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Is Breast Cancer Avoidable?

How To Assess Your Risk

By CARMEN MARTI

Some things are unavoidable, like death and taxes. Other things we can work to steer clear of, like many carcinogens. According to the American Cancer Society, "More than two-thirds of all fatal cancer cases can be prevented." Many of these cancers are the result of prolonged exposure to cancer-causing agents, such as high levels of radiation, too much sunlight, hormone-treated food or cigarettes. Avoiding those agents decreases a person's risk of getting cancer.

Cancer is the result of carcinogens causing certain cells to mutate. Once a body has propagated these mutations, it can not only develop cancer, but also pass abnormal cells along the DNA chain. Thus, cancer can be genetic.

It took researchers a long time to unravel those basic tenets of cancer, and they still have a lot to learn. But one thing that's gaining more understanding and an increased demand for research dollars is how to stop cancer from developing in the first place.

For years the war on cancer, as declared by President Richard Nixon in 1971, was fought with early detection and treatment. Now health experts are increasingly recommending behavior choices that can help reduce the risk.

"Everyone is at risk for cancer," says breast cancer specialist Dr. Marisa Weiss, founder and president of breastcancer.org. "But you can reduce your risk. We don't like to say prevent because we can't promise. Still, we know how to significantly reduce the risk of getting cancer."

We know smoking cigarettes can cause lung cancer; there has been a campaign against smoking for decades. But is it possible to avoid breast cancer? Doesn't it seem like a lot of women get it, and isn't it on the rise?

The answer is yes in all cases. Breast cancer is the leading cancer among women of all races and the second leading cause of cancer-related deaths among women (after lung cancer) in the United States. It's the most frequently diagnosed non-skin cancer among U.S. women.

Still, most experts agree that some cancers can be avoided. Not only are there tangible lifestyle choices a woman can make, there are medications and surgeries that can help prevent breast cancer from developing in women at the highest risk.

October is National Breast Cancer month. What follows is an outline of the risks and choices women face today:

Risk Calculation

It's never too early to adopt a cancer-fighting lifestyle, and the place to start is by assessing your current risk of breast cancer. At first this can feel dismal. According to Dr. Weiss, the biggest risk for breast cancer is "being a woman. Next is growing older."

These aren't avoidable, but other possible risk factors afford more control: Being overweight Long-term use of hormone replacement therapy (estrogen and progesterone combined) Use of oral contraceptives (although some argue this has no effect) Drinking alcohol Physical inactivity Milk from cows injected with growth hormones Meat from animals given hormones Genetic predisposition, such as certain mutations in BRCA1 or BRCA2 genes Older age at onset of menopause Older age at first birth Never breast feeding or minimal breast feeding Never having given birth Personal history of breast cancer or certain benign breast diseases Family history of breast cancer, especially in mother, sister or daughter Treatment with radiation therapy to the breast/chest during adolescence Older age Younger age at onset of menstrual periods Other breast conditions: lobular carcinoma in situ (LCIS) or atypical hyperplasi.

In addition to these risk factors, many experts believe that regular ingestion of hormones in food and ingesting hormone-mimicking environmental substances may increase the risk of cancer. Some also argue that prolonged exposure to carcinogenic household products and occupational hazards can increase the risk of breast and other cancers, as well.

To help assess where you are on this list of risks, the National Cancer Institute (NCI) has established a Breast Cancer Risk Assessment Tool. They use the following risk factors: personal history of breast abnormalities, current age, age at first menstrual period, age at first live birth, breast cancer history of close relatives, whether a woman has had a breast biopsy and race.

Personal history of breast abnormalities Two breast tissue abnormalitiesductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS)are associated with increased risk for developing an invasive breast cancer.

Age The risk of developing breast cancer increases with age. The majority of breast cancer cases occur in women older than age 50.

Age at menarche (first menstrual period) Women who had their first menstrual period before age 12 have a slightly increased risk of breast cancer.

Age at first live birth Women who had their first full-term pregnancy after age 30 and women who have never borne a child have a greater risk of developing breast cancer.

Blood Relatives Having one or more first-degree blood relatives (sisters, mother, daughters)who have been diagnosed with breast cancer increases a woman's chances of developing this disease.

