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Monday, June 20, 2011

“B” for Breast Cancer

By Laura Corio, MD

breast cancer illustrationI

n the United States, the most common female cancer is breast cancer. It is also the second most common cause of death from cancer in women. Because 50% of breast cancer cases can be attributed to risk factors and another 10% to family history, we are able to identify the women most at risk and screen them more closely, thereby decreasing their risk.

So let us talk about risk factors and see what we can alter.

Age and gender are strong risk factors for breast cancer. A very small percentage of men will get breast cancer, and the incidence of breast cancer increases with age. Women should be encouraged to be screened late in life.  Unfortunately, neither of these risk factors can be altered.

Race seems to also play a strong part. White women in the US have the highest rate of breast cancer. However, black women suffer from more aggressive tumors. Again, we have no control over this particular risk factor.

In the past, breast biopsies have shown that atypical cells increase a woman’s risk for breast cancer. Women who show dense breasts on their mammograms are also at increased risk for breast cancer. Having had breast cancer puts a woman at risk for a recurrence.

Family history of breast cancer is an important factor for breast cancer risk. The BRCA 1 and the BRCA 2 genes are strong genetic mutations that will increase the chance of having breast cancer at an early age (before 50). Also, being of Ashkenazi (East European) Jewish descent will increase your risk for breast cancer.

But there are lifestyle and dietary factors that can be modified to decrease the risk.

Weight is a really important factor to the postmenopausal woman. Higher body mass index and postmenopausal weight gain increase a woman’s risk for breast cancer. A woman who has a BMI of more than 33 is 27% more likely to get breast cancer than a woman with a BMI of less than 21. Losing about 22 pounds will lower your risk, Regular physical activity can help women protect themselves from breast cancer. Engaging in, say, fast walking for 10 hours or more per week can benefit women immensely.

Drinking alcohol has definitely been shown to be a risk factor and the more one drinks, the higher the risk. I always say, “one drink is good for the heart, but two drinks are bad for your breasts”.

Other factors that seem to help decrease the risk: eating olive oil, sticking to a low-fat diet that includes monounsaturated and polyunsaturated fats, complex carbohydrates and minimal red meat.  Taking Vitamin D and CoQ10 may also help lower your risk. Soy is still controversial, so I advise eating no more than what is in a  standard Asian diet — 20 grams per day.

Hormone replacement therapy is considered a risk factor for breast cancer. A lot of women take hormones during their perimenopausal and early menopausal years for menopausal symptoms. After five years on hormones, the treatment should be reevaluated by both the patient and physician. Do the benefits outweigh the risks at this point? Now, I am a great believer in bioidentical hormones, but estrogen is still part of the makeup of these hormones. The longer one stays on hormones, the higher the risk for breast cancer. I let my patients stay on natural progesterone without worrying. But Provera, a progestin, has been shown to increase the risk of breast cancer after it has been taken for seven years (as part of HRT therapy).

Breastfeeding for a least six months may decrease breast cancer risk. With every 12 months of breastfeeding, a reduction of 4.3% was seen for breast cancer risk.

Birth control pills do not increase breast cancer risk later in life. This is wonderful to hear, because mothers of teen patients tend to be concerned about the long-term risks when the gynecologist places their daughters on birth control pills at an early age, usually because of irregular bleeding or severe cramping.

Finally, if a woman can control for this, she should try to have a baby at a younger age. Having a first baby before age 25 will decrease a woman’s risk by 10% and having a baby before 35 decreases her risk by 5%. Unfortunately, having a first baby later in life puts a woman at greater risk for breast cancer because of perimenopausal breast changes from hormones of pregnancy.

So we have now seen some of the risk factors for breast cancer that any woman can try to lower. In conclusion, please do not delay screening for breast cancer because “breast cancer doesn’t run in my family”. We are all at risk. Regular mammography screening — along with yearly breast exams by your physicians, breast sonograms, and MRI’s of the breast –  could lower your risk of dying from breast cancer.

Photo: iStockphoto

Posted by: Laura Corio, MD at 9:34 am


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