at more advanced stages among minority and poor women, and these women also have higher mortality rates.

Major risk factors for breast cancer include older age, Caucasian race, higher socioeconomic status, and never marrying. Early onset of menstruation, late menopause, no full-term pregnancies before age 30, and never having given birth are additional risk factors. A family history of breast cancer in a woman's mother or sister is an important risk factor for about 5–10 percent of total cases (Colditz et al., 1993; Slattery and Kerber, 1993). In general, these risk factors are not easily modifiable, but two behavioral factors, alcohol consumption and breast feeding, may offer opportunities to reduce risk. Consuming more than two alcoholic beverages a day appears to increase the risk of developing breast cancer (Longnecker et al., 1995), and breast feeding appears to have a protective effect (Newcomb et al., 1994). Identifying risk factors for breast cancer can provide some guidance for prioritizing screening and early intervention programs, but current screening guidelines rely primarily on age.

Cervical Cancer

Cervical cancer is one of the most curable cancers in women, if caught in time through early screening and intervention. Cervical cancer carries a five-year survival rate of about 90 percent if localized, but only 40 percent of women with invasive disease survive five years (Ries et al., 1994). Of concern is evidence that since 1986 the previous downturn in the incidence of cervical cancer in women over age 50 has reversed and that it is now increasing about 3 percent each year (Washington State Department of Health, 1994). Early intervention through effective screening is critical for influencing health and survival.

Attention should also be given to the opportunities for prevention of cervical cancer. Risk factors include early age of sexual intercourse, multiple sex partners, human papilloma virus (HPV) infection (i.e., genital warts), lower socioeconomic status, and non-white race (Kjaer et al., 1992). Use of barrier methods of contraception appears to have a protective effect, perhaps due to decreasing exposure to HPV and other viruses (Slattery et al., 1989a). In addition, there may be an association between cigarette smoking and cervical cancer (Slattery et al., 1989b). An understanding of the risk factors for cervical cancer can point to interventions that can promote prevention. It can also help prioritize screening and early intervention programs, but efforts might also focus on



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