link between breast concentrations of organochlorines in blood and fat tissue and cancer and abortion (either spontaneous or induced).176 Although sumer products – increases the risk of human breast cancer. 171 Exposure to light at night cinogens before it is fully differentiated. involving about 15% to 20% Diethylstilbestrol exposure of workers in the US and Europe.170 Shift work at night is a common exposure. Experimental evidence suggests that melatonin may also inhibit the growth of small. the use of permanent hair dyes and breast cancer. in air. Hair dyes and antiperspirants trations of these chemicals in the general environment – which A combined analysis of 14 studies found no association between occurs alone or in combination. chemicals can increase mammary tumor development. ence circadian rhythm disruption caused by crossing multiple particularly those who were first exposed at younger ages.g. some pregnant women were in industrialized countries is exposed to artificial light at night.

A woman considering breast tissue by mammography.9% 26 must be monitored for osteoporosis.3% 44 than half in high-risk women taking anastrozole or exemestane 60 3. Early clinical trial 40 1. Women at very high risk of breast cancer (such as those with Source: 18 SEER Registries.4% 69 results are promising: breast cancer risk was reduced by more 50 2. but act like estrogen in others.186-189 Prophylactic salpingo- Breast implants oophorectomy (surgical removal of the fallopian tubes and No association has been found between breast implants and ovaries) reduces the risk of both breast and ovarian cancers in risk of breast cancer. These drugs are classified as selective estrogen receptor modu- lators (or SERMs) because they block estrogen in some tissues of the body.7. This operation removes one or both breasts. but raloxifene is only approved for use in postmenopausal women. when scheduling a mammogram. Clinical trials are also examining another class of drugs – aro- Table 5. there is growing concern that women who carry BRCA mutations. Other more serious side effects are rare. BRCA gene mutations) may elect prophylactic (preventive) American Cancer Society. as these medications can Lifetime risk 12. Removing both breasts before cancer is diagnosed reduces the risk of breast cancer by 90% or more. The use of additional x-ray See page 22 for further discussion of contralateral prophylac- pictures (called implant displacement views) may be used to tic mastectomy. however.182 Tamoxifen can be used by both premenopausal and postmenopausal women.4% 225 ing ovaries (such as postmenopausal women). the most common of which is menopausal symptoms. but include blood clots and endometrial cancer. Probabilities derived using NCI DevCan Software. Currently. Chemoprevention and prophylactic surgery Chemoprevention The use of drugs to reduce the risk of disease is called chemopre- vention.183 Although the benefit is limited to ER+ disease. Aromatase inhibitors tar- age is … cancer in the next 10 years is:† or 1 in: get the enzyme that is responsible for producing estrogen in fat 20 0. Currently. these drugs lower the risk of both invasive breast cancer and ductal carcinoma in situ. 185 Women taking aromatase inhibitors 70 3.674 tissue. Age-specific Probabilities of Developing matase inhibitors – to see if they may be effective for reducing Invasive Female Breast Cancer* breast cancer risk. *Among those free of cancer at beginning of age interval.189.1% 1. these drugs are only approved to If current The probability of developing breast help treat women with breast cancer. A woman with breast implants prophylactic surgery should discuss the benefits and limitations should inform the mammography facility about the implants with her doctor and a second opinion is strongly recommended. 190 women with implants may be at increased risk of a rare type of It is important to note that not all women who elect to have these lymphoma. Percentages and “1 in” numbers may not be numerically Prophylactic surgery equivalent due to rounding.000 high-risk women from 9 breast cancer prevention trials. SERMs are associated with some side effects.179-181 Breast implants can also make it harder to see surgeries would have developed cancer. thus. they are only effective in women without function- 30 0. Inc. Based on cases diagnosed 2010-2012. However. allow for more complete breast imaging. Surveillance Research.5% 29 compared to placebo. 2015 mastectomy.3. Premenopausal women taking tamoxifen can also experience menstrual changes.3% 8 decrease bone density. Version 6. found that taking a SERM reduced breast cancer risk by 38% over 10 years.183 Breast Cancer Facts & Figures 2015-2016  17 . National Cancer Institute.184.. including more than 83. A recent meta-analysis. the US Food and Drug Administration (FDA) has approved two drugs for the prevention of breast cancer in high-risk women: tamoxifen and raloxifene.

The Society does not recommend clinical breast examination tionally. 3. limitations. women 40 to 44 years should have the choice to begin for breast cancer screening among average-risk women at annual screening. as well as magnetic resonance imaging to screening was reduced by more than 40%. in some cases. However. There are three main types of mammography: film. increase the chance that a breast cancer is detected early before which could lead to different decisions about screening. compared to digital mammography alone. a suspected or confirmed genetic mutation for those with dense breast tissue. recommendation). the most recent guideline for MRI use for high-risk women was breast-conserving surgery like lumpectomy versus mastectomy) released in 2007.g. to biennial screening. Addi. described on the next page. familiar with the potential benefits. Mammography mammography screening does have potential harms. the FDA approved the use of digital breast tomosynthe- sis or 3-dimensional (3-D) mammography. In 2015.196 The benefits and risks of tomosynthesis in community Recommendations*: practice are still being assessed. and harms associated with breast cancer screening. 199 Early detection (MRI) for women at high risk. or even. the option to forgo chemotherapy. women receive about twice the radiation dose. A recent study indicated the 1. or about patients’ values and preferences.191. at age 55 women may transition of 10 years or more (qualified recommendation). whereas digital mam- Breast Cancer Screening.198.e. This newer type of mammographic screening is not yet available in •  Women should have the opportunity to begin annual screening between the ages of 40 and 44 (qualified all communities or fully covered by health insurance. or a history of previous radiotherapy to the chest at a young age. Combined results from randomized controlled screening trials suggest that mammography reduces the risk of dying from breast cancer by about 20%. Recently. the Society updated its of breast cancer by mammography also leads to a greater range breast cancer screening guideline for average-risk women. 192 and the use of chemotherapy with fewer serious side effects. i.. In 2011.193-195 known to increase risk of breast cancer (e. The American Cancer Society recommends that average-risk 2. Recommended screening intervals are based on 18  Breast Cancer Facts & Figures 2015-2016 .. which appears to be breast cancer. including less-extensive surgery (e. and digital breast tomosynthesis. dose to that similar to conventional digital mammography. and of treatment options. it has spread. Women should continue screening mammography as long women should undergo annual screening mammography as their overall health is good and they have a life expectancy beginning at 45 years of age. or continue with annual screening. their overall health is good and they have a life expectancy of 10 *A strong recommendation conveys the consensus that the benefits of years or more. Women should continue screening as long as any age (qualified recommendation). images. alization of the internal structure of the breast. which are Mammography is a low-dose x-ray procedure that allows visu. digital. conventional 2-D images. when •  Women who are age 45 to 54 should be screened the 2-D images are produced separately from the tomographic annually (qualified recommendation). the FDA approved the use of tomographic images to produce •  Women who are age 55 and older should transition to biennial screening or have the opportunity to continue synthetic. Film mammography uses general-purpose x-ray American Cancer Society Guideline for equipment to record images of the breast. to be used in combination with a 2-D digital mammography image. Women with an average risk of breast cancer should addition of breast tomosynthesis to digital mammography may undergo regular screening mammography starting at age reduce false positives and detect slightly more invasive cancers 45 years (strong recommendation).. which constructs a The Society recommends that all women should become 3-D image of the breast with multiple high-resolution x-rays. thus reducing the radiation screening annually (qualified recommendation). women without a personal history of even more accurate for women younger than 50 years of age and breast cancer.g. adherence to that intervention outweigh the undesirable effects that may result from screening.197 However. 2015191 mography uses more specialized computerized equipment and These recommendations represent guidance from the delivers lower doses of radiation. BRCA). Qualified recommendations indicate there is clear evidence of the benefit of screening but less certainty about either the It is especially important that women are regularly screened to balance of benefits and harms. whereas studies of mod- American Cancer Society recommendations for the early detec- ern mammography screening programs in Europe and Canada tion of breast cancer vary depending on a woman’s age and found that the risk of breast cancer death among women exposed include mammography. Film mammography has been American Cancer Society for women at average risk of largely replaced by digital mammography. the duration of time a breast cancer is detectable before symp- Breast Cancer Screening toms develop.

