Signs and Symptoms of Cancer What are signs and symptoms?

Signs and symptoms are both signals of injury, illness, disease, or that something is not right in the body.
A sign is a signal that can be seen by someone else—maybe a loved one, or a doctor, nurse, or other health care professional. For example, fever, fast breathing, and abnormal lung sounds heard through a stethoscope may be signs of pneumonia.
A symptom is a signal that is felt or noticed by the person who has it, but may not be easily seen by anyone else. For example, weakness, aching, and feeling short of breath may be symptoms of pneumonia.
Having one sign or symptom may not be enough to figure out what’s causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. Sometimes, a patient’s signs and symptoms still don’t give the doctor enough clues to be sure what is causing the illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.

How does cancer cause signs and symptoms?

Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.
As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms.
But sometimes cancer starts in places where it will not cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually do not cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time a pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started—the pancreas.
A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Or the cancer may cause the immune system to react in ways that produce these signs and symptoms.
Sometimes, cancer cells release substances into the bloodstream that cause symptoms which are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.

How are signs and symptoms helpful?

Treatment works best when cancer is found early—while it’s still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.
A good example of the importance of finding cancer early is melanoma skin cancer. It can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people who live at least 5 years after diagnosis) at this stage is around 97%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops below 20%.
Sometimes people ignore symptoms. Maybe they don’t know that the symptoms could mean something is wrong. Or they might be frightened by what the symptoms could mean and don’t want to get or can’t afford to get medical help. Some symptoms, such as tiredness or coughing, are more likely caused by something other than cancer. Symptoms can seem unimportant, especially if there’s an obvious cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has lasted a long time or is getting worse.
Most likely, any symptoms you may have will not be caused by cancer, but it’s important to have them checked out, just in case. If cancer is not the cause, a doctor can help figure out what is and treat it, if needed.
Sometimes, it’s possible to find cancer before you have symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early, before symptoms start. For more information on early detection tests, see our document American Cancer Society Guidelines for the Early Detection of Cancer. But keep in mind, even if you have these recommended tests, it’s still important to see a doctor if you have any symptoms.

What are some general signs and symptoms of cancer?

You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer—many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what’s going on.

Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.

Fever

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all patients with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that does not get better with rest. It may be an important symptom as cancer grows. It may happen early, though, in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Skin changes

Along with cancers of the skin, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

• Darker looking skin (hyperpigmentation)
• Yellowish skin and eyes (jaundice)
• Reddened skin (erythema)
• Itching (pruritis)
• Excessive hair growth

Signs and symptoms of certain cancers

Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible.

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be seen by a health professional.

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Coughing up blood in the sputum (phlegm) may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than the expected lump.

Indigestion or trouble swallowing

Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully.

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the voice box (larynx) or thyroid gland.

Other symptoms

The signs and symptoms listed above are the more common ones seen with cancer, but there are many others that are not listed here. If you notice any major changes in the way your body works or the way you feel – especially if it lasts for a long time or gets worse – let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what’s going on and, if needed, treat it. If it is cancer, you’ll give yourself the chance to have it treated early, when treatment works best.

To learn more

More information from your American Cancer Society

We have selected some related information that may also be helpful to you. Many of these materials can be read on our Web site, www.cancer.org. Free copies can be ordered from our toll-free number, 1-800-227-2345.

General information about cancer and cancer prevention

What Is Cancer? (also in Spanish)
American Cancer Society Guidelines for the Early Detection of Cancer (also in Spanish)
American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention (also in Spanish)
Prevention Checklist for Men
Prevention Checklist for Women
Is Cancer Contagious? (also in Spanish)

Tests for cancer

Imaging (Radiology) Tests
Testing Biopsy and Cytology Specimens for Cancer

Living with cancer

Questions People Ask About Cancer (also in Spanish)
After Diagnosis: A Guide for Patients and Families (also in Spanish)

National organizations and Web sites*

Along with the American Cancer Society, other sources of information and support include:
CancerCare
Toll-free number: 1-800-813-4673
Web site: www.cancercare.org

Offers cancer information and support to people with cancer, caregivers, and loved ones

National Cancer Institute (NCI)
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
TTY: 1-800-332-8615
Web site: www.cancer.gov

Provides accurate, up-to-date cancer information to patients, their families, and the general public.

