[Wellness] Facts about Breast Cancer

["Karen Patterson" <Patterson@womens-wellness.com>]

Because the causes and cure of breast cancer are not yet fully known, many
people have misconceptions about the disease.  During this month in
particular I think it is important to state the facts:

While the risk of breast cancer increases with age, all women are at risk
for getting breast cancer.

Most women who get breast cancer have no family history of the disease.
However, a woman whose mother, sister, or daughter had breast cancer has an
increased risk.

Just because you do not have a mutated BRCA@ or BRCA2 gene, you can still
get breast cancer.  About 90 to 95 percent of women who get breast cancer
actually do not have an inherited form of breast cancer, or a mutated BRCA1
or BRCA2

The majority of women diagnosed with breast cancer have no known risk
factors outside their gender.  All women are at risk.

>From American Cancer Society:

Family history of breast cancer: Breast cancer risk is higher among women
whose close blood relatives have this disease. Your risk of developing
breast cancer is increased if:

You have 2 or more relatives with breast or ovarian cancer.

Breast cancer occurs before age 50 in a relative (mother, sister,
grandmother or aunt) on either side of the family. The risk is higher if
your mother or sister has a history of breast cancer.

You have relatives with both breast and ovarian cancer.

You have 1 or more relatives with two cancers (breast and ovarian, or 2
different breast cancers).

You have a male relative (or relatives) with breast cancer.

You have a family history of breast or ovarian cancer and Ashkenazi Jewish
heritage.

Your family history includes a history of diseases associated with
hereditary breast cancer such as Li-Fraumeni or Cowdens Syndromes.
Having 1 first-degree relative (mother, sister, or daughter) with breast
cancer approximately doubles a woman's risk, and having 2 first-degree
relatives increases her risk 5-fold. Although the exact risk is not known,
women with a family history of breast cancer in a father or brother also
have an increased risk of breast cancer. Altogether, about 20% to 30% of
women with breast cancer have a family member with this disease.

Personal history of breast cancer: A woman with cancer in one breast has a
3- to 4-fold increased risk of developing a new cancer in the other breast
or in another part of the same breast. This is different from a recurrence
(return) of the first cancer.

Race: White women are slightly more likely to develop breast cancer than are
African-American women. But African-American women are more likely to die of
this cancer. Many experts now feel that the main reason for this is because
African-American women have more aggressive tumors (see basal-like breast
cancer, below). The reasons for this are not known. Asian, Hispanic, and
Native American women have a lower risk of developing and dying from breast
cancer.

Previous abnormal breast biopsy: Women whose earlier breast biopsies
detected any of these changes have a slightly higher risk of breast cancer
(1.5 to 2 times greater than other women):

fibroadenoma with complex features
hyperplasia without atypia
sclerosing adenosis
multiple papillomas
Atypical hyperplasia (ductal or lobular) increases a woman's breast cancer
risk by 4 to 5 times.

Having a biopsy specimen diagnosed as fibrocystic changes without
proliferative breast disease or fibroadenoma does not affect breast cancer
risk.

Previous breast radiation: Women who as children or young adults have had
radiation therapy to the chest area as treatment for another cancer (such as
Hodgkin disease or non-Hodgkin lymphoma) are at significantly increased risk
for breast cancer. Some reports found the risk to be 12 times normal risk.
This varies with the age of the patient at the time of radiation. Younger
patients have a higher risk. If chemotherapy was also given, the risk may be
lowered if the chemotherapy stops ovarian hormone production.

Menstrual periods: Women who started menstruating at an early age (before
age 12) or who went through menopause at a late age (after age 55) have a
slightly higher risk of breast cancer.

Diethylstilbestrol (DES): In the 1940s through the 1960s some pregnant women
were given diethylstilbestrol because it was thought to lower their chances
of losing the baby. Recent studies have shown that these women have a
slightly increased risk of developing breast cancer.

Lifestyle-Related Factors and Breast Cancer Risk

Not having children: Women who have had no children or who had their first
child after age 30 have a slightly higher breast cancer risk. Having
multiple pregnancies and becoming pregnant at an early age reduces breast
cancer risk.

Oral contraceptive use: It is still not certain what part oral
contraceptives (birth control pills) might play in breast cancer risk.
Studies have suggested that women now using oral contraceptives have a
slightly greater risk of breast cancer than women who have never used them.
Women who stopped using oral contraceptives more than 10 years ago do not
appear to have any increased breast cancer risk. When considering using oral
contraceptives, women should discuss their other risk factors for breast
cancer with their health care team.

Hormone replacement therapy: It has become clear that long-term use (several
years or more) of hormone replacement therapy (HRT) after menopause,
particularly estrogens and progesterone combined increase your risk of
breast cancer. They may also increase your chances of dying of breast
cancer.

If you still have your uterus (womb), doctors generally prescribe estrogen
and progesterone (known as combined HRT). Estrogen relieves menopausal
symptoms and delays osteoporosis (thinning of the bones that can lead to
fractures). But estrogen can increase the risk of developing cancer of the
uterus. Progesterone is added to help prevent this.

