CAUSE: UNKNOWN

RISK FACTORS
1. GENDER - Simply being a woman is the main risk factor for developing breast
cancer. Men can develop breast cancer, but this disease is about 100 times more
common among women than men. This is probably because men have less of
the female hormones estrogen and progesterone, which can promote breast
cancer cell growth
The biggest reasons for the difference in breast cancer rates between men and
women are:

Women's breast development takes 3 to 4 years and is usually complete by

age 14. It's uncommon for men's breasts to fully form -- most of the male
breasts you see are fat, not formed glands.

Once fully formed, breast cells are very immature and highly active until a
woman's first full-term pregnancy. While they are immature, a women's breast
cells are very responsive to estrogen and other hormones, including hormone
disrupters in the environment.

Men's breast cells are inactive and most men have extremely low levels of
estrogen.

So hormonal stimulation of highly responsive and vulnerable breast cells in women,

particularly during the extra-sensitive period of breast development, is why breast
cancer is much more common in women than in men.
2. AGE - Everyone alive is growing older. And as with many other diseases, your
risk of breast cancer goes up as you get older. For example, according to the
American Cancer Society, about 1 out of 8 invasive breast cancers develop in
women younger than 45. About 2 out of 3 invasive breast cancers are found in
women 55 or older.
In fact, the aging process is the biggest risk factor for breast cancer. That's because
the longer we live, there are more opportunities for genetic damage (mutations) in
the body. And as we age, our bodies are less capable of repairing genetic damage.
3. REPRODUCTIVE FACTORS
a. Nulliparity: Women who haven't had a full-term pregnancy or have their first
child after age 30 have a higher risk of breast cancer compared to women who
gave birth before age 30.
When breast cells are made in adolescence, they are immature and very active until
your first full-term pregnancy. The immature breast cells respond to the hormone
estrogen as well as hormone-disrupting chemicals in products. Your first full-term

pregnancy makes the breast cells fully mature and grow in a more regular way. This
is the main reason why pregnancy helps protect against breast cancer. Being
pregnant also reduces your total number of lifetime menstrual cycles -- which may
be another reason why earlier pregnancy seems to offer a protective effect.

b. Late 1st pregnancy (after age of 35 year old)

4. HORMONAL FACTORS (estrogen exposure)
a. Early menarche (before age 12 yr)
b. Late menopause (after age 55 yr)
c. Post-menopausal estrogen therapy
d. Oral contraceptive use: Current or recent past users of hormonal replacement
therapy (HRT) have a higher risk of being diagnosed with breast cancer.
Before the link between HRT use and breast cancer risk was established,
many postmenopausal women took HRT for many years to ease menopausal
symptoms (hot flashes, fatigue) and to reduce bone loss. Since 2002, when
research linked HRT and risk, the number of women taking HRT has dropped
dramatically. Still, many women continue to use HRT to handle bothersome
menopausal symptoms.
There are two main types of HRT:

combination HRT contains the hormones estrogen and progesterone

estrogen-only HRT contains only estrogen

Each type of HRT seems to have a different effect on breast cancer risk.
Combination HRT increases breast cancer risk by about 75%, even when
used for only a short time. Combination HRT also increases the likelihood that
the cancer may be found at a more advanced stage, as well as increasing the risk
that a woman diagnosed with breast cancer will die from the disease. Breast cancer
risk increases the most during the first 2 to 3 years of taking combination HRT.
Higher-dose combination HRT increases breast cancer risk more than lower-dose
combination HRT. Breast cancer risk goes back down to average about 2 years after
you stop taking combination HRT.
Estrogen-only HRT increases the risk of breast cancer, but only when used
for more than 10 years. Estrogen-only HRT also can increase the risk of ovarian
cancer.