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

Department of Health and Human Services. Agency for Toxic Substances and Disease Registry. Cancer Fact Sheet. Accessed at www.atsdr.cdc.gov/COM/cancer-fs.html on August 10, 2012.
National Cancer Institute. Cancer: Questions and Answers. Accessed at www.cancer.gov/cancertopics/factsheet/Sites-Types/general on December 18, 2009. Content no longer available.

Last Medical Review: 08/13/2012
Last Revised: 08/13/2012

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+ -Text Size Medicare Coverage for Cancer Prevention and Early Detection

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Medicare Coverage for Cancer Prevention and Early Detection

Medicare is a government-funded health insurance program. It covers people age 65 or older and some people with disabilities.
Medicare pays for certain preventive health care services and some of the tests used to help find diseases early. It also covers a “Welcome to Medicare” physical exam and a yearly “Wellness exam.” Medicare coverage for tests and services that are related to cancer prevention and early detection are outlined here. Please call us toll-free at 1-800-227-2345, or visit our Web site, www.cancer.org, if you would like to learn more about cancer prevention and early detection.
There are several parts to Medicare.

• Part A covers most hospitalization and inpatient expenses.
• Part B covers medically needed care such as doctor visits, outpatient care, home care, some services to prevent disease, and certain tests used to help find diseases early.
• Part D covers prescription drugs.

Before you start, you’ll want to be sure that your doctor accepts Medicare, and find out whether he or she “accepts assignment.” (A doctor who accepts assignment takes the amount Medicare pays, along with your standard deductible and co-pay, as payment in full. In the case of many preventive services, you do not have to pay the deductible and co-pay. These are discussed below.)
For more detailed information on Medicare eligibility and coverage, contact the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit their Web site at www.cms.hhs.gov.

The “Welcome to Medicare” exam

Medicare pays for one “Welcome to Medicare” preventive doctor visit. You must have the exam in the first year you enroll in Medicare Part B. You pay nothing for the exam if your doctor accepts assignment from Medicare.
This exam is intended to help you stay as well as you can and look at ways to reduce your risk of serious health problems in the future. It includes questions about your past and current health, surgeries, medical problems, social history, and risk factors for depression.
Make a list of all surgeries, medical problems, hospital stays, and vaccines you’ve had before you go if you’re seeing a new doctor. To get the most from your visit, take another list showing all of the medicines, vitamins, and supplements you use, including the doses and how often you take them. And finally, bring a list of the other doctors who are involved in your health care.
The Welcome visit includes a physical exam, a look at your ability to do everyday things, and your overall safety. End-of-life planning may also be discussed, so that your doctor can have an idea of what you want if you later become unable to speak for yourself.
The doctor or nurse may talk to you about how to live a healthy lifestyle, with exercise and a proper diet. And you may be referred to other experts for teaching or counseling if needed. The doctor might also recommend certain tests to look for cancer, heart disease, or other problems and will also make sure you are up to date with your shots.

The yearly “Wellness” exam

Once every 12 months you can have a wellness exam. This is very much like the “Welcome to Medicare” exam and can be a yearly follow-up to it. But you don’t need to have a “welcome” exam to have a “wellness” exam later. The Wellness exam includes everything that the Welcome to Medicare visit does, as listed above. If your doctor accepts Medicare, you do not have to pay for these yearly visits.
This visit is also a chance to review your cancer risks, talk about the tests you should have to look for cancer, and plan how often you should have them.