Breast biopsies Women who have had breast biopsies have an increased risk of breast cancer, especially if the biopsy showed a change in breast tissue known as atypical ductal hyperplasia. This overgrowth of unusual looking breast cells goes along with increased risk of further abnormal cell action, NOT because of the biopsies themselves.

Race White women have greater risk of developing breast cancer than black women (although black women diagnosed with breast cancer are more likely to die of the disease).

The Breast Cancer Risk Assessment Tool gives an estimated risk. It is not accurate for women who are younger than age 20, whose family history of breast cancer comes from the father's side, who have already had a diagnosis of breast cancer or who are known to have specific alterations in breast cancer susceptibility genes (BRCA1 or BRCA2). There is also some doubt about whether women from other countries will have accurate results because the tool is based on U.S. women and their lifestyles.

You can visit an online risk calculator here.

Lifestyle

For nearly half a century, Dr. Samuel Epstein, professor emeritus of environmental and occupational medicine at the University of Illinois at Chicago, has called for cancer prevention through lifestyle choices. He has written books about the carcinogenic effects of environmental pollutants and certain consumer products. His titles include Safe Shopper's Bible, The Breast Cancer Prevention Program, The Politics of Cancer Revisited, Unreasonable Risk: How to Avoid Cancer from Cosmetics and Personal Care Products and the recent What's In Your Milk?, released by Trafford Publishing this year.

Dr. Epstein stresses that "cancer is avoidable." He says one of the greatest causes of breast cancer is the consumption of milk from cows injected with the growth hormone rBGH (recombinant Bovine Growth Hormone). Red meat is also high on his list of carcinogens, along wih non-organic fruits and vegetables because of potential exposure to pesticides. Stick to organics, he says. "You can feel much better with organic food, but it must be USDA certified. Otherwise it doesn't mean anything."

Dr. Weiss agrees that organic food is the way to go when possible. She also suggests bottled water if your water source has even trace contaminants. She urges people to think about what they eat, drink and breathe. "A lot of what you can control comes down to what you put in your mouth," she says. "Stick with organic food, low fat foods, limited alcohol, no smoking. These can add up to making a significant difference in breast cancer risk."

In Dr. Weiss's opinion, one of the biggest changeable breast cancer risks today is obesity. "Weight management is really important," she says. "It is the key to every other health issue. As we get heavier as a society, we will continue to see breast cancer rates rise."

Beyond Lifestyle

Scientists have long identified the genetic markers for breast cancerabnormal BRCA1 and BRCA2 genesand they can identify them through a blood test. But just because a woman carries abnormal BRCA1 and BRCA2 genes doesn't mean she'll get breast cancer. Some women who test negatively for BRCA1 and BRCA2 still get cancer. It's hard to predict who exactly will get breast cancer. What is predictable is exposure to risk. For women at high risk, medications are available that have the potential to inhibit cancerous tumor formation. Taking one of these medicines is called chemoprevention.

Tamoxifen, the first and only such FDA-approved drug, has been used for more than 30 years to reduce the incidence of breast cancer. Taken once a day, the pill interferes with the activity of estrogen, a female hormone that promotes the growth of breast cancer cells. It has been shown to reduce incidence of cancer by about 50 percent in high-risk women. It doesn't seem, however, to reduce mortality for women only marginally at high risk for breast cancer. Tamoxifen also carries rare, potentially fatal side effects such as stroke and endometrial cancer.

Because of tamoxifen's downsides, researchers are working hard to find alternative drugs to reduce breast cancer risk. For example, raloxifene, a drug approved by the FDA for the prevention and treatment of osteoporosis in postmenopausal women, is being studied for breast cancer prevention.

A large clinical trial has been conducted by the huge NCI and National Surgical Adjuvant Breast and Bowel Project (NSABP) trial since 1999. The Study of Tamoxifen and Raloxifene (STAR) was designed to compare raloxifene and tamoxifen in reducing incidence of breast cancer in postmenopausal women who are at an increased risk of developing the disease. Initial results of STAR show that raloxifene is as effective as tamoxifen. Participants in STAR who were assigned to take raloxifene also had slightly fewer serious side effects from that drug than participants assigned to take tamoxifen, including fewer uterine cancers and blood clots.