The higher breast cancer risk from using HRT is the same for so-called "bioidentical"
and "natural" hormones as it is for synthetic hormones. "Bioidentical" means the
hormones in the product are identical to the hormones your body produces.
Bioidentical hormones are said to be "natural" -- derived from plants. Synthetic
hormones are made in a lab and are also chemically identical to the hormones in
your body. It's important to know that many herbal and bioidentical HRT products
fall outside the jurisdiction of the United States Food and Drug Administration and
so aren't subject to the same regulations and testing that medications are.
5. ENVIRONMENTAL and LIFESTYLE
a) Radiation:
If you had radiation to the chest to treat another cancer (not breast cancer),
such as Hodgkin disease or non-Hodgkin lymphoma, you have a higher-thanaverage risk of breast cancer. If you had radiation to the face as an adolescent to
treat acne (something that's no longer done), you are at higher risk of developing
breast cancer later in life. The amount of risk increase depends on how old you were
when you had radiation. The increase in risk is highest if you had radiation during
adolescence, when your breasts were developing.
b. Environmental chemicals :
Exposure to Chemicals in Food
Pesticides are used in many commercially grown fruit, vegetable, and grain crops to
protect them from insects, weeds, fungi, diseases, mice and other animals, bacteria,
viruses, and mold. In the United States, pesticide use is regulated by the United
States Environmental Protection Agency (EPA), the U.S. Food and Drug
Administration (FDA), and the U.S. Department of Agriculture (USDA).
Similarly, antibiotics and other drugs are used to protect livestock from diseases
and parasites. Extra hormones may be given to animals to increase meat and milk
production. In the U. S., use of these drugs is regulated by the FDA.
By getting rid of disease sources, pesticides and antibiotics help increase food
production, reduce food loss, and keep the U.S. food supply safe from threats. But
many people question how safe these chemicals and hormones are in the body.
They worry about the pesticide residues found in fruits and vegetables and in
animal feed -- which can end up in meat, poultry, fish, and dairy products, on top of
any extra antibiotics or hormones. There's a real concern that these chemicals may
cause health problems, including an increase in breast cancer risk. There are also
concerns about mercury in seafood and industrial chemicals in food and food
packaging.
No studies so far show a direct connection between pesticide exposure and an
increased risk of breast cancer in people. Still, young female farm workers are at

higher risk for a range of medical conditions. And some of the most commonly used
pesticides have been shown to mimic estrogen in laboratory animals. For example,
Atrazine, commonly used to grow corn, can increase estrogen production by turning
on the aromatase enzyme. So the "better safe than sorry" principle makes sense
here. And common sense suggests that eating extra chemicals is probably
unhealthy.
Exposure to Chemicals When Food Is Grilled/Prepared
When meat is cooked at high temperatures until welldone, a group of chemicals -heterocyclic amines (HCAs) -- forms. The longer and hotter the cooking, the more
HCAs form, especially in the blackened parts of the meat. The National Cancer
Institute has identified 17 HCAs that may increase the risk of cancer. Another group
of chemicals -- polycyclic aromatic hydrocarbons (PAHs) -- form in smoke produced
when fat burns or drips on hot grill coals. PAHs have been linked to breast cancer.
Research has shown that women who ate a lot of grilled, barbecued, and smoked
meats and very few fruits and vegetables had a higher risk of breast cancer
compared to women who didn't eat a lot of grilled meats.
c. Dietary/alcohol: Research consistently shows that drinking alcoholic beverages
-- beer, wine, and liquor -- increases a woman's risk of hormone-receptor-positive
breast cancer. Alcohol can increase levels of estrogen and other hormones
associated with hormone-receptor-positive breast cancer. Alcohol also may
increase breast cancer risk by damaging DNA in cells.
Compared to women who don't drink at all, women who have three alcoholic
drinks per week have a 15% higher risk of breast cancer. Experts estimate that the
risk of breast cancer goes up another 10% for each additional drink women
regularly have each day.
Teen and tween girls aged 9 to 15 who drink three to five drinks a week have
three times the risk of developing benign breast lumps. (Certain categories of noncancerous breast lumps are associated with a higher risk of breast cancer later in
life.)
While only a few studies have been done on drinking alcohol and the risk of
recurrence, a 2009 study found that drinking even a few alcoholic beverages per
week (three to four drinks) increased the risk of breast cancer coming back in
women whod been diagnosed with early-stage disease.
The bottom line is that regularly drinking alcohol can harm your health, even if you
dont binge drink or get drunk. All types of alcohol count. One drink equals 12
ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor.