Quitting smoking

Medicare will pay for counseling to help you quit using tobacco (called tobacco cessation counseling). It’s covered if you don’t yet have any problems related to tobacco use. You pay nothing for this counseling because it’s covered as a preventive service. If you do have a health problem due to smoking, co-pays and deductibles may apply.
Medicare will help pay for counseling to quit tobacco if you have a condition that is worsened by smoking or tobacco use. Some examples would be heart disease, cancer, stroke, lung disease, osteoporosis (weak bones), hypertension (high blood pressure), diabetes, cataracts, or macular degeneration (vision loss). You may also qualify if smoking or using tobacco is causing problems with the way your body processes a drug used to treat another medical condition. Insulin and certain drugs used to treat high blood pressure, blood clots, and depression are some of the drugs affected by tobacco.
If your doctor prescribes counseling help for quitting because you are having health problems, Medicare will help pay up to 8 face-to-face visits in a 12-month hperiod. But you have to pay 20% of the Medicare-approved amount and the Part B deductible for your counseling. If you get counseling in a hospital outpatient setting, you’ll also have to pay the hospital co-pay.
Medicare Part D may also cover some prescription drugs used to help you stop smoking. Certain drugs may need to be pre-approved, and you may have a limited number of refills. You will need to check with your Part D provider for details of coverage for each drug. Over-the-counter treatments, such as nicotine patches or gum, are not covered.

Breast cancer

One screening mammogram every 12 months is fully covered for all women with Medicare age 40 and older. You can get one baseline mammogram between ages 35 and 39, too. Medicare also covers newer digital mammograms.
Medicare pays for a clinical breast exam (CBE) once every 24 months for women at average risk of breast cancer. A CBE is covered once every 12 months for those at high risk and women of child-bearing age who have had an exam that showed cancer or other changes in the past 3 years. (The CBE is usually done at the same time as your pelvic exam. See the “Cervical cancer” section below.) You pay nothing for these exams if the doctor accepts assignment.
At this time, Medicare’s cancer screening coverage information does not include MRI along with mammogram as a covered screening method for women who are at high risk for breast cancer. If your mammogram shows something abnormal that requires more pictures, you may have to pay the deductible and co-pay for a diagnostic mammogram.
Talk to your doctor about your breast cancer risk. If you and your doctor agree that you are at high risk, you may be able to find out more by talking with your doctor’s billing service about Medicare coverage for more frequent exams and breast MRI.

Cervical cancer

Medicare covers one Pap test and pelvic exam every 24 months if you are at low risk for cervical cancer. If you are at high risk for cervical cancer or are of childbearing age and have had an abnormal Pap test in the last 3 years, the tests are covered every 12 months.
You pay nothing for the Pap lab test or for collecting the Pap test and the pelvic exam, as long as your doctor accepts Medicare. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.
Talk to your doctor about your cervical cancer risk and the testing plan that is best for you.

Colorectal cancer

Medicare covers colorectal screening tests in people 50 and older to help find colorectal cancer and/or pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer. Coverage for these tests depends on the person’s risk for colorectal cancer, when they had their last test, and whether or not something is found that needs to be removed.
If you are age 50 and older with Medicare and are at average risk for colorectal cancer, any one of the listed tests is covered. You should not have to pay anything for the test. But keep in mind that you may have to pay a co-pay for the doctor’s services, anesthesia, or hospital visit. And coverage will be denied if your last test was too recent (for instance, you have a colonoscopy and have another one 9 years and 11 months later.)

• Fecal occult blood test (FOBT) once every 12 months
• Flexible sigmoidoscopy once every 4 years, or 10 years after a previous colonoscopy
• Colonoscopy once every 10 years, but not within 4 years of a flexible sigmoidoscopy
• Barium enema once every 4 years (if used instead of colonoscopy or flexible sigmoidoscopy)

If you have Medicare, are age 50 and older, and are at high risk for colon cancer, Medicare pays for some tests at shorter intervals, such as these:

• Colonoscopy once every 2 years (with no minimum age listed)
• Barium enema once every 2 years (instead of colonoscopy or flexible sigmoidoscopy)

But, again, you may have to pay a co-pay or deductible for the doctor’s office or hospital visit.
Talk to your doctor about your colorectal cancer risk, the tests that are best for you, and how often you should be tested. Also be sure you understand if and how much it will cost you to have the tests that are planned. Keep in mind that Medicare covers people at high risk of colorectal cancer for more frequent testing at younger ages. Medicare has its own definition of what makes a person high risk, so talk with your doctor about whether you fit that definition.
Note that if a screening test leads to a biopsy or removal of a growth, the test is considered diagnostic rather than screening and you must pay the co-pay. In this situation, you should not have to pay the deductible. (This means that you may not know if you have a co-pay until after the test is done.)
As of 2012, Medicare’s cancer screening coverage information does not list virtual colonoscopy or stool DNA testing as covered screening methods for colorectal cancer.

