Breast Cancer Prevalence, Diagnosis, and Treatment in Illinois

Introduction: Breast Cancer Prevalence in the United States

Breast cancer is a disease that has devastated the lives of many people and their families. Its presence has changed the manner in which the medical community approaches diagnosis and treatment. Throughout the past few decades there has been a great deal of research conducted concerning the causes, diagnosis, and treatment of breast cancer. The need for such research is reflected in the sheer number of people diagnosed with the disease each year. The purpose of this discussion is to examine the prevalence of breast cancer in the United States and in Madison County, Illinois, specifically. The research addresses diagnosis, treatment, and support available to breast cancer patients and their families.

According to Healthy People 2010, cancer is currently the second leading cause of death in America. In the year 2000, more than 1.2 million people were expected to be diagnosed with cancer, and more than half a million were expected to die as a result of the disease. These estimates exclude the majority of skin cancers, for which new cases were expected to exceed 1 million. Nearly 50% of all new cancer cases are diagnosed in people aged 65 and older (Healthy People 2010).

Healthy People 2010 further explains that approximately 491,400 people diagnosed with cancer each year—or roughly 40% of all those diagnosed—are expected to be alive five years after diagnosis. Additionally, "when adjusted for normal life expectancy (accounting for factors such as dying of heart disease, injuries, and diseases of old age), a relative 5-year survival rate of 60% is seen for all cancers. This rate means that the chance of a person recently diagnosed with cancer being alive in 5 years is 60% of the chance of someone not diagnosed with cancer. Five-year relative survival rates are commonly used to monitor progress in the early detection and treatment of cancer and include persons who are living 5 years after diagnosis, whether in remission, disease free, or under treatment (Healthy People 2010)."

According to the National Cancer Institute's SEER Stat Fact Sheets, from 2002 to 2006 the median age at diagnosis for breast cancer was 61 years. Approximately 0.0% of cases were diagnosed in patients under age 20; 1.9% between ages 20 and 34; 10.5% between 35 and 44; 22.5% between 45 and 54; 23.7% between 55 and 64; 19.6% between 65 and 74; 16.2% between 75 and 84; and 5.5% at age 85 or older (SEER Stat Fact Sheets). The Institute also reports that the median age at death from breast cancer in the United States is 68. Death rates by age group are as follows: ages 20–34, 1%; ages 35–44, 6.2%; ages 45–54, 15.1%; ages 55–64, 20.3%; ages 65–74, 19.8%; and ages 75–84, 22.8% (SEER Stat Fact Sheets).

Regarding Illinois specifically, the Illinois Department of Public Health has published statistics on breast cancer prevalence for the entire state and for individual counties. These statistics cover only female breast cancer cases; however, it is important to note that men can also be diagnosed with breast cancer. According to these statistics, there were 44,145 cases of breast cancer in Illinois from 2005 to 2009, representing an annual average of approximately 8,830 women diagnosed each year ("Projected Female Breast Cancer Incidence…"). In Madison County, 935 women were diagnosed with breast cancer during this same five-year period, an average of 185 cases per year ("Projected Female Breast Cancer Incidence…").

Although breast cancer continues to be a serious problem, researchers have noted some decline in the number of diagnosed cases. There has been speculation as to why this phenomenon has occurred. Some researchers argue that the decrease is due to a decline in the number of women receiving estrogen treatments, which have been linked to the development of breast cancer. According to an article published in the New England Journal of Medicine, the number of women diagnosed with breast cancer in 2003 fell by nearly 7% compared with 2002. The article further explains that:

"Data from 2004 showed a leveling off relative to the 2003 rate, with little additional decrease. Regression analysis showed that the decrease began in mid-2002 and had begun to level off by mid-2003. A comparison of incidence rates in 2001 with those in 2004 (omitting the years in which the incidence was changing) showed that the decrease in annual age-adjusted incidence was 8.6% (95% confidence interval [CI], 6.8 to 10.4) (Ravdin et al. 2007, 1670)."

Integrated Review of Research

The article also explains that the decrease in breast cancer cases was most apparent in women aged 50 and over, and was most evident in estrogen-receptor–positive cancers rather than estrogen-receptor–negative cancers (Ravdin et al. 2007, 1670). The authors conclude that the decline is most likely related to the first report of the Women's Health Initiative and the subsequent drop in the use of hormone-replacement therapy among postmenopausal women in the United States (Ravdin et al. 2007, 1670). Other potential contributing factors have not been excluded but appear less likely to have played a major role (Ravdin et al. 2007, 1670).

Although breast cancer is a serious disease, in many cases it can be completely remedied when diagnosed early. Several methods are used to diagnose breast cancer. One of the most common and reliable is the mammogram. According to the Illinois Department of Public Health, "a mammogram is an X-ray examination of the breast in a woman who has no breast complaints (asymptomatic). The goal of screening mammography is to find cancer when it is still too small to be felt by breast self-examination or your doctor. Finding small breast cancers early by a screening mammogram greatly improves your chance for successful treatment ('About the IBCCP')."

Mammograms are effective because they yield high-quality X-rays while requiring only minimal radiation exposure. During the procedure, the breasts are placed between two smooth plastic plates and flattened, which allows a low dose of radiation to be used. Although the flattening can be temporarily uncomfortable, the entire procedure generally takes only 20 minutes to complete ("About the IBCCP").

In addition to mammograms, breast self-exams are also important. A significant percentage of women have discovered breast abnormalities through self-examination. These exams should be performed 10 days after the first day of a woman's menstrual period ("About the IBCCP"). Because they are done monthly, self-exams allow a woman to detect any changes in her breasts over time.

Diagnosing Breast Cancer

For individuals at increased risk of breast cancer, additional screening measures have been recommended, including starting testing at a younger age and supplementing mammography with MRI screening. As Saslow et al. (2007) explain:

"Screening MRI is recommended for women with an approximately 20–25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin disease. There are several risk subgroups for which the available data are insufficient to recommend for or against screening, including women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography."

The purpose of increased surveillance for those with a genetic predisposition is to catch cancer at its earliest stage, preventing death or the need for more intensive treatment (Saslow et al., 2007).

Once an individual is diagnosed with breast cancer, several treatment options are available. These include surgery, chemotherapy, radiation, hormone therapy, dietary changes, and other complementary approaches. According to the National Cancer Institute, surgery is the first step in treatment for many people with cancer, and several surgical options exist (Breast Cancer Treatment).

The first category is breast-conserving surgery, which includes the following options:

Conclusion

The purpose of this discussion was to examine the prevalence of breast cancer in the United States and in Madison County, Illinois. The research found that thousands of people in the United States are diagnosed with breast cancer each year. It also found that since researchers alerted the public to the link between hormonal treatments and certain cancers, the breast cancer rate has declined considerably. Despite this encouraging trend, the disease remains a serious problem. In Illinois alone, nearly 9,000 women were diagnosed with breast cancer over a recent five-year period, and in Madison County approximately 1,000 women were affected during the same timeframe.