Smoking : Smoking causes a number of diseases and is linked to a higher risk of

breast cancer in younger, premenopausal women. Research also has shown that
there may be link between very heavy second-hand smoke exposure and breast
cancer risk in postmenopausal women.
b) Obesity and dietary fat
Overweight and obese women -- defined as having a BMI (body mass index) over
25 -- have a higher risk of being diagnosed with breast cancer compared to women
who maintain a healthy weight, especially after menopause. Being overweight also
can increase the risk of the breast cancer coming back (recurrence) in women who
have had the disease.
This higher risk is because fat cells make estrogen; extra fat cells mean more
estrogen in the body and estrogen can make hormone-receptor-positive breast
cancers develop and grow.
Still, the link between extra weight and breast cancer is complicated and
affected by other factors. For example, the location of the extra weight matters.
Extra fat around your belly may increase risk more than the same amount of extra
fat around your thighs or hips.
DIETARY FAT
Diet is thought to be partly responsible for about 30% to 40% of all cancers. No food
or diet can prevent you from getting breast cancer. But some foods can make your
body the healthiest it can be, boost your immune system, and help keep your risk
for breast cancer as low as possible. Research has shown that getting the nutrients
you need from a variety of foods, especially fruits, vegetables, legumes, and whole
grains, can make you feel your best and give your body the energy it needs. Eating
food grown without pesticides may protect against unhealthy cell changes
associated with pesticide use in animal studies.
Breast cancer is less common in countries where the typical diet is plant-based and
low in total fat (polyunsaturated fat and saturated fat). Still, research on adult
women in the United States hasn't found breast cancer risk to be related to dietary
fat intake. But one study suggests that girls who eat a high-fat diet during puberty,
even if they don't become overweight or obese, may have a higher risk of
developing breast cancer later in life.
More research is needed to better understand the effect of diet on breast cancer
risk. But it is clear that calories do count -- and fat is a major source of calories.
High-fat diets can lead to being overweight or obese, which is a breast cancer risk
factor. Overweight women are thought to be at higher risk for breast cancer
because the extra fat cells make estrogen, which can cause extra breast cell
growth. This extra growth increases the risk of breast cancer.
6. FAMILIAL FACTORS

- Women with close relatives who've been diagnosed with breast cancer have
a higher risk of developing the disease.
a) Breast cancer in 1st degree relative age 60 yr: If you've had one first-degree
female relative (sister, mother, daughter) diagnosed with breast cancer, your
risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5
times higher than average.
If your brother or father have been diagnosed with breast cancer, your risk is
higher, though researchers aren't sure how much higher.
In some cases, a strong family history of breast cancer is linked to having an
abnormal gene associated with a high risk of breast cancer, such as the BRCA1
or BRCA2 gene. In other cases, an abnormal CHEK2 gene may play a role in
developing breast cancer.
a. Premenopausal or bilateral breast cancer
b. Postmenopausal breast cancer in 1st degree relative
c. Breast cancer in 2 1st degree relatives
********Genetics
About 5% to 10% of breast cancers are thought to be hereditary, caused by
abnormal genes passed from parent to child.
Genes are particles in cells, contained in chromosomes, and made of DNA
(deoxyribonucleic acid). DNA contains the instructions for building proteins. And
proteins control the structure and function of all the cells that make up your body.
Think of your genes as an instruction manual for cell growth and function.
Abnormalities in the DNA are like typographical errors. They may provide the wrong
set of instructions, leading to faulty cell growth or function. In any one person, if
there is an error in a gene, that same mistake will appear in all the cells that contain
the same gene. This is like having an instruction manual in which all the copies have
the same typographical error.
BRCA1 and BRCA2 genes
Most inherited cases of breast cancer are associated with two abnormal genes:
BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two).
Everyone has BRCA1 and BRCA2 genes. The function of the BRCA genes is to repair
cell damage and keep breast cells growing normally. But when these genes contain

abnormalities or mutations that are passed from generation to generation, the

genes don't function normally and breast cancer risk increases. Abnormal BRCA1
and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every
10 cases.
Having an abnormal BRCA1 or BRCA2 gene doesn't mean you will be diagnosed with
breast cancer. Researchers are learning that other mutations in pieces of
chromosomes -- called SNPs (single nucleotide polymorphisms) -- may be linked to
higher breast cancer risk in women with an abnormal BRCA1 gene as well as women
who didn't inherit an abnormal breast cancer gene.
Women who are diagnosed with breast cancer and have an abnormal BRCA1 or
BRCA2 gene often have a family history of breast cancer, ovarian cancer, and other
cancers. Still, most people who develop breast cancer did not inherit an abnormal
breast cancer gene and have no family history of the disease.
You are substantially more likely to have an abnormal breast cancer gene if:

You have blood relatives (grandmothers, mother, sisters, aunts) on either

your mother's or father's side of the family who had breast cancer diagnosed
before age 50.