Prostate cancer

For men over age 50 with Medicare, one digital rectal exam (DRE) and one prostate-specific antigen (PSA) blood test are covered every 12 months. This coverage starts the day after your 50^th birthday.
You pay nothing for the PSA test. But you must pay 20% of the Medicare-approved amount for the DRE after the yearly Part B deductible.

To learn more

More information from your American Cancer Society

We have selected some related information that may also be helpful to you. These materials may be read online at www.cancer.org, or ordered from our toll-free number, 1-800-227-2345.
American Cancer Society Guidelines for the Early Detection of Cancer (also in Spanish)
Taking Charge of Your Health -- for African Americans
Cancer Facts for Men (also in Spanish)
Prevention Checklist for Men
Cancer Facts for Women (also in Spanish)
Prevention Checklist for Women
Breast Cancer: Early Detection (also in Spanish)
Cervical Cancer: Prevention and Early Detection (also in Spanish)
Colorectal Cancer Early Detection (also in Spanish)
Prostate Cancer: Early Detection (also in Spanish)
Health Insurance and Financial Assistance for the Cancer Patient (also in Spanish)
Medicare Part D: Things People With Cancer May Want to Know
No matter who you are, we can help. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

Centers for Medicare and Medicaid Services. Medicare. Accessed at www.cms.hhs.gov/home/medicare.asp on January 4, 2012.
Centers for Medicare and Medicaid Services. Medicare & You 2012. Accessed at www.medicare.gov/Publications/Pubs/pdf/10050.pdf on January 4, 2012.
Centers for Medicare and Medicaid Services. The Guide to Medicare’s Preventive Services. March 2011. Accessed at www.cms.gov/MLNProducts/downloads/mps_guide_web-061305.pdf on December 22, 2011.
Centers for Medicare and Medicaid Services. Your Guide to Medicare’s Preventive Services. Accessed at www.medicare.gov/Publications/Pubs/pdf/10110.pdf on December 22, 2011.

Last Medical Review: 02/07/2012
Last Revised: 02/07/2012

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Breast Cancer Overview + -Text Size Download Printable Version [PDF]» Causes, Risk Factors, and Prevention TOPICS Document Topics GO » SEE A LIST » Previous Topic How many women get breast cancer? Next Topic Can breast cancer be prevented? What are the risk factors for breast cancer?

Breast Cancer Overview

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Causes, Risk Factors, and Prevention TOPICS

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How many women get breast cancer?

Next Topic

Can breast cancer be prevented?

What are the risk factors for breast cancer?

Certain changes in DNA can cause normal breast cells to become cancer. DNA is the substance in each of our cells that makes up our genes — the instructions for how our cells work. Some inherited DNA changes (mutations) can increase the risk for developing cancer. These changes cause the cancers that run in some families. For instance, BRCA1 and BRCA2 are tumor suppressor genes — they keep cancer tumors from forming. When they are changed, they no longer cause cells to die at the right time, and cancer is more likely to develop.
But most breast cancer DNA changes happen in single breast cells during a woman's life rather than having been inherited. So far, the causes of most of the DNA mutations that could lead to breast cancer are not known.

Risk factors

While we do not yet know exactly what causes breast cancer, we do know that certain risk factors are linked to the disease. A risk factor is something that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as smoking, drinking, and diet are linked to things a person does. Others, like a person's age, race, or family history, can’t be changed.
But risk factors don’t tell us everything. Having a risk factor, or even several, doesn’t mean that a woman will get breast cancer. Some women who have one or more risk factors never get the disease. And most women who do get breast cancer don't have any risk factors (other than being a woman and growing older). Some risk factors have a greater impact than others, and your risk for breast cancer can change over time from aging or lifestyle.
Although many risk factors may increase your chance of having breast cancer, it is not yet known just how some of these risk factors cause cells to become cancer. Hormones seem to play a role in many cases of breast cancer, but just how this happens is not fully understood.

