If American women suffer from mass anxiety, it’s surely about breast cancer. One woman confided that she examined her breasts every day. Another, who was too scared to examine them at all, burst into tears on her thirty-third birthday, the age at which her grandmother had developed breast cancer. The fears of some are focused on dying; for others it’s the thought of living with a mutilated body.

Now there is reassuring news about these twin fears. Many women who do develop breast cancer are learning that breast-sparing surgery is a viable option accepted by a growing number of specialists. New research is allowing thousands of other women to put their fears into realistic focus and to stop fighting the cancer bogeyman. These exaggerated fears often stem from misinterpretations of the facts. Among the most common:

One in every eleven American women will develop breast cancer during her lifetime. This is true but misleading because it taken in all the years of a woman’s life. Your risk of having breast cancer before you are fifty is only 1.5 percent.

If your mother had breast cancer, you’ll get it too. Each of the 114,000 Americans who develop the disease every year generally has two or more female relatives who share this concern, but most are at little more than average risk. Even with the worst possible family history, a daughter or sister of a breast cancer patient still has a 50 percent chance of not getting the disease.

Fibrocystic disease increases breast cancer risk. Many of the 400,000 women per year who have breast biopsies are mistakenly told this, but, The Breast Cancer Digest, published by the National Cancer Institute (NCI) states clearly: "The very common breast nodularity sometimes referred to as "fibrocystic disease" carries no extra risk of breast cancer.

Breast cancer is a death sentence. Not so. More than two out of three breast cancer patients live ten years or more, and one third live at least twenty years. About half of all breast cancers discovered these days are diagnosed at the stage where cure is most likely, and new treatments are expected to boost survival figures more than 15 percent.

1. Age: Two thirds of breast cancers offur after fifty. If you’re thirty-five now, the chance of your getting breast cancer in the next twenty years is less than 2.5 percent.

2. Previous cancer: If you’ve had cancer in one breast, there’s a 20 percent chance you’ll eventually develop it in the other. Risk is believed to increase 1 percent a year.

3. Family History: Breast cancer in the immediate family (mother, daughter, sister) puts you at a higher risk. Breast cancer on your father’s side of the family adds some risk but how much is unknown. The same is true for secondary relatives like aunts and cousins. Family breast cancer is likely to develop early (before menopause) and to be bilateral (occurring in both breasts). Thus, if your mother had cancer in one breast at age sixty, it’s not likely to be the family kind. But if your mother died at forty-eight after discovering cancer in both breasts, and your sister received the same diagnosis at forty, your risk may be as high as 50 percent. Many factors must be considered, however, so those with reason to be concerned should seek genetic counseling.

4. Biopsies of a breast lump: As a group, women who’ve had biopsies have a higher rate of cancer. This is a statistical oddity caused by the fact that a doctor is more likely to perform a biopsy on a woman in a high-risk category. When statisticians separate out these high-risk women, however, the hazard for the rest is only slightly above normal.

5. Reproductive history: Generally, the earlier you had your first child, the less chance you have of developing breast cancer. Childless women have a slightly lower risk than those who were over thirty at initial childbirth. The number of children doesn’t affect the risk.

6. Menstrual history: If you started menstruating early (before age twelve) or ended late (after fifty-five) your risk is greater than if your menstrual years are shorter than average. If you lose your ovaries in surgery before natural menopause. Your risk is reduced. (But if you then take large doses of estrogen for ten years or more, you’ll increase the risk.)

There are six known factors - roughly in order of importance - that influence your chances of getting breast cancer. Except for age, however, they apply to only one out of four cases. It’s wise to be particularly alert if you are at special risk, but no woman can afford to be complacent about the disease.

Many other risks you may have heard about are too trivial for concern or don’t exist. You are not at risk of cancer is you suffer a blow to the breast, if your breasts are extra large or small, if you sleep on your side or on your stomach. Breast-feeding has no effect one way or the other. And most painful breasts - 90 percent - are not cancerous.

The popular belief that contraceptive pills can cause breast cancer is now being refuted too. A large research study by D. Peter Layde of the Centers for Disease Control reports no increased incidence of breast cancer even among women who took the Pill for a decade and also had a family history of breast cancer. (Women who started taking pills with a high progesterone content before age twenty-five, however, may have a slightly higher risk of breast cancer, according to another study that has not yet been confirmed.)

Change your diet. Scientists suspect that high levels of estrogen play a role in the disease and that a high-fat, low-fiber diet promotes excess estrogen retention. Many suggest that women reduce the fat content of their diets and increase the fiber. Less fat can help control weight too, which is also important. Women who are overweight after menopause have a higher risk.

Eat enough selenium. Areas with a high selenium level in the soil have a low incidence of breast cancer. Seafood, organ meats, and some grains are rich in selenium, but it’s unwise to overdose with a nutritional supplement; too much could be poisonous.

Avoid excess radiation, particularly during the teens or pregnancy; it can cause breast cancer many years later. No one knows how many rads are dangerous - possibly fifty - but the damage is cumulative. Although a mammogram or chest x-ray is unlikely to add even one rad, these diagnostic aids should be used cautiously.

