Breast Cancer Screening (PDQ®): Screening - Health Professional Information [NCI]

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Incidence and Mortality

Breast cancer is the most common noncutaneous cancer in U.S. women, with an estimated 207,090 new cases of invasive disease (plus 54,010 cases of in situ disease) and 39,840 deaths in 2010.[1] Males account for 1% of breast cancer cases and breast cancer deaths (refer to the Special Populations section of this summary for more information).

Ecologic studies from the United States [2] and the United Kingdom [3] demonstrate an increase in breast cancer incidence during the last three decades, rising from 82 cases per 100,000 people in 1973 to 124 per 100,000 in 2007. Between 1970 and the early 1980s the increase was small and has been attributed to changes in reproductive behavior and hormone use. Since the mid-1980s, with the widespread adoption of screening mammography, the increase has been dramatic. By illustration, the incidence among British women aged 50 to 65 years nearly doubled between 1984 and 1994. Similarly, in Sweden, where more cancers are discovered in younger women, the incidence of breast cancer increased dramatically in counties that adopted screening.[4] Similar findings have been documented in the United States. Mammographic screening has also increased the diagnosis of noninvasive cancers and premalignant lesions. Whereas ductal carcinoma in situ was a rare condition before 1985, it is currently diagnosed in more than 54,000 American women per year (refer to the Ductal Carcinoma In Situ section of this summary for more information).

One might expect that screening will identify many cancers before they cause clinical symptoms, followed by a subsequent compensatory decline in cancer rates, seen either in annual population incidence rates or in incidence rates in older women. So far, no compensatory drop in incidence rates attributable to a change in screening patterns has been observed. This raises concerns about overdiagnosis—screening that identifies clinically insignificant cancers (refer to the Overdiagnosis section of this summary for more information).

The risk of breast cancer depends on age (see Table 3). As shown in Table 3, the interval risk increases with starting age. Thus, a 60-year-old woman has a higher risk of being diagnosed with breast cancer in the next 10 years compared with a 40-year-old woman. Breast cancer is rare among younger women; among women aged 30 years, 4 in 1,000 will develop breast cancer in the next 10 years.

The cumulative lifetime risk decreases across the age groups as shown in Table 3. This is because a woman who is aged 50 years has lived through some of her risk period without having cancer. The common risk cited that one in eight women will develop breast cancer is based on lifetime risk starting from birth and does not account for the woman's current age. For example, women who are aged 60 years have lived a good portion of their life expectancy without cancer, therefore their remaining lifetime risk is less than for women who are aged 30 years (91 per 1,000 vs. 123 per 1,000).[2]

Table 3. Probability of Developing Invasive Breast Cancer Among Womena

a Based on an analysis of data from the Surveillance, Epidemiology, and End Results registry for 2005–2007.[2]
b Women who are free from invasive breast cancer at their current age.
c Number of women in 1,000 who would develop invasive breast cancer in the next period of time.
Current Age in YearsbRisk per 1,000 Womenc
 in 10 years in 20 years in 30 years Lifetime
304 1741 123
401437 68 120
50245686 109
6034 6786 91
703758—65

In 2010, an estimated 39,840 women will die of breast cancer, compared with about 71,080 women who will die of lung cancer.[1] Approximately one in six women diagnosed with breast cancer dies of the breast cancer, while nearly all women with lung cancer die of lung cancer.

Breast cancer mortality increases with age. For a 40-year-old woman without a breast cancer diagnosis, the chance of dying from breast cancer within the next 10 years is extremely small, but for a woman older than 65 years, it is about 1% (see Table 4). Women older than 70 years have an even higher risk of dying of breast cancer, but they are even more likely to die of other causes.[5]

Table 4. Mortality Risk According to Age: Breast Cancer and All Causesa

a Adapted from Schwartz, Woloshin, and Welch.[6]
For Women Aged:Chance of Dying of Breast Cancer in the Next 10 Years per 1,000 Women Chance of Dying From Any Cause in the Next 10 Years per 1,000 Women
40–44 321
45–49 4 33
50–54 6 51
55–59 7 81
60–64 8 120
65–69 10 180
70–74 11 270
75–79 12 410
80–84 12 670
85+ 11 790

Other Risk Factors

Additional risk factors include a strong family history of breast or ovarian cancer (particularly first-degree relatives, on either the mother's or father's side); early age at menarche and late age at first birth (reflecting estrogen exposure); and a history of breast biopsies, especially for proliferative benign breast disease,[7,8] including radial scalloping lesions (a pathologic entity also called radial scars, even though unrelated to previous surgeries or scars).[9] The Gail model estimates individual risk over time based on these factors for women aged 40 years or older who receive regular mammography.[10,11,12] (Refer to the Breast Cancer Risk Assessment Tool.)

