“1 in 8” – Fear Mongering and the Probability of Developing Breast Cancer

Every year, over 700 thousand women in the United States are diagnosed with some type of cancer. Breast cancer is the most frequently diagnosed cancer in women and is the second leading cause of cancer death (after lung cancer). In 2009, the American Cancer Society estimated over 192 thousand new cases of breast cancer among women and over 40 thousand deaths. Although 80 percent of new breast cancer cases were in women over age fifty, a growing number were diagnosed at earlier ages. Nearly 33,000 newly diagnosed women in 2008 were under the age of forty-five. During a woman’s lifetime, the cumulative probability of developing breast cancer is 1 in 8.

These frightening statistics should sound familiar. The “1 in 8” ratio is commonly used in public service announcements and breast cancer advertisements to warn all women that they should be concerned about developing breast cancer. As a result, fear of the disease is paramount in the United States and many women (over 70 percent) try to get mammograms on a regular basis. However, the “1 in 8” cumulative incidence of breast cancer does not mean that out of eight women sitting in a room, one will definitely get breast cancer. Instead the ratio shows an average probability for the entire population of women over a lifetime.

The probability of getting breast cancer increases with age. Whereas the American Cancer Society reports that only 1 in 208 women will be diagnosed with breast cancer from birth to age 39, the ratio changes to 1 in 16 women after age 70. By the time they would die of old age, 1 out of 8 women in the United States who avoided equally serious life-threatening events while they were younger will be diagnosed with breast cancer. As populations live longer without infectious diseases, their chances of developing any number of chronic illnesses—including cancer—increase over a lifetime. Likewise, the chances of developing most types of cancers (except leukemia and lymphoma which are most prevalent in those aged 15-39) increase with age. Still, most people die from something besides cancer.

Overall, cancer accounts for 1 in 4 deaths in the United States. According to the Centers for Disease Control and Prevention heart disease is the leading cause of death, followed by cancer, stroke, chronic respiratory disease, and accidents (unintentional injuries). In addition to the chances of dying from one of these other causes, some cancer diagnoses do not result in death anyway because the cancer grows too slowly, goes into remission naturally or with treatment, or the condition was not life threatening to start. The latter is especially important for understanding the contemporary context of breast cancer.

Studies reported in the mid-1980s found that autopsies done on women who died from a variety of causes found that between 6 and 16 percent had a stage zero breast condition called ductal carcinoma in situ (DCIS), a condition commonly diagnosed with mammograms. Though DCIS can be a precursor to breast cancer, or a risk factor for the eventual development of breast cancer, it is not really a carcinoma (i.e., malignant tumor) because it is a cluster of abnormal cells that stays in place and does not metastasize. A 2008 editorial in the Journal of the National Cancer Institute stated that “a senior pathologist involved in developing classification systems confided…that he regretted the use of the term carcinoma in DCIS” because it was a misnomer. Despite this fact, the rise in DCIS diagnoses since the mid-1980s (which accompanied increases in widespread screening mammography) has worked together with the proliferation of the “1 in 8” ratio and other statistics to spread ardent fear of the disease.

While it is not the leading cause of death for women, breast cancer is the leading cause of fear. Women are ten times more likely to die from heart disease than from breast cancer, and they are also more likely to die from cancers of the respiratory (71,550 per year) and digestive (59,810 per year) systems than they are from breast cancer (40,170 per year). In addition to diverting attention from other pressing health issues, fear of breast cancer begets stress, increased surveillance, and unnecessary procedures including unnecessary biopsies, treatments, and prophylactic mastectomies.

A report by the Institute of Medicine stated that 75 percent of all positive mammograms, upon biopsy, were “false-positives” (i.e., did not show the presence of cancer). The rate is so high that by the time a woman has had 10 mammograms, she will have a 50 percent chance of being told her results are abnormal, resulting in unnecessary biopsies for the majority of women who have them. Unnecessary or not, the act of waiting for biopsy results impacts stress hormones (i.e., cortisol) just as much as finding out you have breast cancer. In addition, the increased detection of abnormal tissue that will never become symptomatic (i.e., DCIS) is a form of “overdiagnosis” that leads to 30 percent more surgery, 20 percent more mastectomies, more use of radiotherapy, and more aggressive treatment for both diagnosed and undiagnosed alike. The number of women who were diagnosed with cancer only in one breast who had mastectomies on both sides increased from 1.8 percent in 1998 to 4.5 percent in 2003 for fear that they would develop breast cancer on the other side. Increasingly, women without breast cancer who believe they are at an increased consider removing healthy breasts for preventive reasons.

In his book Unnatural History: Breast Cancer and American Society Dr. Robert Aronowitz of the University of Pennsylvania explains why there is such a huge gap between social understandings of breast cancer and its biological effects: “fear of breast cancer has too often been oversold.” Widespread statistics seem to indicate that breast cancer is inevitable, and research studies that do not clearly explain what risk really means give the impression that almost anything and everything will contribute to the development of breast cancer. Breast cancer advertisements then use fear statistics to garner support for the cause, sell products, and raise funds.

Breast and other cancers are more prevalent than they should be. That’s what population level statistics tracked over many years tell us. Breast cancer rates have increased about 1 percent per year since the 1940s, and the cumulative incidence ratio that is now “1 in 8” was about “1 in 11” in 1975. But these averages tell individual women nothing about their personal risk. Population level statistics such as these show trends that allow researchers and policy makers to determine public health and research agendas.

What is clear from these statistics is that the breast cancer burden has increased. Since the known risk factors account for only 30 percent of total cases and unknown factors account for the remaining 70 percent, putting our efforts into identifying unknown causes would make a lot of sense. The state of the evidence suggests that the primary causes of breast cancer are multi-faceted, environmental, and systemic—not individual. To decrease the total breast cancer burden, environmental causes should be our focus. In the meantime, we need to take a deep breath and calm down. The diagnosed already have enough to deal with, and fear mongering is not going to help.

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2 comments to “1 in 8” – Fear Mongering and the Probability of Developing Breast Cancer

  • R Waller

    Shameful, isn’t it. I just finished TX 4/5/11 for stage II triple negative b.c. with squamous cell tumor with apocrine features but p63 negative. It took me quite a while to find this study and I looked for it throughout my 7 1/2 months of treatment. I have a friend who did bilateral mastectomy with reconstruction with a dcis dx. It’s criminal!

  • It’s hard to think that a person whose diagnosis is classified as noninvasive – and therefore not life threatening – is having aggressive interventions and a person with triple negative at this point has so few options. There are side effects from all of these treatments. It is shameful. Thank you for sharing your situation. My heart goes out to you.

"women urged to get screened because it might save their lives. But that’s only 1 possible outcome, and it’s the least likely one" @cragcrest cutt.ly/jei8WJr

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