Risk factors you cannot change

Gender: Being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.
Age: The chance of getting breast cancer goes up as a woman gets older. About 2 of 3 women with invasive breast cancer are 55 or older when the cancer is found.
Genetic risk factors: About 5% to 10% of breast cancers are thought to be linked to inherited changes (mutations) in certain genes. The most common changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk, too.
Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother’s or father’s side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman’s risk. It’s important to note that most (over 85%) women who get breast cancer do not have a family history of this disease, so not having a relative with breast cancer doesn’t mean you won’t get it.
Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer (called a recurrence).
Race: Overall, white women are slightly more likely to get breast cancer than African-American women. African American women, though, are more likely to die of breast cancer. And in women under 45 years of age, breast cancer is more common in African American women. Asian, Hispanic, and Native-American women have a lower risk of getting and dying from breast cancer.
Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for doctors to spot problems on mammograms.
Certain benign (not cancer) breast problems: Women who have certain benign breast changes may have an increased risk of breast cancer. Some of these are more closely linked to breast cancer risk than others. For more details about these, see our document, Non-cancerous Breast Conditions.
Lobular carcinoma in situ: In this condition, cells that look like cancer cells are in the milk-making glands (lobules), but they do not grow through the wall of the lobules and cannot spread to other parts of the body. It is not a true cancer or pre-cancer, but having LCIS increases a woman's risk of getting cancer in either breast later. For this reason, it's important that women with LCIS make sure they have regular mammograms and doctor visits. Women with lobular carcinoma in situ (LCIS) have a 7 to 11 times greater risk of developing cancer in either breast.
Menstrual periods: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen and progesterone.
Breast radiation early in life: Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer. The risk varies with the patient’s age when she had radiation. The risk from chest radiation is highest if the radiation were given during the teens, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk.
Treatment with DES: In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby (miscarriage). Studies have shown that these women have a slightly increased risk of getting breast cancer. The effect on the children exposed in the womb is less clear, but they may also have a slightly higher risk of breast cancer. For more information on DES see our document, DES Exposure: Questions and Answers.

Breast cancer risk and lifestyle choices

Not having children or having them later in life: Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant many times and at an early age reduces breast cancer risk. Being pregnant lowers a woman’s total number of lifetime menstrual cycles, which may be the reason for this effect.
Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly greater risk of breast cancer than women who have never used them. This risk seems to go back to normal over time once the pills are stopped. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. It's a good idea to talk to your doctor about the risks and benefits of birth control pills.
Depot-medroxyprogesterone acetate (DMPA or Depo-Provera^®) is an injectable form of progesterone that is given once every 3 months as a “shot” for birth control. Women now using DMPA seem to have an increase in breast cancer risk, but the risk doesn’t seem to be increased if this drug was stopped more than 5 years ago.
Using hormone therapy after menopause: Post-menopausal hormone therapy (PHT) has been used for many years to help relieve symptoms of menopause and to help prevent thinning of the bones (osteoporosis). This treatment goes by other names, such hormone replacement therapy (HRT), and menopausal hormone therapy (MHT).
There are 2 main types of PHT. For women who still have a womb (uterus), doctors most often prescribe both estrogen and progesterone (known as combined hormone therapy or combined HT). Estrogen alone can increase the risk of cancer of the uterus, so progesterone is needed to help prevent this. For women who no longer have a uterus (those who’ve had a hysterectomy), estrogen alone can be prescribed. This is known as estrogen replacement therapy (ERT) or just estrogen therapy (ET).

• Combined HT: Use of combined HT after menopause increases the risk of getting breast cancer. It may also increase the chances of dying from breast cancer. Breast cancer in women taking hormones may also be found at a more advanced stage, perhaps because it lowers how well mammograms work by increasing breast density. Five years after stopping HT, the breast cancer risk seems to drop back to normal. The word bioidentical is sometimes used to describe versions of estrogen and progesterone with the same chemical structure as those found naturally in people. The use of these hormones has been marketed as a safe way to treat the symptoms of menopause. It is important to keep in mind that although there are few studies comparing “bioidentical" or “natural” hormones to man-made versions of hormones, there is no evidence that they are safer or work better. The use of these bioidentical hormones should be assumed to have the same health risks as any other type of hormone therapy.
• ET: The use of estrogen alone does not seem to increase the risk of developing breast cancer. In fact, some research has seemed to show that women who have had their uterus removed and who take estrogen actually have a lower risk of breast cancer. But women taking estrogen seem to have more problems with strokes and other blood clots. And when used for a long time (for more than 10 years), some studies have found that ET increases the risk of ovarian cancer.