Preventative Mastectomy

Called prophylactic or risk-reducing mastectomy (RRM), preventative mastectomy is the surgical removal of one or both breasts in an effort to prevent or reduce the risk of breast cancer.

"This is a big step," says Dr. Weiss. "Surgery is the most permanent form of intervention. You can't undo it."

She says it's for women with a proven gene abnormality and a family history of breast cancer. "For these women, there can be significant benefit to mastectomy," says Dr. Weiss. "But some still chose not to do it. Women with an inherited gene abnormality may decide to remove the ovaries and leave the breast. We can detect breast cancer early; we're not good at finding ovarian cancer early."

Researchers have found a correlation between breast and ovarian cancer. The removal of the ovaries reduces the risk of breast cancer in pre-menopausal women. After menopause, Dr. Weiss says, removing the ovaries doesn't seem to have an impact on breast cancer.

Even women who have finished child-bearing should weigh the option of an ovariectomy, removal of ovaries. Although it can cause premature menopause, an ovariectomy can reduce breast cancer risk 50 to 60 percent; mastectomy reduces breast cancer by 90 percent.

Mammography

The only way to know if the precautions you take to avoid breast cancer are working is to stay alert to your body. Dr. Epstein, founder and chairman of the Cancer Prevention Coalition, contends that regular self-examinations are sufficient to detect breast cancer. However, most members of the medical community recommend regular mammograms in tandem with self-exams as the best way to find breast cancer early, when it's the most treatable.

The American Cancer Society's recommendation for mammograms is a baseline mammogram between the ages of 35 and 40 years. Between 40 and 50 years of age, mammograms are recommended every other year. After age 50 years, yearly mammograms are recommended.

When it's found early, breast cancer patients can have a 100 percent survival rate.

To find more information, visit the following websites:

Early Diagnosis is Key

Medical opinion emphasizes early detection and there are many diagnostic tools available to detect breast cancer at an early stage. The most important of these tools are at your fingertips: Regular self-exams and physician examinations are still the most important tests in early detection. Self-exams should be done every month. Mammograms are usually recommended every year for those over 50. Be sure to go to a hospital that does thousands of mammogramsthose with the newest low-dose technology and greatest expertise in evaluating images. Mammography has a 10 percent false-negative rate, which means it does miss finding cancer. This can happen when tissue appears dense. Magnetic resonance imaging (MRI) is being increasingly used in diagnosis following an unclear Xray, especially in high-risk womenthose who have had breast cancer or have a sister or mother who has. An MRI creates pictures of horizontal slices that the radiologist interprets. Ultrasound and ductography are also diagnostic tools used to complement mammogram screening for breast cancer. Surgical biopsies and newer image-guided biopsies using magnetic resonance are able to evaluate abnormalities. In the MRI biopsies, a local anesthetic is used, and they can be performed in an hour, leaving little or no scarring.

Breast Cancer in the News

Approximately 200,000 women in the United States are diagnosed with breast cancer every year, and 40,000 women will die of breast cancer. Now approximately 30,000 U.S. women will be using the drug Herceptin, that which may save the lives of 7,000 women. Herceptin targets the gene HER2, which causes a particular protein that is involved in about 20 percent of breast tumors. The drug, which costs roughly $48,000 a year, has been used to treat advanced cancer. Studies completed last year show the drug to be effective in early stages of breast cancer, too. Side effects of Herceptin may include heart failure. Specialists are hoping that drugs such as Herceptin, which target a specific genetic marker, may eventually replace more invasive conventional therapies such as chemotherapy and radiation.USA Today

For early-stage breast cancer, there is another treatment being tested for women who have had a lumpectomy. Unlike whole breast radiation, partial breast radiation uses radioactive seeds that are delivered in a series of treatments through catheters to the spot where the tumor was removed.Cure

A test named OncoPlan can predict the aggressiveness of a breast cancer's tumor and the relative risk of disease recurrence by measuring two "push pull" pathways important to each other in the development of aggressive cancer and may help to ensure that individual patients receive the most beneficial therapies.American Association for Cancer Research Home

Published: August 01, 2006
Issue: November 2006