211. Mammography sometimes leads to follow-up examinations. 10% of women will be Race/Ethnicity recalled from each screening examination for further testing Non-Hispanic White 69 (most often additional mammographic views of areas of suspi- Non-Hispanic Black 70 cion).False-positive results Table 6. of time. National Health Interview cer.” §Response option provided on the NHIS was “straight. specific age at which mammography screening should be dis- Breast Cancer Facts & Figures 2015-2016  19 . and some breast cancers that are screen-detected still have poor Note: Mammography prevalence estimates do not distinguish between exami- nations for screening and diagnosis.. 212 In US 10 or more years 69 GED = General Educational Development high school equivalency. or more “false alarms. on the NHIS was “gay or lesbian. contact According to the American Cancer Society guideline. the decision to stop regular mammography dations (e. some scientists are attempt- ing to determine which combinations of conventional and new risk factors could be used to individualize screening recommen. 2015 minimize the harms of screening. Estimates of the rate of overdiagnosis are highly variable. that is.204-210 Yes 72 Immigration Radiation exposure Born in US 69 Although many people are concerned about radiation exposure. Mammography in the Past 2 Years (%). Rather. #Estimate not provided due to instability. prognosis. US.203 Education Some high school or less 56 Overdiagnosis High school diploma or GED 64 Mammography likely results in some overdiagnosis. Surveillance Research. 2013. Not all breast cancer will be detected by a mammogram. without any out-of-pocket expense for patients. Born in US territory ¶ 64 the dose required for a mammogram is very small and the risk of In US fewer than 10 years 38 harm is minimal.200 Other Age factors that increase the likelihood of a false positive include 45-64 69 the use of postmenopausal hormone therapy and having more 65+ 67 dense breast tissue. As long as a woman is in good Despite these limitations. Source: Centers for Disease Control and Prevention. Women 45 and Older. these are referred Characteristic % to as false-positive test results. and Hispanic/Latina 64 about 19% will undergo biopsy. Inc. Health insurance coverage gram. over the course of 10 screening examinations. continued. cancer several years before physical symptoms develop. It is the position of the American Cancer Society that the balance of The Affordable Care Act requires that Medicare and all new benefits to possible harms strongly supports the value of regular health insurance plans fully cover screening mammograms breast cancer screening in women for whom it is recommended. American Indian and Alaska Native 61 about one-half of women will experience a false-positive. A false-positive is most likely Overall 69 following a woman’s initial screening mammogram. Since it is not Gay/Lesbian‡ 75 currently possible to distinguish a nonprogressive cancer from Straight§ 68 a progressive one.200.)213 efits and risks of screening within the context of overall health status and estimated longevity. but will undergo regular screening and may experience one Survey. 201 On average. the Some college/Assoc. Most women will never be diagnosed with breast can. Limitations of mammography *Percentages are age adjusted to the 2000 US standard population. degree 70 detection of cancers that would not cause a woman any harm College graduate 78 in her lifetime and that would not have progressed or other. †Does not include Native Hawaiians or other Pacific Islanders. there is no the American Cancer Society at 1-800-227-2345. ‡Response option provided As with all screening tests. determine which women could start screening at screening should be individualized based on the potential ben- older ages and/or be screened less often. No 39 ranging from <5% to more than 30%. For help locating a free or low-cost screening mammogram in your area. overdiagnosis is estimated from long-term Bisexual # evaluation of observed versus expected cases in a screening pro. when there is no cancer. mammography is the single most health and would be a candidate for breast cancer treatment. but only 5% of these women will have cancer. Public use data file. effective method of early detection since it can often identify she should continue to be screened with mammography. Sexual orientation wise been detected in the absence of screening.202 According Asian American† 69 to one US study.g..” ¶Have been in the US for any length tive. mammography is not 100% effec. 2013 including biopsies. that is not gay or lesbian.” In an effort to maximize the benefits and American Cancer Society.

it also increases the likelihood of the exam to improve the ability to capture detailed images of false-positive results. or have older who have had a mammogram within the past 2 years by a first-degree relative with one of these syndromes state. the scan must be should talk with their doctors about the benefits and limitations repeated at another facility if a biopsy is necessary. who have no •  Have a first-degree relative (mother. Efforts to not had genetic testing themselves increase screening should specifically target socioeconomically •  Had radiation therapy to the chest when they were disadvantaged women and recent immigrants. Higher-quality images are produced by dedicated breast An expert panel convened by the Society published recommen.218 The panel recommended annual imaging centers do not have dedicated breast MRI equipment MRI screening in addition to mammography for women at high available. many hospitals and for breast cancer in 2007. declined slightly from 2000 to 2005. Women at high lifetime risk (~20%-25% or greater) of mography prevalence increased from 29% in 1987 to 70% in breast cancer include those who: 2000. or atypical lobular hyperplasia ing and diagnostic services for low-income women and was •  Have extremely dense breasts or unevenly dense breasts recently shown to help save lives from breast cancer. however.217 The American Cancer Society is committed to helping protect and increase funding for breast tissue.27 •  Have a known BRCA1 or BRCA2 gene mutation Women who have less than a high school education. and then stabilized. most major insur- criteria for MRI screening (right). mam- NBCCEDP in order to expand the number of women who can be mography screening.214 Among women 40 years of age and older. 20  Breast Cancer Facts & Figures 2015-2016 . However. or who are recent immigrants to the or child) with a BRCA1 or BRCA2 gene mutation. chest. MRI exams for exam. than 15%. Although of adding MRI screening to their yearly mammogram. between 10 and 30 years of age Table 7.Prevalence of mammography According to the National Health Interview Survey. Studies have shown that ultrasound detects more can- breast imaging use a contrast material (usually gadolinium cer than mammography alone when screening women with DTPA) that is injected into a vein in the arm before or during dense breast tissue. breast MRI also requires special equip- Magnetic resonance imaging (MRI) ment. A recent study indicates that while MRI use in com- munity practice is increasing for high-risk women. page 19). health insurance coverage. lobular carcinoma in situ (LCIS).220 The use of ultrasound instead of mam- mograms for breast cancer screening is not recommended. father. but not replace. the percent. See risk MRI is more expensive than mammography. based on data from the 2012 Behavioral Risk Factor Sur. but have US are least likely to have had a recent mammogram. It is important that screening MRIs are done at facili- lifetime risk (~20%-25% or greater) beginning at 30 years of age. due in part to funding shortages. Otherwise. mam. American Cancer Society Risk Criteria age of women 45 years of age and older who reported having had for Breast MRI Screening as an Adjunct a mammogram within the past 2 years was 69% in 2013 (Table to Mammography218 6. served through the program. ductal carcinoma and Cervical Cancer Early Detection Program (NBCCEDP) was in situ (DCIS). shows the percentage of US women 45 years of age and •  Have Li-Fraumeni syndrome or Cowden syndrome. atypical established in 1990 to improve access to breast cancer screen. reported rates of mammography range •  Have a lifetime risk of breast cancer of 15% to 20%. from 66% in Wyoming to 87% in Massachusetts. Women at moderately increased (15%-20% lifetime veillance System. ties that are capable of performing an MRI-guided breast biopsy Women at moderately increased risk (15%-20% lifetime risk) in case abnormalities are found. brother. MRI screening is not recom. MRI equipment than by machines designed for head. Just as mammography uses x-ray machines designed especially to image the breasts.215 Among women of all races combined 45 risk) risk include those who: years of age and older. sister. cross-sectional images of the body. dations for the use of MRI for screening women at increased risk or abdominal MRI scanning. MRIs should supplement. ductal hyperplasia. according to risk assessment tools that are based mainly on family history The Centers for Disease Control and Prevention’s National Breast •  Have a personal history of breast cancer.219 Breast ultrasound is sometimes used to evaluate abnormal find- MRI uses magnetic fields instead of x-rays to produce very ings from a screening or diagnostic mammogram or physical detailed.216 However. when viewed by mammograms the CDC estimates that the program is currently only reaching about 11% of the women eligible to receive a screening mammo- gram. ance companies will cover some portion of the costs if a woman mended for women whose lifetime risk of breast cancer is less can be shown to be at high risk. it is often Breast ultrasound used in women who are not at high risk for breast cancer.

