Breast Cancer Awareness

As October is Breast Cancer Awareness Month, it’s a good time to review information about this topic. Spreading awareness is especially important to me as the daughter of a breast cancer survivor. 

Cancer, of all kinds, is when the body’s cells grow out of control. While most breast lumps are not cancerous and do not become cancerous, monitoring changes is still important. Breast cancer starts in breast tissue (often in the lobules or ducts) and can spread through the blood or lymph system. When cancer spreads to other parts of the body (becomes metastatic), it becomes harder to cure. 

While skin cancer is the most prevalent cancer in women, breast cancer is the second and accounts for 30% of new female cancers annually. One in eight American women are diagnosed with breast cancer during their lifetime and over 42,000 women die because of it every year. After lung cancer, it is the second most fatal form of cancer in women. The mortality risk is especially high for women under 40 or older than 75 years old. Fortunately, the overall death rate of breast cancer has steadily been dropping over the past 35 years, due to earlier detection technologies (like mammograms) and more effective treatments. There are over 4 million breast cancer survivors in the US alone. 

KNOWN BREAST CANCER RISK FACTORS 

Like all cancers, breast cancer does have risk factors, both those we can control and those we cannot. Here are some lifestyle factors that can increase your risk of breast cancer: 

1. Drinking alcohol. One drink a day increases your risk by 10%, while 2-3 increases it by 20%. 

2. High levels of certain hormones. There is a strong hormonal component to most breast cancers. If you are injecting insulin or using systemic estrogen (oral or patch), using higher levels of these hormones can increase your chance of breast cancer. 

3. Some forms of birth control. While oral contraceptives can slightly increase your risk, it decreases back to baseline levels after 10 years off of the pill. However, it is unclear if other forms of birth control like shots (like Depo Provera) or IUDs increase your risk of breast cancer. 

4. Menopausal hormone therapy. There is a possible increased risk from combined (estrogen and protestogen) therapy, but there is no associated risk from estrogen-only therapy for women without a uterus. This data is from older studies on synthetic hormones, and there is not adequate research on bio-identical hormone replacement therapy to determine its risk. 

5. Smoking cigarettes. The more cigarettes a woman smokes, the higher her risk of breast cancer. Smoking both introduces cancer causing compounds to her body and weakens her immune system, making it harder for her body to correct DNA damage that leads to cancer. 

There are other breast cancer risks that cannot be changed. They include: 

1. Being born female. While those who are born male can develop breast cancer, it is rare. Transfeminine people on estrogen have a higher breast cancer risk than cisgender males but lower than cisgender women. 

2. Aging. Breast cancer is more common in women older than 55. 

3. Having a first degree relative who was diagnosed. If you have a mother, sister, or daughter who has had breast cancer, your breast cancer risk doubles. 

4. The presence of specific genes. BRCA1 and BRCA2 are genetic mutations that make it harder for cells to repair damaged DNA. As damaged DNA has a higher risk of producing cancer, these genes increase the risk of multiple types of cancer (such as ovarian, prostate, pancreatic as well as breast). 

5. Certain demographics. White women are more likely to have breast cancer than black women, but so are taller women as compared to shorter women. 

6. Having dense breasts. As there is more tissue available, there is a higher chance of some of it becoming cancerous. 

7. Starting your period before 12 years of age. 

8. Starting menopause after 55 years of age. 

9. Having a history of chest radiation. 

REDUCING YOUR BREAST CANCER RISK 

There are several myths about breast cancer. One of them is that if you do not have a family history of breast cancer, then you will not have it either. However, only about 10% of breast cancer cases are inherited; most women are the first in their family to be diagnosed. Other false links to breast cancer are the use of antiperspirants and bras, as well as a pregnancy loss (either due to a miscarriage or an abortion). 

Alternatively, here are some factors that may decrease your risk of breast cancer: 

1. Being physically active. Exercise helps keep your body in balance. Ideally, you should exercise at a moderate level for over 5 hours each week. Still, at least 2.5 hours of moderate activity or at least 1.5 hours of vigorous activity each week will reduce its risk. 

2. Having children. Having more than one child, and having your first child before age 30, can further reduce your risk. 

3. Breastfeeding your children, especially if it is for longer than a year. 

4. Maintaining a healthy weight. What that looks like varies person to person; generally, eating healthy foods and exercising reduces both metabolic disease (like hypertension and diabetes) and cancers. There is also evidence that women who eat more vegetables from the cabbage family (cruciferous vegetables like broccoli, kale, and cauliflower) have lower rates of breast and colon cancers due to compounds like indole-3-carbinol that modifies estrogen metabolism and inhibits tumor growth. 

BREAST CANCER DETECTION 

Mammograms can help identify breast cancer. According to the US Preventive Services Task Force, women should have mammograms every two years between the ages of 40 to 74. If you are at a higher risk, it is advised to get mammograms once a year. 

While many women fear mammograms because of radiation exposure, the radiation exposure from mammograms is minimal. Mammograms expose women to 0.4 millisieverts of radiation. In comparison, an abdominal CT scan exposes patients to 10 millisieverts. A three hour plane ride exposes you to 0.1 millisieverts; a roundtrip flight from Los Angeles to New York City exposes you to the equivalent radiation of one mammogram procedure. 

There are additional breast imaging techniques. If there are areas of the breast that are unclear on mammogram, an Automated Breast Ultrasound (ABUS) can help. It is a 3D imaging technology that is used in addition to a mammogram that can help examine denser areas of the breast that do not show up clearly on a mammogram. When there is an area that is poorly visualized, it is common to repeat a more detailed mammogram (“diagnostic mammogram”) and add an ultrasound. Women at high risk of breast cancer often have MRIs of the breast as well. 

Advances in both imaging and treatment mean that a diagnosis of breast cancer no longer carries the grim prognosis that it did for our grandmothers. When detected at early stages, breast cancer has a survival rate of over 90%. Treatments are more targeted, less disfiguring, and much more successful than in the past. Early detection and modern treatments save lives. My own mother, now 87 years old, has been living breast cancer free for 16 years.