Breast cancer is a slow growing malignancy that may have started ten or even twenty years before the first symptom. Every woman should follow routine procedures for early detection that could save her life.

Breast self-examination. Only two in five women examine their breasts monthly, and most don’t do it properly. Women who have been taught how are most likely to examine themselves regularly, so ask your doctor or nurse to give you a lesson.

Since breasts are different at various times of the month, they should be examined at regular intervals - about a week after your period starts, or, after menopause, on a day that’s easy to remember like the first of the month. What you’re looking for is any change - a lump or dimpling or puckering of the skin, retraction (inversion) of a nipple, a discharge of fluid or a scaly area around the nipple.

The doctor’s examination. Should you find something that worries you, it’s important to have a doctor look at it. But even if you find nothing, the American Cancer Society recommends having a physical examination (palpation) of breasts every three years until age forty, and annually thereafter. Your family physician or gynecologist can do the exam, going over both breasts when you are sitting up and lying down.

The mammogram. This x-ray of the breasts is the only technique that improves on human fingers; it can find malignancies which are less than a half inch in diameter. But it’s not fool-proof. The technique misses about one cancer in six. It is least accurate with young women whose breasts are dense. And the x-ray is only as good as the radiologist who interprets it. (Definitive treatment should never be given on the basis of mammography alone.) It’s important to choose a radiologist who specializes in breast x-ray and ask how much radiation the machine delivers. If it’s more than half a rad, go elsewhere.

The American Cancer Society now advises every woman to get a baseline mammogram - for comparison purposes - between the ages of thirty-five and forty. Then she should have a mammogram at least every other year in her forties and annually starting at age fifty. Those at special risk or with suspicious lumps should be x-rayed more often.

It probably isn’t cancer (eight out of ten lumps are not, but you must check it out. Among the most common benign lumps (often referred to as fibrocystic disease) are these: fibroadenoma, which feels slippery and round like a marble and turns up in young women between fifteen and thirty; lipoma, a soft fatty tumor that older women get; and cyst, a fluid-filled sac that enlarges and becomes painful just before menstruation. Women between thirty-five and fifty get cysts, sometimes in clusters. They are movable and firm to the touch.

Breast lumps are not easy to diagnose; sometimes a mammogram or a specialist is required. If a cyst is suspected, the doctor will use a fine needle to draw out (aspirate) the fluid. This usually makes the mass collapse and nothing more need be done. But if no fluid can be drawn, the lump doesn’t disappear or it recurs three or more times, a biopsy to remove and examine the tissue may be recommended.

To lessen the occurrence of lumps, some doctors advise women to give up coffee, tea, chocolate and cola; others suggest taking vitamin E. The real question, however, is whether cysts lead to breast cancer. A pamphlet put out by the National Cancer Institute says, "Benign lumps do not change into cancerous lumps." In one study of six hundred women with cysts, some followed for over thirty years, only nineteen developed cancer later. Although small, this number is higher than expected. Researchers suspect that other tissue changes that sometimes accompany cyst formation may provide the occasional cancer link.

When uncertain of the diagnosis, a doctor will advise a biopsy - the removal of suspicious tissue for examination by a pathologist. In some hospitals biopsies under a local anesthetic are now a simple outpatient procedure. In others, surgeons still insist on general anesthesia and the patient’s advance agreement to immediate mastectomy should the tissue be cancerous. Several years ago the NCI recommended a two-step procedure (biopsy followed by a doctor-patient decision on further treatment). If a doctor insists on the one-step plan, a woman may be wise to go elsewhere.

Sometimes a biopsy shows the lump to be neither invasive cancer nor benign, but a shadowy state between - either pre-malignancy or carcinoma-in-situ (cancer than has not invaded surrounding tissue). In such cases, the next step depends on the woman, her physician and the type of breast tissue involved, but a second opinion - or even a third - is certainly in order.

When a biopsy shows pre-malignancy (suspicious tissue changes but no cancer yet), many doctors feel a woman has little to lose from watchful waiting. Recent studies show that many, perhaps a majority of these precancers eventually regress and disappear. At Boston’s Dana-Farber Cancer Institute, where careful observation is the byword, high-risk patients return every three to six months for tests. Some cancers have developed among this group, says Dr. Robert Shirley, but all were caught at an early stage and successfully treated.

Traditionally, doctors recommended mastectomy for every case of breast cancer. Some still do, but many now realize that each woman’s problem is unique. After a mammogram or biopsy there may still be unanswered questions and several treatment options. It’s always wise to seek expert opinion at a center that specializes in breast disease. There, advice is given by a team that includes an oncologist, a breast surgeon, a gynecologist, a radiotherapist and a nurse, instead of by a single surgeon who may be bound by the old cut-and-cure beliefs.

Today the chances of getting early, effective treatment are better than ever. No woman needs let fear of breast cancer run or ruin her life.