61 34 .. 2012 No usual 45 to 65 years source of No health All races NH Whites NH Blacks 64 years and older medical care* insurance† Alabama 77 77 81 78 77 47 45 Alaska 72 70 ‡ 71 75 53 41 Arizona 73 74 ‡ 71 75 44 43 Arkansas 68 68 74 66 71 39 42 California 80 80 87 79 82 47 50 Colorado 71 73 68 70 72 36 42 Connecticut 81 81 83 83 79 38 56 Delaware 82 81 86 82 83 38 59 District of Columbia 84 80 86 84 82 57 § Florida 75 75 72 72 78 46 43 Georgia 79 77 83 76 83 46 49 Hawaii 78 75 ‡ 79 76 46 54 Idaho 67 68 ‡ 66 69 34 36 Illinois 76 76 81 77 75 44 56 Indiana 70 70 75 69 70 30 41 Iowa 78 78 ‡ 79 77 46 47 Kansas 77 77 80 77 77 46 47 Kentucky 74 73 84 73 74 37 45 Louisiana 76 75 80 76 77 48 58 Maine 81 82 ‡ 82 81 33 51 Maryland 81 80 89 81 83 48 46 Massachusetts 87 86 88 89 83 56 67 Michigan 78 78 81 78 79 30 40 Minnesota 81 81 75 81 81 60 60 Mississippi 70 70 70 71 69 46 50 Missouri 75 75 84 74 78 39 39 Montana 68 68 ‡ 68 68 32 44 Nebraska 72 72 74 72 72 41 47 Nevada 71 72 78 69 76 51 40 New Hampshire 82 82 ‡ 82 81 35 51 New Jersey 78 77 85 79 76 55 63 New Mexico 71 70 ‡ 70 72 44 47 New York 79 78 78 78 79 61 57 North Carolina 78 78 80 77 80 48 48 North Dakota 75 77 ‡ 76 75 45 35 Ohio 77 76 82 76 77 48 41 Oklahoma 68 69 70 66 70 35 34 Oregon 73 74 ‡ 69 79 35 38 Pennsylvania 77 77 87 78 77 42 46 Rhode Island 83 84 ‡ 83 83 44 65 South Carolina 74 72 80 72 77 37 45 South Dakota 75 76 ‡ 76 74 46 47 Tennessee 76 76 81 75 78 43 47 Texas 71 72 78 68 75 36 38 Utah 71 71 ‡ 71 71 46 47 Vermont 78 79 ‡ 79 78 47 45 Virginia 79 79 80 79 80 56 57 Washington 75 75 87 73 77 41 42 West Virginia 75 75 86 76 75 37 54 Wisconsin 81 80 88 81 80 49 58 Wyoming 66 66 ‡ 65 67 43 36 United States (median) 76 76 81 76 77 44 47 Range 66 .89 67 . American Cancer Society. Note: The mammography prevalence estimates do not distinguish between examinations for screening and diagnosis. 2012. Source: Centers for Disease Control and Prevention. Public use data file. Mammography in the Past 2 Years (%) by State. Inc. Women 45 and Older. BRFSS 2012 data results are not directly comparable to BRFSS data prior to 2011 because of the changes in weighting methodology and the addition of the cell phone sampling frame.86 68 . *Among women 45 years and older with no personal doctor or healthcare provider.67 NH = non-Hispanic. ‡Sample is insufficient to provide a stable estimate.87 66 . Behavioral Risk Factor Surveillance System. †Among women ages 45-64 years.83 30 . Surveillance Research.Table 7.89 65 . 2015 Breast Cancer Facts & Figures 2015-2016  21 .