Women with a personal history of invasive breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ have a 0.6% to 1.0% estimated annual risk of developing a new primary breast cancer.[13]

Women treated with thoracic radiation, especially when younger than 30 years, have a 1% annual risk of breast cancer, starting 10 years after the irradiation.[14]

Radiological breast density [15,16,17] is a strong risk factor for breast cancer and also presents challenges in the interpretation of mammograms. Dense fibroglandular tissue seen on mammography is associated with a threefold to sixfold increased risk of breast cancer compared with fatty breast tissue.

Behavioral factors such as menopausal hormone use, obesity, and alcohol intake are associated with an increased risk of breast cancer. (Refer to the PDQ summaries on Cancer Prevention Overview and Breast Cancer Prevention for more information.)

Breast cancer incidence and mortality risk also vary according to geography, culture, race, ethnicity, and socioeconomic status and are discussed more fully below (refer to the Special Populations section of this summary for more information).

References:

  1. American Cancer Society.: Cancer Facts and Figures 2010. Atlanta, Ga: American Cancer Society, 2010. Also available online. Last accessed April 29, 2011.
  2. Altekruse SF, Kosary CL, Krapcho M, et al.: SEER Cancer Statistics Review, 1975-2007. Bethesda, Md: National Cancer Institute, 2010. Also available online. Last accessed April 21, 2011.
  3. Johnson A, Shekhdar J: Breast cancer incidence: what do the figures mean? J Eval Clin Pract 11 (1): 27-31, 2005.
  4. Hemminki K, Rawal R, Bermejo JL: Mammographic screening is dramatically changing age-incidence data for breast cancer. J Clin Oncol 22 (22): 4652-3, 2004.
  5. Kerlikowske K, Salzmann P, Phillips KA, et al.: Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness. JAMA 282 (22): 2156-63, 1999.
  6. Schwartz LM, Woloshin S, Welch HG: Risk communication in clinical practice: putting cancer in context. J Natl Cancer Inst Monogr (25): 124-33, 1999.
  7. London SJ, Connolly JL, Schnitt SJ, et al.: A prospective study of benign breast disease and the risk of breast cancer. JAMA 267 (7): 941-4, 1992.
  8. McDivitt RW, Stevens JA, Lee NC, et al.: Histologic types of benign breast disease and the risk for breast cancer. The Cancer and Steroid Hormone Study Group. Cancer 69 (6): 1408-14, 1992.
  9. Jacobs TW, Byrne C, Colditz G, et al.: Radial scars in benign breast-biopsy specimens and the risk of breast cancer. N Engl J Med 340 (6): 430-6, 1999.
  10. Gail MH, Brinton LA, Byar DP, et al.: Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81 (24): 1879-86, 1989.
  11. Bondy ML, Lustbader ED, Halabi S, et al.: Validation of a breast cancer risk assessment model in women with a positive family history. J Natl Cancer Inst 86 (8): 620-5, 1994.
  12. Spiegelman D, Colditz GA, Hunter D, et al.: Validation of the Gail et al. model for predicting individual breast cancer risk. J Natl Cancer Inst 86 (8): 600-7, 1994.
  13. Gail MH, Costantino JP, Bryant J, et al.: Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst 91 (21): 1829-46, 1999.
  14. Goss PE, Sierra S: Current perspectives on radiation-induced breast cancer. J Clin Oncol 16 (1): 338-47, 1998.
  15. Ma L, Fishell E, Wright B, et al.: Case-control study of factors associated with failure to detect breast cancer by mammography. J Natl Cancer Inst 84 (10): 781-5, 1992.
  16. Goodwin PJ, Boyd NF: Mammographic parenchymal pattern and breast cancer risk: a critical appraisal of the evidence. Am J Epidemiol 127 (6): 1097-108, 1988.
  17. Fajardo LL, Hillman BJ, Frey C: Correlation between breast parenchymal patterns and mammographers' certainty of diagnosis. Invest Radiol 23 (7): 505-8, 1988.

Purpose of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about breast cancer screening. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Reviewers and Updates

This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board. Board members review recently published articles each month to determine whether an article should:

  • be discussed at a meeting,
  • be cited with text, or
  • replace or update an existing article that is already cited.

Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.

Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.

Levels of Evidence

Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

Permission to Use This Summary

PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."

The preferred citation for this PDQ summary is:

National Cancer Institute: PDQ® Breast Cancer Screening. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional. Accessed <MM/DD/YYYY>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.

Disclaimer

The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page page.

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More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.

Last Revised: 2011-01-28

© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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