True or false: Smoking is linked to breast cancer. Breast pain is not a sign of breast cancer. One out of nine women will get breast cancer.

If you think you know the answer to those questions, you might be surprised.

Are You Really at Risk?
Misleading statistics and statements often confuse the public and lead others - like the media and advocacy groups - to unintentionally disseminate misinformation, says Dr. Eric Winer, physician and director of breast oncology at Dana-Farber Cancer Institute in Boston, Mass.

Misinformation not only frightens women unnecessarily, but also can affect their diagnosis and treatment decisions, he says. "The one in eight figure about a woman's chance of developing breast cancer is often misunderstood," says Dr. Winer. "That number is a lifetime risk. On the other hand, a woman born today has less than a 2 percent chance of developing breast cancer before the age of 50. Almost half of all cases of breast cancer occur in women over 65. Of course, certain risk factors, such as a family history, may increase the risk to a modest extent."

Figures like that aren't broken down into ethnicity, age and other risk factors that determine a woman's risk either, he says. However, he does urge women to be conscientious about breast health.

"Breast cancer is the leading cancer death in women under 60," Dr. Winer says

Age is another misunderstood factor in calculating a woman's risk, doctors say. "No one is too old to have breast cancer," Dr. Winer says. "It's very uncommon in women under 30, and it's almost unheard of in women under 25, but it can occur."

Dr. Ruth Oratz, an oncologist at New York University Medical Center and an associate professor of medicine at NYU's School of Medicine, agrees. "We've seen women in their 20s and women in their 90s with breast cancer," she says. "Women of any age can get breast cancer." Still, women in their 50s and 60s face the biggest risk, with 64 as the average age of diagnosis.

Debbie Franklin, 37, a new mother, knows firsthand that no one is too young to get cancer. "I was 36 and breastfeeding my first baby when I was first misdiagnosed with mastitis, then found to have inflammatory breast cancer that was already in my bones," she says. "Quite a few doctors, including a breast surgeon, had examined me before the proper diagnosis was made. And later I was told that doctors don't expect to find a young nursing mother with breast cancer. They don't want to see it."

Franklin is currently undergoing treatment in Southern California. "But as the most recent newsletter of the Young Survival Coalition [breast cancer advocacy group], says: 'You're too young to have cancer' is not a diagnosis," she says.

Tests You Should Know
Following recent studies and statements by patient advocacy groups, one of the biggest controversies has been about mammograms, including at what age to have them, how often to have them and whether they're as beneficial as initially thought.

"There is not a simple answer about mammograms. Currently, I don't believe the screening regulations that we've followed for the past five to 10 years should be changed," says Dr. Winer, a member of the National Comprehensive Cancer Network panel that develops breast cancer guidelines for physicians and patients. "That means women older than 50 should have an annual mammogram, and women ages 40 to 50 should talk to their doctors about their risks and whether they should start screening."

All women, he says, should perform self-exams, and women age 30 and older should have a yearly clinical breast exam by their doctor. Women with a family history of breast cancer should have clinical exams and mammograms earlier than the general recommendations.

In those exams, Dr. Oratz says, women should be looking not only for lumps in the breast, but also under the arm, redness of the skin, inverted nipples, crusting over of the nipple, discharge from the nipple, changes in the shape of the breast and anything else that's unusual.

Most of the time, pain is not a symptom of breast cancer, Dr. Winer says, but it is in about 10 percent of the cases. For Franklin, it was the intense breast pain that first sent her to the doctor – something she didn't realize could be an indicator of breast cancer.

As for the debate over whether mammograms are beneficial, Dr. Winer says, "I think the American public overestimates how effective they are. Does that mean women should stop having mammograms? Of course not."

Despite problems with the screening process with mistakes often blamed on the technician reading the results and not the actual mammogram test, it's the best option women have, says Dr. Oratz. "It is the only and the best screening method for the early detection of breast cancer," she says. "It is absolutely necessary. Yes, it can be terrifying, but 200,000 women in the United States will be diagnosed with breast cancer this year, and 40,000 women will die. We can prevent this to a large extent with early detection. We should be vigilant and well-educated."

A blood test called the NMP66 is currently being researched as a potential method to screen for breast cancer, according to Matritech, Inc., a Massachusetts-based company that is developing the test. The test, which detects proteins in a woman's blood that correlate with breast cancer, is in the clinical trial stages in the United States and Germany and could be available to the general public later this year. According to spokeswoman Brooke Tyson, the test could have several advantages over the mammogram such as being able to detect tumors too small to be seen on a mammogram and being more cost-effective.

Other new diagnostic tools include the digital mammogram, which can help better screen younger women with dense breast tissue, says Dr. Oratz.

What Are the Odds?
Another area of confusion regarding breast cancer are the risk factors - particularly taking birth control pills and smoking.

While Dr. Oratz agrees that smoking is not connected to breast cancer and family history is, she's not made up her mind on the issue of birth control pills. Although a recent study in the New England Journal of Medicine finds that birth control pills are not a factor in breast cancer, Dr. Oratz says there are many studies that show some link.

What is clear, according to Dr. Oratz, is the link between long-term hormone replacement therapy (10 or more years) and breast cancer. Also certain, she says, is that a woman with a family history of breast cancer is more likely to develop the disease. But women need to know that the cancer-causing gene can come from the mother's or father's side. Other facts, like how many family members had breast cancer and how old they were when they were diagnosed, help factor a woman's risk, too.

Having a first-degree relative, such as a mother or sister, with breast cancer is most important in determining the family history risk factor. Third-degree relatives, like cousins and great-aunts, can play a role as well, but are much less of a factor, Dr. Winer says. Other risk factors include starting periods at an early age, having menopause after age 55 and having a late first pregnancy or no pregnancy. "All of those factors play a modest role," he says. "If you had periods at 11, it doesn't mean you have a significantly increased risk for breast cancer."

According to Dr. Winer, something else that can cause a slight risk increase is certain biopsy findings. Benign findings, like a woman with a common, non-cancerous fibroadenoma may have a slightly increased risk of developing breast cancer later. Tailored Treatment
"Perhaps the most important concept to convey is that we can treat cancer more effectively without having such a significant impact on the woman's life," Dr. Winer says. "Ten or 15 years ago, we had to make people sick to get them well, but with all of the new hormonal, chemo and antibody therapies, we're moving away from that."

Today, women with breast cancer have fewer surgeries, less radiation and fewer side effects caused by chemotherapy, doctors say.

"We realize that one-size-fits-all treatment doesn't work; it never did," Dr. Winer says. "I think we're moving more toward individuality of treatment for patients."

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