as well as DCIS.226 Younger ditionally cancer in sentinel lymph nodes was an indication for women (those under 40 years of age) and patients with larger additional axillary lymph node surgery. even after a recent normal mammogram. 229. getting dressed. Experts have concluded that self-awareness seems to tumors and increases the probability of false-positives. most lumps are not abnormal. Modified radical to determine if the disease has spread beyond the breast. Most women have shown marked increases in the rate of CPM for women with early stage breast cancer will have some type of surgery.236 patients who have BCS and mastectomy. which can include chemotherapy. breast cancer.228-231 which is often combined with other treatments to reduce the Although CPM nearly eliminates the risk of developing a new risk of recurrence. among women The primary goals of breast cancer surgery are to remove the with more advanced breast cancer (stage III or IV). 3% have radia- tion or chemotherapy without surgery. Breast Cancer Treatment Treatment decisions are made jointly by the patient and the cancer in one breast choose to have the unaffected breast physician after consideration of the stage and biological char. axillary lymph node dissection among most women – but the Increasingly. 222 Given be at least as effective for detecting breast cancer as structured the time constraints of a clinical visit. However. reduces the need for full all of the cancer. BCS. as with a radical mastectomy. Reasons include reluctance to undergo and/or a blue dye into the breast before surgery. diagnosed with invasive breast cancer. The presence of any cancer cells in the nodes under the arm. Recent studies the risks and benefits associated with each option. Simple or total mas- of one or more regional lymph nodes from the armpit (or axilla) tectomy includes removal of the entire breast. 58% have mastectomy. This is known as contralateral prophylactic acteristics of the cancer. With BCS (also known as partial these treatments (Figure 11). and/or targeted therapy. and mastectomy (CPM) or bilateral mastectomy. Radical gery. breast cancer have BCS. Although tra- radiation therapy after BCS and fear of recurrence. 36% have mastectomy.221. 17% receive radiation therapy and/ Surgical treatment for breast cancer involves breast-conserving or chemotherapy without surgery.223-225 Women who detect their own breast cancer usually clinicians to use this time to counsel women on the importance of find it outside of a structured breast self-exam while bathing or being alert to breast changes and the potential benefits. 227 Some women who are diagnosed with breast cer cells are found only in one or two sentinel lymph nodes in 22  Breast Cancer Facts & Figures 2015-2016 . and medical treatments. radiation. all for CBE in conjunction with screening mammography or alone. although long-term outcomes are very similar for management of lymph nodes may vary for different situations. harms. In contrast. 232-235 therapies.228. important aspects of preventive services.226. and 11% do not receive any of surgery (BCS) or mastectomy. such as radiation therapy. 14% undergo cancer from the breast and to determine the stage of disease. it does not improve long-term breast cancer sur- hormonal (endocrine) therapy. and about 2% do not Surgery receive any treatment (Figure 11). If symptoms develop. only cancerous tissue plus a rim of Both BCS and mastectomy are usually accompanied by removal normal tissue (tumor margin) are removed. patients eligible for BCS Sentinel nodes are identified by injection of a radioactive tracer are electing mastectomy. This mastectomy includes removal of the entire breast plus lymph helps stage the cancer.23 mastectomy or lumpectomy). removed as well.Clinical breast examination (CBE) Breast self-awareness The American Cancer Society no longer recommends CBE for Although the American Cancer Society no longer recommends average-risk asymptomatic women based on lack of clear benefits that all women perform monthly breast self-exams (BSE). but does not include removal of the under- lymph nodes will help determine the need for subsequent sur- lying chest wall muscle. Sentinel lymph node mastectomy is rarely performed anymore because in most cases biopsy (SLNB). women should become familiar with both the appearance and Compared to mammography alone. the Society encourages BSE. the patient’s age and preferences. and for women who are still menstruating. they can appear and disappear with the menstrual cycle. chemotherapy. in which selected lymph nodes are removed and removal of the underlying chest muscles is not needed to remove tested before any others are excised. new guidelines state and/or more aggressive tumors are also more likely to undergo that axillary lymph node dissection may be unnecessary if can- mastectomy. targeted therapy. CBE plus mammography has feel of their breasts and report any changes promptly to their been shown to detect only a small proportion of breast cancer physician. Fifty-eight percent of women diagnosed with early stage (I or II) and hormonal therapy. women should contact a and limitations of screening mammography or to address other doctor immediately. Most breast lumps are not cancerous. Patients vival for the vast majority of women and it is also associated with metastatic disease are primarily treated with systemic with a number of potential harms.

who receive SLNB.244-246 Some mastectomy-treated icaid. Female Breast Cancer Treatment Patterns (%). tion).243 Although there is a higher risk well as the recovery time.239 A woman considering breast reconstruction should Radiation therapy is the use of high-energy beams or particles to discuss this option with her breast surgeon prior to the mastec- kill cancer cells. Since 1999. Radiation can reconstruction at a later date (often called delayed reconstruc- also be used to treat the symptoms of advanced breast cancer. American Cancer Society. Source: National Cancer Data Base. as about 20% in most patients. or a combination of the two. RT = radiation therapy. Plastic surgeons may be able to correct these issues with recon- Patients should talk with their doctors to determine whether struction strategies such as fat grafting or scar revision. In that tory appearance of asymmetry due to volume loss or scarring.240 There are a number of effective therapies tion. Figure 11. a recent population. chemo = chemotherapy and includes targeted therapy and immunotherapy drugs. BCS is almost always followed by radiation therapy because types of reconstruction can begin during the mastectomy itself it has been shown to reduce the risk of breast cancer recurrence (often called immediate reconstruction). SLNB is widely available in the US. tissue from another for lymphedema. the Women’s Health and of local recurrence (cancer returning to the breast) with BCS Cancer Rights Act (WHCRA) has required group health plans. 2012 35 34 33 30 BCS alone 25 BCS + RT BCS + RT + chemo 20 Mastectomy alone Percent 17 17 16 Mastectomy + RT 15 14 12 Mastectomy + chemo 11 10 Mastectomy + RT + chemo 10 9 7 RT and/or chemo 6 5 No surgery. It affects about 20% of women nique. who undergo axillary lymph node dissection and 6% of patients Women who undergo mastectomy may have breast reconstruc. Women who do patients also benefit from radiation if their tumor is larger than not choose reconstruction prior to surgery can opt to undergo 5 cm or if their cancer is found in the lymph nodes. severity of this condition. by Stage. RT. Reconstruction is also covered by Medicare and Med- if she had chosen mastectomy. Although reported exercise and physical therapy may reduce the risk and lessen the rates of breast reconstruction vary widely. or underarm surgeon will work together to coordinate treatment plans. Surveillance Research. they intend to perform SLNB. than with mastectomy. a full axillary lymph node dissection is often indicated. her breast cancer surgery should nodes can lead to lymphedema.237. 242 based study of women in Los Angeles and Detroit reported that 42% of patients having mastectomy underwent reconstructive Radiation therapy surgery. Radiation is often used after surgery to destroy tomy. 238 SLNB is not typically an option if one or more axillary those done immediately. Breast Cancer Facts & Figures 2015-2016  23 . The surgeon performing the mastectomy and the plastic cancer cells remaining in the breast. Some area.241. The options for this type of reconstruction may differ from apy. case. or chemo 3 3 2 2 2 1 0 Early stage (I and II) Late stage (III and IV) BCS = breast conserving surgery. and reconstruction by about 50% and the relative risk of breast cancer death by influences the time spent in the hospital after a procedure. If a woman is eligible for SLNB and Surgery (and radiation therapy) involving the axillary lymph wishes to have this procedure. either with a saline or silicone implant. and health maintenance organizations follow-up data have confirmed that a woman who chooses BCS that offer mastectomy coverage to also pay for reconstructive and radiation will have the same expected long-term survival as surgery. a serious swelling of the arm be performed by a medical care team experienced with the tech- caused by retention of lymph fluid. BCS may also result in an unsatisfac- lymph nodes are found to contain cancer prior to surgery. 2012. clinical trials with more than 20 years of insurance companies. Inc. and some evidence suggests that upper-body part of the body. 2015 patients who undergo BCS followed by whole breast radiother. chest wall.. though Medicaid benefits vary by state.