There is both breast and ovarian cancer in your family, particularly in a single
individual.

There are other gland-related cancers in your family such as pancreatic,

colon, and thyroid cancers.

Women in your family have had cancer in both breasts.

You are of Ashkenazi Jewish (Eastern European) heritage.

You are African American and have been diagnosed with breast cancer at age
35 or younger.
A man in your family has had breast cancer.

If one family member has an abnormal breast cancer gene, it does not mean that all
family members will have it.
The average woman in the United States has about a 1 in 8, or a 12-13%, risk of
developing breast cancer in her lifetime. Women who have an abnormal BRCA1 or
BRCA2 gene (or both) can have up to an 80% risk of being diagnosed with breast
cancer during their lifetimes. Breast cancers associated with an abnormal BRCA1 or
BRCA2 gene tend to develop in younger women and occur more often in both
breasts than cancers in women without these abnormal genes.

Women with an abnormal BRCA1 or BRCA2 gene also have an increased risk of
developing ovarian, colon, pancreatic, and thyroid cancers, as well as melanoma.
Men who have an abnormal BRCA2 gene have a higher risk for breast cancer than
men who don't -- about 8% by the time they're 80 years old. This is about 80 times
greater than average.
Men with an abnormal BRCA1 gene have a slightly higher risk of prostate cancer.
Men with an abnormal BRCA2 gene are 7 times more likely than men without the
abnormal gene to develop prostate cancer. Other cancer risks, such as cancer of the
skin or digestive tract, also may be slightly higher in men with abnormal BRCA1 or
BRCA2 genes.
Other genes
Changes in other genes are also associated with breast cancer. These abnormal
genes are much less common and don't seem to increase risk as much as abnormal
BRCA1 and BRCA2 genes, which are considered rare. Still, because these genetic
mutations are rarer, they haven't been studied as much as the BRCA genes.

ATM: The ATM gene helps repair damaged DNA. DNA carries genetic
information in cells. Inheriting two abnormal copies of this gene causes the
disease ataxia-telangiectasia, a rare disease that affects brain development.
Inheriting one abnormal ATM gene has been linked to an increased rate of breast
cancer in some families because the abnormal gene stops the cells from
repairing damaged DNA.

p53 (also called the TP53 gene): The p53 gene provides instructions to the
body for making a protein that stops tumor growth. Inheriting an abnormal p53
gene causes Li-Fraumeni syndrome, a disorder that causes people to develop
soft tissue cancers at a young age. People with this rare syndrome have a
higher-than-average-risk of breast cancer and several other cancers, including
leukemia, brain tumors, and sarcomas (cancer of the bones or connective
tissue).

CHEK2: The CHEK2 gene also provides instructions for making a protein that
stops tumor growth. Li-Fraumeni syndrome also can be caused by an inherited
abnormal CHEK2 gene. Even when an abnormal CHEK2 gene doesn't cause LiFraumeni syndrome, it can double breast cancer risk.

PTEN: The PTEN gene helps regulate cell growth. An abnormal PTEN gene
causes Cowden syndrome, a rare disorder in which people have a higher risk of
both benign (not cancer) and cancerous breast tumors, as well as growths in the
digestive tract, thyroid, uterus, and ovaries.

CDH1: The CDH1 gene makes a protein that helps cells bind together to form
tissue. An abnormal CDH1 gene causes a rare type of stomach cancer at an

early age. Women with an abnormal CDH1 gene also have an increased risk of
invasive lobular breast cancer.

PALB2: The PALB2 gene is called the partner and localizer of BRCA2. It
provides instructions to make a protein that works with the BRCA2 protein to
repair damaged DNA and stop tumor growth. Researchers believe that an
abnormal PALB2 gene doubles breast cancer risk. Inheriting two abnormal PALB2
genes causes Fanconi anemia type N, which suppresses bone marrow function
and leads to extremely low levels of red blood cells, white blood cells, and
platelets. People with Fanconi anemia also have a higher risk of several other
types of cancer, including kidney cancer and brain cancer.