If you no longer have your uterus, estrogen alone can be prescribed. This is
commonly known as estrogen replacement therapy (ERT). This probably does not
increase the risk of breast cancer very much, if at all.

Several large studies, including the Women's Health Initiative (WHI), have
found that there is an increased risk of breast cancer related to the use of
combined HRT. The most recent results from the WHI found that not only did
combined HRT increase breast cancer risk, but it also increased the
likelihood that the cancer would be found at a more advanced stage. This is
because it appeared to reduce the effectiveness of mammography, as more
abnormal findings on mammograms were noted. A large study from the United
Kingdom has now found that women who took the combined therapy were also
more likely to die of breast cancer than women who didn't.

The risk of HRT appears to apply only to current and recent users, and a
woman's breast cancer risk seems to return to that of the general population
within 5 years of stopping HRT.

Estrogen alone (ERT) does not appear to increase the risk of developing
breast cancer. In fact, a separate part of the large WHI study found that it
may slightly decrease the risk (although it was linked to an increased risk
of stroke).

At this time there appear to be few strong reasons to use hormone
replacement therapy (combined HRT or ERT), other than possibly for the
temporary relief of menopausal symptoms. In addition to the increased risk
of breast cancer, the WHI found that combined HRT also increased the risk of
heart disease, blood clots, and strokes, and did not have a beneficial
effect on mental function or preventing Alzheimer's disease. It did lower
the risk of colorectal cancer and osteoporosis, but this must be weighed
against the possible harms, and with the understanding that there are other
effective ways to prevent osteoporosis. And, as noted above, while ERT did
not seem to have much effect on the risk of breast cancer, it did increase
the risk of stroke.

The decision to use hormone replacement therapy after menopause should be
made by the woman and her doctor after weighing the possible risks
(including increased risk of heart disease, breast cancer, strokes, and
blood clots) and benefits (relief of menopausal symptoms, reduced risk of
osteoporosis), and considering each woman’s other risk factors for heart
disease, breast cancer, osteoporosis, and the severity of her menopausal
symptoms.

Breast-feeding and pregnancy: Some studies suggest that breast-feeding may
slightly lower breast cancer risk, especially if breast-feeding is continued
for 1.5 to 2 years. Other studies found no impact on breast cancer risk.

The explanation of this may be that both pregnancy and breast-feeding reduce
a woman's total number of lifetime menstrual cycles. This may be similar to
the reduction of risk due to late menarche (start of menstrual periods) or
early menopause, which also decrease the total number of menstrual cycles.
One study concluded that having more children and breast-feeding longer
could reduce the risk of breast cancer by half.

Alcohol: Use of alcohol is clearly linked to an increased risk of developing
breast cancer. The risk increases with the amount of alcohol consumed.
Compared with nondrinkers, women who consume 1 alcoholic drink a day have a
very small increase in risk, and those who have 2 to 5 drinks daily have
about 1½ times the risk of women who drink no alcohol. Alcohol is also known
to increase the risk of developing cancers of the mouth, throat, and
esophagus. The American Cancer Society recommends limiting your consumption
of alcohol.

Obesity and high-fat diets: Obesity (being overweight) has been found to be
a breast cancer risk in all studies, especially for women after menopause.
Although your ovaries produce most of your estrogen, fat tissue produces a
small amount of estrogen. Having more fat tissue can increase your estrogen
levels and increase your likelihood of developing breast cancer.

The connection between weight and breast cancer risk is complex, however.
For examplerisk appears to be increased for women who gained weight as an
adult but is not increased among those who have been overweight since
childhood. Also, excess fat in the waist area may affect risk more than the
same amount of fat in the hips and thighs. Researchers believe that fat
cells in various parts of the body have subtle differences in their
metabolism that may explain this observation.

Studies of fat in the diet have not clearly shown that this is a breast
cancer risk factor. Most studies found that breast cancer is less common in
countries where the typical diet is low in total fat, low in polyunsaturated
fat, and low in saturated fat.

On the other hand, many studies of women in the United States have not found
breast cancer risk to be related to dietary fat intake. Researchers are
still not sure how to explain this apparent disagreement. Many scientists
note that studies comparing diet and breast cancer risk in different
countries are complicated by other differences (such as activity level,
intake of other nutrients, genetic factors) that might also alter breast
cancer risk.

More research is needed to better understand the effect of the types of fat
eaten and body weight on breast cancer risk. But it is clear that calories
do count and fat is a major source of these. A diet high in fat has also
been shown to influence the risk of developing several other types of
cancer, and intake of certain types of fat is clearly related to heart
disease risk. We recommend you maintain a healthy weight and limit your
intake of red meats, especially those high in fat or processed.

Physical activity: Evidence is growing that physical activity in the form of
exercise reduces breast cancer risk. The only question is how much exercise
is needed. In one study from the Women’s Health Initiative as little as 1.25
to 2.5 hours per week of brisk walking reduced a woman's risk by 18%.
Walking 10 hours a week reduced the risk a little more.


I am asked about risk factors often by friends and acquaitances so I thought
it very important to share with you.
My best for health and wellness,
Karen Patterson, Founder of Womens-Wellness.com and a breast cancer survivor

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