although External beam radiation is the standard type of radiation for data from gene panels. and distant recurrence. not just to 6 months. therapy. all of which work through different mechanisms. Hormonal therapy apy drugs generally work by attacking cells that grow quickly. as well as doctor and patient preference.248. but studies suggest a The benefit of chemotherapy is dependent on multiple factors.especially when it has spread to the central nervous system or Systemic treatment given to patients after surgery is called bones. Neoadjuvant is routinely used to treat both premenopausal and postmeno- systemic therapy has been found to be as effective as the same pausal cancers. other tissues. depending on the size and extent be beneficial due to the distant spread of the disease. 249 However. Treatment of ER+ breast cancer with tamoxifen therapy given after surgery in terms of survival. This usually metastatic breast cancer. Breast cancer in premenopausal and postmenopausal is called neoadjuvant or preoperative therapy. Hormonal therapy works by either block. Traditionally. characteristics (hormone receptor and HER2 status). PAM 50 is typically given daily for 5 days. Systemic therapy is treatment that travels through the blood. a retrospective ROR. Micrometastases are generally cancer cells that are tion or brachytherapy. of the cancer.250 Additional follow-up data are needed to the predictive value of these tests in women with intermediate determine the long-term efficacy and risks associated with risk scores and those with node positive disease. Estrogen. stage. women with breast cancer. ing the body’s natural hormones or lowering the levels of those Patients with ER+/PR+ breast cancer can be given hormonal hormones. For breast cancer. it is often used to shrink the tumor enough to make sur- gical removal easier and less extensive (such as BCS in women Tamoxifen is a treatment that blocks the effects of estrogen and who would otherwise have required mastectomy). Chemotherapy istered daily over a period of 5 to 7 weeks. Radiation from a machine outside Systemic therapy is the main treatment option for women with the body is focused on the area affected by cancer. such as Oncotype DX. For example. may include the chest wall and underarm area as well. and. The way the radiation therapy scans. tumors.247 including the size of the tumor. The use of adjuvant systemic therapy is therefore pri- is given depends on the type. these cancer drugs are injected into and cycle of drugs are completed in a timely manner. cells. catheters that are put into the cavity left after BCS and is often and the amount of HER2 protein made by the cancer cells. disease progres. such as CT or bone of radiation in combination. for at least 5 years has been shown to reduce the rate of recur- sion. significant delays in starting treatment. Systemic therapy includes chemo. This treatment is most effective when the full dose one area. therapy (also called endocrine therapy) to lower estrogen levels geted drugs are newer and work by attacking specific molecules or to block the effects of estrogen on the growth of breast cancer in or on cells that may be more common or active in cancer cells. which sometimes act to promote cancer growth.253 intracavitary brachytherapy and to identify which patients are Research has established that combinations of drugs can be the best candidates for this option. can also play a role. rence in women with early stage breast cancers and potentially apy were more likely to have certain complications and receive identify those who would more likely benefit from chemother- a subsequent mastectomy than those treated with whole breast apy. and reduces breast cancer mortality by about one-third through- 24  Breast Cancer Facts & Figures 2015-2016 . external beam radiation therapy was admin. Clinical trials are currently underway to further evaluate radiation therapy. promotes the growth of ER+/PR+ breast cancers. Triple an option for patients with early stage breast cancers. Tar. more effective than one drug alone for treatment of early stage breast cancer and several options exist when selecting a chemo- Systemic therapy therapy regimen. It is used to kill any undetected tumor cells (micrometastases) that may have migrated to other parts of Radiation therapy may be administered as external beam radia- the body. hormonal therapy. This negative and HER2+ breast cancers tend to be more sensitive to intracavitary brachytherapy is considered a form of accelerated chemotherapy. and targeted therapy.251 rence by approximately 40%-50% throughout the first decade.252 There are also gene panels (such as Oncotype DX. adjuvant and neoadjuvant chemotherapy is usually given for 3 stream and can affect and treat all parts of the body. Intracavitary brachytherapy sive. it body. the presence of estrogen or progesterone receptors. adjuvant therapy. marily determined by the tumor stage and histopathological patient characteristics. Some patients are treated with both types too small to be detected on body imaging. and location of the tumor. while ER+/PR+ tumors are generally less respon- partial breast irradiation (APBI). the number of lymph nodes Brachytherapy uses a radioactive source placed in one or more involved. which actually increase the hormone levels in the When systemic treatment is given to patients before surgery. For larger breast women may be treated differently. chemother. a hormone produced by the ovaries in addition to such as cancer cells. without a vein or given by mouth. Depending on the combination of drugs used. and MammaPrint) that can help assess the risk of recur- study reported that women who were treated with brachyther. in whom surgery has not been found to includes the whole breast. 3-week course of therapy is equally as effective. These drugs are different than postmenopausal hormone therapies.

such as letrozole. and has been shown to shrink tumors and extend static breast cancer. In addition. It is made up of the same monoclonal antibody found that reduces the number of estrogen receptors as well as blocks in trastuzumab attached to the chemotherapy drug DM-1. However.org/clinicaltrials or call the on the production of estrogen by the ovaries. visit cancer. The combination of LHRH analog and operative setting.260 For women with nal antibody that seems to attach to a different location on earlier stage breast cancer.264 which are the main source of estrogen prior to menopause.g. be tested for the HER2 gene amplification or protein overexpres- ian ablation is achieved with a class of drugs called luteinizing sion in order to identify women who would benefit from this hormone-releasing hormone (LHRH) analogs (e. It is an anti-estrogen intramuscular injection survival.254 More recently. and other musculoskeletal About 14% of breast cancers overproduce the growth-promot- symptoms because they completely deplete postmenopausal ing protein HER2 and multiple medications are now approved women of estrogen. More often. Trastuzumab (Herceptin) is timing and duration of these treatments.259 Although AIs have fewer serious side effects than tamoxifen.262 called TDM-1). participants receive either the state-of-the-art standard treatment or a Aromatase inhibitors (AIs). are another class of drugs used to treat both early side effects. joint pain.267 Breast Cancer Facts & Figures 2015-2016  25 . appropriate treatment options. Generally. goserelin therapy.255-257 human disease and health problems. In 2013.266 alone or tamoxifen with ovarian suppression in women with ear. it has been shown to prolong survival by over 15 months tion reduced the risk of recurrence more than either tamoxifen compared to docetaxel and trastuzumab alone. studies have shown that extended use of tamoxifen (10 years versus 5 years) further Clinical trials reduces the risk of breast cancer recurrence and mortality. Per. includ- produced in the adrenal glands to estrogen. and therefore do American Cancer Society at 1-800-303-5691.gov/clinicaltrials or by calling the use of AIs first requires treatment to halt ovarian estro. breast cancer. Targeted therapy tor-positive breast cancer.out the first 15 years. For more information about clinical trials. 52% and 33%. 1-800-4-CANCER. they can cause osteoporosis (with Therapy aimed at HER2 resulting bone fractures). anastrozole. so A clinical trial is an experiment that is used to assess the clinical practice guidelines now recommend consideration of safety and efficacy of treatments or other interventions for adjuvant tamoxifen therapy for 10 years. a monoclonal antibody that directly targets the HER2 protein. ado-trastuzumab emtansine (Kadcyla. a recent study has shown that this combina. In premenopausal women. and new therapy that may offer improved survival and/or fewer exemestane. Information not affect estrogen levels in women with functioning ovaries can also be obtained by visiting the National Cancer (including premenopausal women). taking the chemotherapy drug directly to the cancer cells.258 Treat- ment guidelines recommend AIs should usually be included in the treatment of postmenopausal women with hormone recep. antibody acts as a homing device. Clinical trials in postmenopausal women have demonstrated a small advantage to including an AI initially or over the course of treatment rather than 5 years of tamoxifen alone. some women positive breast cancer reduces the risk of recurrence and death by may also benefit from the removal or suppression of the ovaries. They have no effect ing how to enroll. compared to chemotherapy alone. Participation in clinical trials provides essential and advanced hormone receptor-positive breast cancer.265 to tamoxifen has been shown to improve survival in women with advanced (metastatic) hormone receptor-positive breast Pertuzumab (Perjeta) is a more recently approved monoclo- cancer when compared to tamoxifen alone. Patients should consult their personal doctors and cancer specialists for detailed information about gen production with medications or by removal of the ovaries. formerly lier stage disease. and the HER2 protein than trastuzumab. therapy. respectively. All invasive breast cancers should ovaries (oophorectomy). however. updated guidelines were released aimed at [Zoladex] or leuprolide [Lupron]). potentially reversible ovar. When given along with docetaxel (Taxotere) AIs has been used for some time in the treatment of metastatic and trastuzumab to patients who have not yet received chemo- disease. the benefit is less clear. The combined results of two large trials indicate that adding The mainstay of treatment for premenopausal women with trastuzumab to standard chemotherapy for early stage HER2- hormone-sensitive tumors is tamoxifen. The estrogen binding. This drug is also a standard part of the treatment for advanced manent ovarian ablation can be done by surgically removing the HER2-positive breast cancer. can be used to treat HER2-positive metastatic Fulvestrant (Faslodex) is another treatment used to treat meta. Adding ovarian suppression improving the accuracy of HER2 testing.. This drug can be used may be limited to certain subgroups of women.261-263 Ovarian in combination with trastuzumab and chemotherapy to treat suppression can also allow the use of aromatase inhibitors in HER2-positive breast cancer in either the metastatic or pre- premenopausal women. Another drug. Institute’s website at cancer. Clinical trials continue to assess the optimal for the treatment of this subtype. AIs information on the effectiveness and risks of a new treat- work by interfering with the body’s ability to convert androgens ment.