At this time, there seem to be few strong reasons to use PHT, other than for short-term relief of menopausal symptoms. Because there are other factors to think about, you should talk with your doctor about the pros and cons of using PHT. If you and your doctor decide to try PHT for symptoms of menopause, it is usually best to use it at the lowest dose that works for you and for as short a time as possible.
Not breastfeeding: Some studies have shown that breastfeeding slightly lowers breast cancer risk, especially if the breastfeeding lasts 1½ to 2 years. This could be because breastfeeding lowers a woman’s total number of menstrual periods, as does pregnancy. But this has been hard to study because, in countries such as the United States, breastfeeding for this long is uncommon.
Alcohol: The use of alcohol is clearly linked to an increased risk of getting breast cancer. Women who have one drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol. Too much alcohol use is also known to increase the risk of several other types of cancer.
Being overweight or obese: Being overweight or obese after menopause (or because of weight gain that took place as an adult) is linked to a higher risk of breast cancer. But the link between weight and breast cancer risk is complex. The risk seems to be higher if the extra fat is around the waist.
Lack of exercise: Studies show that exercise reduces breast cancer risk. The only question is how much exercise is needed. One study found that as little as 1 hour and 15 minutes to 2½ hours of brisk walking per week reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more.

Risk factors that are not certain or that haven’t been proven

Diet and vitamin intake: Many studies have looked for a link between what women eat and breast cancer risk, but so far there are no clear answers. Some studies seemed to show that diet may play a role, while others found no evidence that diet has an effect on breast cancer risk. Studies have looked at the amount of fat in the diet, intake of fruits and vegetables, and intake of meat. No clear link to breast cancer risk was found. Studies have also looked at vitamin levels, but again the results are not clear. So far, no study has shown that taking vitamins lowers breast cancer risk. This is not to say that there is no point in eating a healthy diet. A diet low in fat, low in red meat and processed meat, and high in fruits and vegetables can have many health benefits.
Most studies found that breast cancer is less common in countries where the typical diet is low in fat. On the other hand, many studies of women in the United States have not found breast cancer risk to be linked to how much fat they ate. Researchers are still not sure how to explain this difference. More research is needed to better understand the effect of the types of fat eaten and body weight on breast cancer risk.
Antiperspirants and bras: Internet e-mail rumors have suggested that underarm antiperspirants can cause breast cancer. There is very little evidence to support this idea. A large study of breast cancer causes found no increase in breast cancer in women who used antiperspirants. Also, there is no evidence to support the idea that bras cause breast cancer.
Induced abortions: Several studies show that induced abortions do not increase the risk of breast cancer. Also, there is no evidence to show a direct link between miscarriages and breast cancer. For more detailed information, see our document, Is Abortion Linked to Breast Cancer?
Breast implants: Silicone breast implants can cause scar tissue to form in the breast. But studies have found that this does not increase breast cancer risk. If you have breast implants, you might need special x-ray pictures during mammograms.
Pollution: A lot of research is being done to learn how the environment might affect breast cancer risk. This issue understandably invokes a great deal of public concern, but at this time research does not show a clear link between breast cancer risk and exposure to things like plastics, certain cosmetics and personal care products, and pesticides (such as DDE). More research is needed to better define the possible health effects of these and similar compounds.
Tobacco smoke: For a long time, studies found no link between active cigarette smoking and breast cancer. In recent years, though, some studies have found that smoking may increase the risk of breast cancer. The increased risk seems to affect certain groups, such as women who started smoking when they were young. In 2009, the International Agency for Research on Cancer concluded that there is limited evidence that tobacco smoking causes breast cancer.
An issue that continues to be a focus of research is whether secondhand smoke (smoke from another person's cigarette) may increase the risk of breast cancer. But the evidence about secondhand smoke and breast cancer risk in human studies is not clear. In any case, a possible link to breast cancer is yet another reason to avoid being around secondhand smoke.
Night work: A few studies have suggested that women who work at night (nurses on the night shift, for instance) have a higher risk of breast cancer. This is a fairly recent finding, and more studies are being done to look at this.

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