I. EPIDEMIOLOGY

A. 182,000 women in United States

B. 46,000 deaths

C. 2% per year rate increase

D. One in nine women by age 85

E. Survival unchanged since 1930

F. 75 % no risk factors

G. Age 1. < 30 years: 1% 2. 30s: 6% 3. 40s: 17% 4. 50 and older: 75%

H. Specific risk

Table 1

IIIII

Magnitude of fibrosystic

Risk Factor High-Risk Group Low-Risk Group Differential

Age Old Young

Country of birth North America, Asia, Africa

Socioeconomic status High Low ~[

Marital status Never married Ever married

Place of residence Urban Rural

Northern US Southern US ~/

Race: > 45 years White Black fibroadenoma, cyst, breast, cancer, mammography, fibrocystic

< 40 years Black White

Nulliparity Yes No ~/

Age at first full-term pregnancy > 30 years < 20 years ~

Oophorectomy premenopausally' No Yes ~

Age at menopause Late Early

Age at menarche Early Late

Weight, postmenopausal women Heavy Thin

History of cancer in one breast Yes No ~ syst cist

History of benign proliferative lesion Yes No ~

Any/first-degree relative with history Yes No ~

of breast cancer

Mother and sister with history of Yes No ]~ ~

breast cancer

History of primary cancer in Yes No ~i~

endometrium or ovary

Mammographic parenchymal patterns ~

parenchyma

Radiation to chest Large doses Minimal exposure ~

= denotes relative risk of 1.1-1.9

~ = denotes relative risk of 2.0--4.0

~ ~ = denotes relative risk of > 4.0

H. RISK FACTOR HISTORY

Table 2

Risk Factor History: What Questions Should You Ask?

The best way to assess a patient's breast cancer risk is historical, and you should obtain answers to the following questions

· How old are you?

· How old were you when you had your first menstrual period?

· Have you ever given birth to a live or stillborn child? How many times? How old were you when you first gave birth?

· Do you still menstruate?