support. seven days a week Help with appearance-related side effects The American Cancer Society is available 24 hours a day. Everolimus may also stop tumors from developing new advanced breast cancer. and emotional support patients and their family members the opportunity to ask ques- to guide them through every step of their experience and to help tions. financial and insur- ance needs. from patient Transportation to treatment education. In women with growing.271. such some of these efforts. 272 improve the effectiveness of hormone therapy drugs. The Society’s Reach To Recovery volunteers have been there. This section provides highlights and information on challenges that can come from a breast cancer diagnosis. 270 Everolimus (Afinitor) is a type of targeted therapy that blocks Palbociclib (Ibrance) is a drug that targets cyclin-dependent mTOR. Callers are connected with a Look Good Feel Better® workshops help women with breast can- cancer information specialist who can help them locate a hospi.Lapatinib (Tykerb) is another drug that has been found to be is approved in combination with exemestane to treat advanced. This drug seems to sion when added to letrozole or fulvestrant. The Society also publishes a wide variety of pam- phlets and books that cover a multitude of topics. tal. To learn more about the program.org or call 1-800-395-LOOK (1-800-395-5665). find a local support group. quality-of-life and caregiving issues to healthy living. the Per- sonal Care Products Council Foundation. and give practical tips on financial resources. and express their them get well. 24 hours a day. seven of treatment days a week online at cancer. wigs. everolimus can help stop cancer cells from monal drugs to treat advanced breast cancer. and hope. Finding a ride to treatment Visit cancer. Our volunteers give cancer vides the information. and lodging when treatment is away from home. by finding cures. feelings. It is indicated in women whose cancers trastuzumab. HER2-negative breast cancer in positive advanced breast cancers that have become resistant to postmenopausal women. By kinase (CDK) 4 and CDK6 that is used in combination with hor- blocking this protein. Everolimus What is the American Cancer Society doing about breast cancer? The American Cancer Society works relentlessly to help save lives Day-to-day help and emotional support from breast cancer – and all cancers – by helping people stay well The American Cancer Society offers patients and their families and get well. Having breast cancer is hard. For matches trained volunteer breast cancer survivors to people women who are diagnosed with breast cancer. The hair loss. talk about their fears and concerns.268 have grown while they were being treated with either letrozole or anastrozole. vices in more than 200 languages. a protein that promotes cell growth and division. and by fighting back against the the resources they need to make decisions about the day-to-day disease. Each registered program par- Society can also help people who speak languages other than ticipant receives a complimentary beauty kit to use during the English or Spanish find the assistance they need. day-to-day help. from prevention to lookgoodfeelbetter. as transportation to and from treatment. and the Professional People can visit cancer.org and by calling the American Cancer Society at 1-800-227-2345. and they offer understanding.269. workshop and to take home. and more. effective in delaying disease progression in women with HER2. Stay Well and Get Well Breast cancer support The American Cancer Society helps women stay well by encour- aging them to take steps to reduce their risk of breast cancer The American Cancer Society Reach To Recovery® program or detect it early. find on skin care. and nail care. facing or living with breast cancer. learn what Trained volunteer beauty professionals teach simple techniques to expect and how to plan.org/bookstore for a complete list of Society books shouldn’t be. program provides free rides to cancer patients to and from treat- 26  Breast Cancer Facts & Figures 2015-2016 . hormone receptor-positive. The American Cancer Society Road To Recovery® that are available for order. survivorship. makeup. which is a collaboration of the American Cancer Society. understand breast cancer and treatment options. palbociclib prolonged time to progres- blood vessels. offering ser.org/breastcancer to find information on Beauty Association. the Society pro. when there are more treatment options. which can also limit growth. Information. and head coverings. cer manage the appearance-related side effects of treatment. address insurance concerns. visit the Look Good Feel Better website at every aspect of the breast cancer experience. Everolimus is also being studied in combination Other targeted drugs with other hormone therapy drugs.

