(Use the following link for a printable handout of the Additional resources.)

Summary of preliminary data suggesting association with breast cancer risk

Aspirin and other NSAID use
Data on the relationship between use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of breast cancer is not conclusive at this time. Results from a case-controlled population based study showed that women who used aspirin or other NSAIDs at least once per week had a 20% lower risk of breast cancer than non-users (Terry, 2004). Limitations of this study included: the use of retrospective reporting of aspirin or NSAID use by women with and without breast cancer, no data on the dose of aspirin, and potential confounding of results by other clinical variables. More recently, data from the 10-year Women's Health Study showed that low-dose aspirin taken every other day, did not reduce women's risk of developing breast cancer (Cook, 2005). More clinical trials are needed.

Antibiotic use
In a recent study, antibiotic use was compared between women who had breast cancer and women who did not have breast cancer (Velicer et al., 2004). Data were obtained from computerized pharmacy and breast cancer screening databases within a large health plan and over a 17-year period. Women with more than 25 prescriptions for antibiotics had a two-fold increase in their risk for breast cancer compared to women with no prescriptions for any antibiotics. Because the database only indicated prescriptions dispensed, the actual dosage of antibiotics taken by these women is unknown. However, these findings are consistent with a previous study of women in Finland. Further research is necessary to more specifically measure actual antibiotic use as well as ages during use and to control for other breast cancer risk factors.

Smoking
In a large, prospective study, current smoking was associated with a higher breast cancer risk, but only among women without a family history of breast cancer. Among women with a family history of breast cancer, no association between current smoking and breast cancer risk was found (Reynolds et al., 2004).

Environmental pollutants
The relationship between environmental pollutants and breast cancer risk may depend on the specific type of pollutant. Women who lived within one mile of hazardous waste sites containing pesticides had an increased breast cancer risk of almost three-fold, after controlling for other risk factors (O'Leary, Vena, Freudenheim, & Brasure, 2004). In contrast, no relationship was found between dichlorodiphenyltrichloroethane (DDT) exposure and breast cancer risk in a meta-analysis of 22 articles on this topic (Lopez-Cervantes, Torres-Sanchez, Tobias, & Lopez-Carrillo, 2004).

BRCA 1 and 2 mutations

• BRCA1 mutation breast cancer:
• Appears to be responsible for 45% of breast cancer in families with multiple cases of breast cancer only, and for 90% of breast cancer in families with both breast and ovarian cancer (NCI, 2005d).
• Occurs more often at a younger age, typically before age 40 (Loman, 2001).
• Tends to be more aggressive than sporadic breast cancers, with lesions that are higher grade and grow more rapidly. Lesions may or may not have an in situ component (Lakhani, 2002) (NCI, 2005d).
• Half of breast cancers diagnosed in women with known BRCA 1 or 2 mutations and scheduled for close surveillance, were diagnosed in between annual mammogram screenings (Komenaka, 2004).
• More likely to be estrogen receptor (ER) negative and have a somewhat worse prognosis (NCI, 2005d).
   

Clinical Pearl BRCA 1 breast cancer may be more difficult to detect with routine clinical breast exams and screening mammograms, since it is more likely to be found in younger women who have more dense breasts and BRCA mutation lesions are faster growing (NCI, 2005b) (Goffin, 2001).



• BRCA 2 mutation breast cancer:
• Appears to be responsible for 35% of breast cancer in families with multiple cases of breast cancer, and is also associated with male breast cancer and cancer of the ovary, prostate and pancreas (NCI, 2005d).
• Tends to occur in younger ages than in the general population, but at older ages relative to BRCA1 carriers (Eeles, 2003).
• Has an increased lifetime risk (56%) of contralateral breast cancer after the primary diagnosis of breast cancer (Eeles, 2003).
• Tends to be a higher overall grade than sporadic cancers (Anon., 1997).
• Is similar to sporadic cancers in ER and PR expression (Eisinger, 1999).

Cancer data resources

Centers for Disease Control and Prevention

• National Program of Cancer Registries
• National Center for Health Statistics - Cancer Fastats

National Cancer Institute - Surveillance Epidemiology and End Results program

NCI and CDC - State Cancer Profiles

Screening and treatment resources for low-income, un/underinsured women

CDC National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

• Breast and cervical cancer screenings for low-income, underinsured women
• Web links for state and territorial programs and other national partner organizations
• Fact sheets and program publications

Federal Medicaid Breast and Cervical Cancer Prevention and Treatment

• Most women screened or diagnosed through a state NBCCEDP, and who are diagnosed and need treatment for breast or cervical cancer, are eligible to get treatment covered through their state Medicaid program

Wisconsin Well Woman Program (WWWP)

• Breast and cervical cancer screenings for low-income, underinsured women

Wisconsin Well Woman Medicaid (WWWMA)

• Treatment for breast or cervical cancer for most women screened or diagnosed through WWWP or Wisconsin's Medicaid Family Planning Waiver

Wisconsin Cancer Drug Repository

• Cancer patients can donate unused or discontinued medications and supplies to a participating pharmacy or medical facility, so those items can be shared with cancer patients who are uninsured or underinsured.

American Cancer Society - Navigator

• Toll-free number to access free, confidential assistance to cancer patients and their families (e.g., provide cancer information, assist in locating local and national resources and support services, arrange for assistive devices, wigs/hats, prostheses) 1-800-227-2345

Komen Foundation - Breast Care Helpline & Linking A.R.M.S.

• Toll-free number for information on breast cancer and referrals to "Linking A.R.M.S.," a joint Komen and CancerCare program for economically disadvantaged breast cancer patients. Eligible breast cancer patients may receive financial assistance grants of up to $300 to help cover oral medication, lymphedema care, and medical equipment. 1-800-462-9273

CancerCare - Assist

• Toll-free number to help cancer patients find financial assistance for cancer care or supports, and limited financial assistance for cancer-related costs (e.g., pain medication, transportation to/from treatment, home care, child care) for financially eligible cancer patients. 1-800-813-4673

Links to patient education resources

Breast cancer

• National Cancer Institute:
• On-line, comprehensive and clinically up-to-date source for patient information on prevention, screening, treatment - Cancer topics
• Understanding Breast Changes
• What You Need to Know About Breast Cancer
• On-line publications to print or can order up to 20 copies at no charge. Includes versions for culturally diverse populations and translations into Spanish and Vietnamese. NCI publications locator
• American Cancer Society:
• On-line, comprehensive and clinically up-to-date patient information on prevention, screening, treatment and coping with breast cancer. Select type of cancer. American Cancer Society home page
• On-line and printable patient education pages on Finding breast cancer early (May/June 2003).
• National Comprehensive Cancer Network and ACS:
• On-line and printable clinical guidelines for patients on treatment and supportive care. Breast cancer: Treatment guidelines for patients.
• American Academy of Family Physicians:
• FamilyDoctor.Org - On-line and printable patient education information that's easy to read and has diagrams.

Cancer & underserved populations

• Intercultural Cancer Council
• Fact sheets for diverse populations (racial, ethnic and rural).
• Native Circle at Mayo Clinic
• Brochures that can be ordered for American Indian women, on cancer and other health topics.
• Breast Health Access for Women with Disabilities
• On-line and printable patient information on breast and cervical cancer screening for women with disabilities, and tips for providers for examination of women with disabilities.
• Mautner Project
• On-line information about cancer risks and education for lesbians or women who partner with women.

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