Breast cancer is a topic that I frequently get asked about by all age groups. With statistics as high as they are – 1 in every 8 women will get breast cancer by the time we are 80 – most of us do wonder whether we will be part of those statistics. The concern is even more relevant for those of us that have relatives with breast cancer. My grandmother had breast cancer in her 70s and opted for a bilateral radical mastectomy. Treatment options were very different back then, but before I became a doctor I wondered if I would be faced with this diagnosis some day. That is why it is important to understand thedata about breast cancer and why I educate my patients regarding their own risks.
There are many areas of concern when it comes to breast cancer. Let’s review:
Women have been taught for years the importance of self breast exams. I am sure that many of you have been shown how to perform one and may be doing this monthly at home on your own. So what does the data actually show? Two large studies have shown that women who performed self breast examinations had no difference in breast cancer mortality than women who did NOT perform self breast examinations. The studies also showed that the group who did self breast exams had twice asmany breast biopsies but did not find more cancers. Neither the United States Preventative Task Force, the American College of Obstetrics and Gynecology, nor the American Academy of Family Physicians recommend self breast exams in women under the age of 40. What IS recommended is a yearly clinical
breast exam done by a physician.
Mammography screening is recommended by most physicians to start at age 40. Some groups, such as the United States Preventative Task Force, recommend starting at age 50. If a woman has a family history of breast cancer in a first degree relative (see below), she should start getting mammograms 10 years prior to the age that the first degree relative was diagnosed at. This means, if your mom was diagnosed with breast cancer at age 42, her daughter should get her first mammogram at age 32. Magnetic resonance imaging (MRI) or molecular breast imaging (MBI) can be useful adjuncts to mammography based on one’s risk factors and breast types. This should be discussed with a physician.
First of all, remember that only about 13% of breast cancers are related to genetics. However, it is often scary to know that you have a family member with the diagnosis. What does that mean for you? A woman with a first degree relative (mother, father, brother, sister, child) with breast cancer is twice as likely to have breast cancer. If she has more than one first degree relative with the diagnosis, the risk can go up 3-4 times. This is not true if the woman’s mother was over the age of 50. A family history of breast and ovarian cancer is often related to a gene change or mutation (see below). Remember, men get breast cancer too! There has also been a link shown between prostate cancer and breast cancer, so be aware of the family history for both the males and females in your life.
If you know that you have a strong family history of breast, ovarian or prostate cancers, there are tests that can be done to determine if there is a genetic marker for increased risk. So who should be screened? Anyone with a strong family history of breast cancer at an early age (less than age 50), a family history of breast and ovarian cancers, those with bilateral breast cancer, a family history of male breast cancer, Ashkenazi Jewish heritage (who also have a family history of breast or ovarian cancer) or a personal history of breast cancer at an early age (less than age 50) should consider genetic screening. The genetic test that is recommended is a blood sample for genes known to be related to breast cancer. The most common inherited gene changes are BRCA1 and BRCA2. Other gene changes include, p53, PTEN/ MMAC1, CHEK2 and ATM. If there is no change to any gene, the cancer was less likely inherited and there is no need for other family members to be tested. If a mutation is found on a gene, then other family members should be tested. A genetic counselor can help determine if genetic testing is right for you based on your family history. If you or an immediate family member is the only person in your family with breast cancer, it is unlikely that your family carries a mutation.
Current studies do show that there is a slight risk of breast cancer in women who use combined hormonal contraception. Almost all of this data focuses on the birth control pill, but there is some evidence regarding the patch and the ring as well, which contain the same type of hormone. The data shows that there is a 10-30% increased risk in women who used combined oral contraception versus those who did not. However, most women on these medications are both young and premenopausal, which are protective factors against breast cancer. Once the medication is stopped, the risk slowly decreases over time. The big issue to remember here is that the breast cancer risk for a young woman in the general population is far less than the risk of pregnancy if they are sexually active. The risks versus benefits must be looked at on an individual basis. These medications also decrease the risk of uterine and ovarian cancers.
There are a few lifestyle choices that women can make that can decrease their breast cancer risk. Maintaining a healthy weight is very important. Your goal for body mass index (BMI) should be between 20 and 25. Adding exercise into your routine can also decrease your risk. As discussed in the last article, your goal should be 150 minutes per week of cardiac activity. Limiting alcohol intake can be beneficial. Studies show that women who drank more than two drinks per day had an increased risk of up to 20% for breast cancer. If you become pregnant, breastfeeding can also decrease your breast cancer risk.
So what has been shown NOT to increase your breast cancer risk? Hair dyes, abortions, miscarriages, plastics, breast implants, bras, deodorant/antiperspirant use, fertility drugs and breast trauma have not been linked to increased risks of breast cancer.
You should discuss your risk factors with your physician and come up with a plan for your breast health. Remember the importance of knowing your family history and of the yearly clinical breast exam done by your physician. Although genes play a large role in some breast cancers, a healthy lifestyle is very important in the prevention of breast cancer in your future.
Dr. Sarah J. Wistreich is a staff physician at the Center for Women’s Health at Capital Health located in Hamilton, NJ. You can follow her on Twitter: @DrWistreich
All information contained herein is the opinion and view of the writer. It is intended to provide helpful and informative material on the subjects addressed and is not meant to malign any company, organization, religion, ethnic group, or individual. Readers should consult their personal physicians or specialists before adopting any of the recommendations or drawing inference from information contained herein. The writer specifically disclaims all responsibility for any liability, loss, risk — personal or otherwise — incurred as a consequence, directly or indirectly, from the use and application of any material provided.