for health promotion. find resources. drug burdens that they face. spread •  Evaluating psychosocial interventions aimed at supporting Cancer education materials Latinas with breast cancer and their family partners in order American Cancer Society I Can Cope® online cancer education to reduce distress and improve quality of life classes are a quick and easy way for people to get the answers •  Exploring new therapies for the treatment of breast cancer they need to help themselves or a loved one during and after that activate cells of the immune system and evaluating breast cancer treatment. day or night. ducted by Society grantees include: cer Survivors Network® is a free online community created by •  Establishing an animal model for triple negative breast can- and for people living with cancer and their families.273 The breast Internally. was designed in direct response to their journey. Trained volunteer second primary cancers. This project. clinical care by primary care providers. The American Cancer Society Can. connect with others.” dardized. development. ing Imaging Interpretation in Breast Cancer Screening. and standard clinical practice a 2015 Institute of Medicine meeting. They can get cers that are resistant to chemotherapy in order to evaluate and give support. and the coordination of care between drivers donate their time and the use of their personal vehicles specialists and primary care clinicians. Visit cancer. BRCA1). Standards report. Classes are free and can be accessed at whether the immune system plays a role in inflammatory cancer. “Assessing and Improv- and is designed to facilitate the provision of high-quality. as well as recommendations racial and socioeconomic disparities in breast cancer screening. and mortality. rently funding more than $86 million in breast cancer research Through its Hotel Partners Program. Using information collected Breast Cancer Facts & Figures 2015-2016  27 . Visit tlcdirect. Find Cures Lodging during treatment The American Cancer Society invests more in breast cancer The American Cancer Society Hope Lodge® program provides research than any other cancer type. Not drugs such as tamoxifen and Herceptin.org/survivorshipguide to download a the Institute of Medicine’s Improving Breast Imaging Quality free copy of the guide. Women with breast cancer and their loved ones do not have to Specific examples of ongoing breast cancer research being con- face their experience alone. developing a test set The end of breast cancer treatment does not mean the end of a that identifies radiologists who could benefit from addi- cancer journey. diagnosis. and creating a continuing medical education late effects resulting from the disease or its treatment. as well as the discovery having to worry about where to stay or how to pay for it allows of genes linked to breast cancer (e. The Life course that aims to reduce recall rates while maintaining or After Treatment: The Next Chapter in Your Survivorship Journey improving cancer detection. screening for incidence.g. clinical. surveillance guidelines. responses that promote cancer progression Support after treatment •  Evaluating factors that influence the accuracy of mammog- raphy interpretation by radiologists. Society-funded research free overnight lodging to breast cancer patients and their care- has led to the development of potentially lifesaving breast cancer givers who have to travel away from home for treatment. and tell new targeted therapies their own story through personal expressions like music and art. and preclinical. and quality of life.org/icancope anytime. variability in mammography interpretation in the US. stan. which highlighted the need to decrease The Society has also recently published a follow-up care guide. survival. The line for breast cancer survivors that builds upon available results of this research program were recently highlighted in evidence. diagnostics (imaging and biomarkers). The Society is cur- patients to focus on the most important thing: getting well. These grants are with local hotels across the country to provide rooms for cancer awarded in multiple areas relevant to the disease.org or tumors and evaluating methods to predict breast cancer’s call 1-800-850-9445 to learn more. etiology. •  Identifying the unmet needs of black breast cancer survivors Hair-loss and mastectomy products in order to develop a program to support and assist in meet- ing those unique needs “tlc” Tender Loving Care® is an American Cancer Society publica- tion that offers affordable hair loss and mastectomy products. Cancer survivors may experience long-term or tional training. treatment.. including patients and their caregivers to help ease some of the financial genetics. surveillance for recurrence. the Society also partners through 204 research and training grants.ments and cancer-related appointments. co-funded by the guide may help cancer survivors as they begin the next phase of National Cancer Institute. as •  Exploring factors that trigger the development of metastatic well as advice on how to use those products. and epidemiological Finding hope and inspiration studies in prevention. to help patients get to the treatments they need. the Society also conducts epidemiologic studies of cancer guideline addresses the assessment and management of breast cancer and performs surveillance research to monitor potential long-term and late effects.

physical activity. to quality. ACS CAN advo- American Cancer Society researchers have also studied the cates for clear. Although over the past decade very large exchanges. In recent years. Specific areas of ongoing research include lifestyle than 50 percent of the women screened are from racial/eth- behaviors (e. policy makers to adequately support their state BCCEDP by The program is also collaborating with researchers at Martin appropriating $1 in state funds for every $3 in federal funds Luther University (Germany) and Addis Ababa University (Ethi. and spontaneous abortion on the increase access to quality breast cancer screenings. obesity. the American Cancer Society Cancer Action NetworkSM diethylstilbestrol (DES). estrogen hormone use. giving cancer patients access were enrolled in the American Cancer Society Cancer Preven. and local levels to of cancer. CPS-3 is the only nationwide study of this magnitude rated “A” or “B” by the US Preventive Services Task Force in the US.from more than 600. body size. The blood specimens and questionnaire data collected (USPSTF). including breast cancer screening. and encourages conducted long-term follow-up of major breast cancer screen. funding to the full $275 million the program was authorized The Society’s Surveillance and Health Services Research pro. ACS CAN continues to urge state international trends in breast cancer incidence and mortality. All new health insurance tion Study-3 (CPS-3). diet. comprehensive coverage of these preventive influence of mammography on breast cancer prognostic factors. emotional health. including breast cancer. While the ACA will continue to greatly issues. ensuring that low-income women diagnosed with and survival. including alcohol consumption. This successful program provides cancer survivors of 10 cancers.. nonpartisan advocacy influence of many risk factors. treatment. in 10 eligible women. One recent analysis essential program for our nation’s most vulnerable popula- of this survey found that although the majority of breast cancer tions. the program can only reach one a subset of survivors had ongoing concerns about symptoms. advocates at the federal. and to enhance research capacity of residents and cancer through the NBCCEDP were provided a pathway to staff of the hospital’s Oncology Department. and common genetic variants the concerns of breast cancer patients and survivors. Additionally. BCCPTA. the NBCCEDP will remain an breast cancer survivors and their caregivers. for in 2007 to ensure that more women have access to cancer gram recently published an overview of the latest data on screening. affiliate. and smoking). more than 304. low- cohorts have been established in some European and Asian income individuals are required to cover preventive services countries. and the lack of social support.000 men and women 30 to 65 years of age into law on March 23. Following on breast cancer risk. family history (ACS CAN). body image nic minority groups. a number of states have considered proposals to eliminate the treatment program due to misconceptions around coverage needs following implementation of the ACA. increase govern- also examined the effect of nutrients found predominantly in ment funding for breast cancer research. states to broaden access to health care coverage for all low- ing studies. program. federal funding has been cut for the survivors 70 years of age and older were reportedly doing well. diagnostic risk of death from breast cancer. at no cost to from CPS-3 participants will provide unique opportunities for patients.000 women in Cancer Prevention Study-II Fight Back (CPS-II). More Survivors. and recommended breast cancer surveillance strate. and nearly all provided a blood sample at plans. state. affordable health care. and care for all women. services. treatment services through their state Medicaid program.g. from 2006 to Care Reform: The Affordable Care Act (ACA) was signed 2013. American Cancer Society epidemiologists study the The American Cancer Society’s nonprofit. strategies. Unfortunately. uninsured. Program (NBCCEDP): Protecting and increasing funding for the NBCCEDP is a high priority for ACS CAN at both the In order to examine the determinants of good quality of life in state and federal levels. including mammography screening. •  The National Breast and Cervical Cancer Early Detection gies that can be applied at the local and national levels. and provide a voice for fruits and vegetables. Additionally. received from the Centers for Disease Control and Prevention. the Soci- community-based breast and cervical cancer screenings ety’s Behavioral Research Center conducted the Study of Cancer to low-income. and coverage provided to newly insured. 28  Breast Cancer Facts & Figures 2015-2016 . the ACA removed cost-sharing for any research in the US. including those offered through state health insurance the time of enrollment. Congress passed the to examine demographic and tumor characteristics. ACS CAN is asking Congress to increase comorbidities. sexuality and intimacy. 2010. and overall quality of life among improve insurance coverage. At current levels. Recently published papers have and treatment services. preventive services covered by Medicare. modeled the cost-effectiveness of chemoprevention income Americans through state Medicaid programs. opia) to create an electronic database for breast cancer patients •  Protecting the Breast and Cervical Cancer Prevention seen at the Addis Ababa University’s teaching hospital in order and Treatment Act (BCCPTA): In 2000. and underinsured women. are some of the efforts that ACS CAN has been involved with in the In order to continue to explore the effects of changing exposures past few years to fight back against breast cancer – and all cancers: and to provide greater opportunity to integrate biological and •  Improving Access to Affordable Care through Health genetic factors into studies of other risk factors. smoking.

While the ACA has significantly increased coverage rates. and caregivers. research. medical can Cancer Society analysis of the SEER 9 Registries Public Use settings. The federal Breast Density and Mammography Society Relay For Life movement is the world’s largest fundrais- Reporting Act directs an evidence-based process to inform ing event to end every cancer in every community. Relay For Life events mends that women who are found to have dense breast tissue raise critical funds that help fuel the mission of the Society. and stage at diagnosis are based cases diagnosed in each age group in the NAACCR data during on delay-adjusted incidence rates from the SEER 13 registries. this legislation encourages new are currently battling cancer. Institute and the National Center on Minority Health and •  The Breast Density and Mammography Reporting Act Health Disparities. which that enable the Society to fund groundbreaking breast cancer would create a coverage solution that incentivizes provid. This method considers geographic publications. Rallying the women of the facts about breast density and risk and recom- passion of four million people worldwide. The organization also is working with millions of women will continue to face barriers to care. prevention. the statistics Incidence rates. and will rely on these programs. and improve access to team-based care coordination for patients with cancer and mammograms. Sources of Statistics General information. Incidence rates are defined as the number of peo- and statements in this booklet refer to invasive (not in situ) ple per 100. and also accounts for expected delays in case reporting.000 who develop a disease during a given time period. from the National Cancer Institute. 275 Short-term trends by Estimates for specific age groups are based on the proportions of race/ethnicity. Unless otherwise stated. the end result will be better to patients. other chronic illnesses. a statistical software package dence. particularly in vulnerable populations. When referenced as such. It is the largest nent to reducing breast cancer deaths and improving quality network of breast cancer events in the nation.2. female breast cancer. Congress and federal agencies to help increase funding for insured and uninsured alike. T  he overall estimated with different age distributions. those who may face a diagnosis research to support the creation of clinical guidelines and in the future. survivors.org) and within the Cancer in North America data standard for incidence.276 2008-2012 applied to the overall 2015 estimate. Breast cancer incidence rates number of new in situ and invasive breast cancer cases diag- for the US in the most recent time period were calculated using nosed in the US in 2015 was projected using a spatiotemporal data on cancer cases collected by NAACCR and population data model based on incidence data from 49 states and the District of collected by the US Census Bureau. and cancer screening behaviors as predictors of inci- Dataset using SEER*Stat 8. raise awareness and funds to end breast cancer. Additionally. The American Cancer mograms. The walks raise critical funds supports the federal Patient Navigation Assistance Act. including the National Cancer comprehensive treatment services through Medicaid. •  Funding for Cancer Research: ACS CAN continues to work grams and continues to advocate at the state level to protect to increase government funding for cancer research at the eligibility and funding for this potentially lifesaving access to National Institutes of Health. patient navigation programs.24 Breast Cancer Facts & Figures 2015-2016  29 . Columbia for the years 1995-2011 that met the North American NAACCR incidence data were made available on the NAACCR Association of Central Cancer Registries’ (NAACCR) high-quality website (naaccr. ing Strides Against Breast Cancer walk is a powerful event to •  Patient Navigation: Patient navigation is a critical compo. tumor size.274. All incidence rates in this publication are age adjusted to the 2000 US standard population to allow comparisons across populations Estimated new breast cancer cases. and early detection. age. US SEER incidence rates and trends were previously made available on SEER’s website (seer. and those who may avoid a diagnosis altogether best practices for screening of and reports to women with thanks to education.1. 26 Long-term incidence trends are based on Ameri- variations in sociodemographic and lifestyle factors. gov) and within the SEER Cancer Statistics Review 1975-2012. an have a follow-up conversation about next steps directly with organization whose reach touches so many lives – those who their doctors. uniting nearly 300 of care.cancer. ACS CAN strongly opposes proposals to eliminate these pro. provide free comprehensive information and services ers to use patient navigators. When referenced as such. The Mak- mammographically dense breasts. ACS CAN communities to finish the fight.25. of 2015: Mammography sensitivity is lower for women with The American Cancer Society also rallies people to fight back mammographically dense breasts because dense breast against the disease through our Relay For Life® and Making tissue makes it harder for doctors to see cancer on mam- Strides Against Breast Cancer® programs.

Probabilities of developing cer cases to the cancer registries. cause-specific survival rates are presented. so the estimated numbers may vary from previ- Review 1975-2012. and other demographic factors are from the National Health Interview Survey.. and family history of breast cancer). Prevalence estimates of mammography by age group during 2008-2012 applied to the overall 2015 estimate.cancer.215 The BRFSS National Center for Health Statistics (NCHS) at the Centers for is an ongoing system of surveys conducted by the state health Disease Control and Prevention. race/ethnicity. cancer incidence rates for the breast cancer were calculated using DevCan 6. When referenced as such. 5-year survival statistics were originally published in SEER Cancer Statistics Review. The esti- a disease during a given time period. Incidence Developing Cancer Software). Relative survival rates are used to adjust for normal life expectancy (and events such as death from heart disease. respectively.Note that because of delays in reporting newly diagnosed can. All death rates in this publication were accurate estimate of the cancer burden in 2015.3 (Probability of most recent diagnosis years may be underestimated. utilization of mammography screening Estimated breast cancer deaths. mortality rates are defined as the number of people per 100.  Five-year survival statistics are based on cancer reported by the SEER program and the NCHS. race. 1975-2012. 10-year survival rates are the preferred statistics to track cancer trends in the US. poverty. sex.g. accidents. ber of breast cancer deaths in the US is calculated by fitting the number of breast cancer deaths for 1997-2011 to a statistical Screening. are based on diagnoses during 1994-2011. are patients diagnosed during 2005-2011. The projection method is website (seer. Similar to incidence rates. discourage the use of our estimates to track changes in can- cer occurrence. cancer deaths compiled by NCHS and population data collected Therefore. and 15-year survival rates from state cancer registries are useful for tracking local trends. Relative survival rates are not calculated for Hispanics.7.24 Death rates were calculated using data on ous years for reasons other than changes in cancer occurrence. Prevalence estimates of mammography by age and model that forecasts the number of deaths expected to occur state were obtained through analysis of data from the Behav- in 2015.24 30  Breast Cancer Facts & Figures 2015-2016 . and American Indians/Alaska Natives because reliable estimates of life expectancy are not available for these groups. Probability of developing cancer.gov) and within the SEER Cancer Statistics model-based. Rates based on diagnoses during 1999-2011. All patients were fol- lowed through 2012. while 3-year-ahead projections provide a reasonably by the US Census Bureau.276 These probabilities reflect the average experience of and are referenced as such. Asians/ Pacific Islanders.000 who die from Important note about estimated cases and deaths. therefore.214 Mortality rates. Cause-specific survival rates are the probability of not dying of breast cancer within 5 years after diagnosis. Death rates used in this mated numbers of new breast cancer cases and deaths in 2015 publication were previously made available by SEER on their should be interpreted with caution. Age-specific estimates were departments in cooperation with the Centers for Disease Con- calculated using the proportions of deaths that occurred in each trol and Prevention. Age-adjusted incidence and mortality rates Survival. developed by the National Cancer rates adjusted for delays in reporting are used when available Institute. women in the US and do not take into account individual behav- iors and risk factors (e. T  he overall estimated num. we strongly age adjusted to the 2000 US standard population. Relative survival is calculated by dividing the percentage of observed 5-year survival for cancer patients by the 5-year survival expected for people in the general population who are similar to the patient group with respect to age. Data on the number of deaths are obtained from the ioral Risk Factor Surveillance System (BRFSS). and diseases of old age). and calendar year of observation.

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