8 Frequently Asked Questions About Breast Cancer
Breast Cancer Awareness Month is the perfect time to examine common questions concerning the devastating form of cancer. About 12% (1 in 8) women are expected to develop invasive breast cancer over the course of her lifetime. In 2017, an estimated 252,710 new cases of invasive breast cancer are expected to be diagnosed among women in the U.S alone. Symptoms of breast cancer can include a lump in the breast, bloody discharge from the nipple, extreme swelling, skin changes and/or changes in the shape or texture of the nipple or breast. Oftentimes breast cancer will not present with any symptoms – making regular screening very important. Consequent treatment depends on the stage of cancer; which may consist of chemotherapy, radiation, and/or surgery.
Considering breast cancer’s high prevalence and distressful effects, let’s take a look at some frequently asked questions concerning breast cancer risk and related issues.
- Are there established risk factors that I cannot change or prevent?
Every woman wants to know what she can do to lower her risk for breast cancer; however, some factors can't be changed. Clearly, being a woman is the most significant risk factor for breast cancer. Also, as with other diseases, the risk of breast cancer goes up as one ages. Nearly 2/3 of all invasive breast cancer patients are women ≥ 55 years old. Genetics influence risk as well; about 5-10% of cases are thought to be caused by abnormal genes passed from parent to child. Although women who have a family history of are in a higher-risk group, most women who have breast cancer have no family history. Along the same lines, if a person has already been diagnosed with breast cancer, she/he is 3-4 times more likely to develop breast cancer again. There are also differences based on race/ethnicity. White women are slightly more likely to develop breast cancer than African American, Hispanic, and Asian women. However, African American women are more likely to develop more aggressive, advanced-stage breast cancer at a younger age. Finally, other influences related to endocrine activity such as starting menstruation younger than age 12 or going through menopause after age 55 can increase risk later in life. The number of menstrual cycles a woman has over their lifetime influences their risk.
- Can exercise reduce the risk for breast cancer?
Exercise boosts the immune system and helps maintain a healthy bodyweight. With as little as three hours of exercise per week (e.g., 30 minutes a day) a woman can gradually lower her risk – this can include aerobic or anaerobic training. Research shows moderate-to-intense exercise for 4-7 hours per week is optimal. The potential weight loss aspect of exercise is synergistically beneficial due to the correlation between obesity and the risk for cancer. Recent research has shown obesity to promote aggravated spreading of the cancer to other tissues such as the lungs (especially after menopause).
- Can a healthy diet help to prevent breast cancer?
The role of dietary factors in breast cancer causation is not completely resolved. Results from prospective studies do not conclusively support fat intake having a major relation to breast cancer risk. Nonetheless, weight gain during middle life contributes substantially to breast cancer risk so moderation of fat intake is still advised. Even though no specific food or diet can prevent you from getting breast cancer, a clean low-fat diet rich in fruits and vegetables can boost the immune system and help keep risk as low as possible. All processed foods, well-done grilled meats which contain carcinogens, as well as various chemicals, antibiotics and hormones found in food/beverage products may have an impact on cancer risk in general.
- Does smoking or drinking contribute to my risk breast cancer?
Smoking and second-hand smoke exposure are confirmed risk factors for many types of cancer, including breast cancer. Smoking also directly contributes to heart/lung diseases that are linked to a higher risk of breast cancer among premenopausal women. Some research also has shown a link between very heavy second-hand smoke exposure and greater risk among postmenopausal women. As it relates to alcohol, moderation is key. A recent report by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF) found strong evidence that drinking the equivalent of a small glass of wine or beer a day increases pre-menopausal breast cancer risk by 5% and post-menopausal breast cancer risk by 9%. Having more than one drink per day has shown to be a more significant risk factor, and the alcohol content does not matter: wine, beer or a mixed drink. Alcohol can increase levels of estrogen and other hormones associated with hormone-receptor-positive breast cancer. Alcohol also may increase breast cancer risk by damaging DNA in cells. Interestingly, drinking one glass of wine a day has also been shown to offer heart-health benefits in some studies. Therefore, most experts recommend limiting oneself to 1-3 drinks per week.
- What kind of impact does stress have on breast cancer?
Recent research has shown that stressful traumatic events and losses can alter immune system strength which may allow cancer cells greater opportunity to grow and spread. It is suggested that it is not necessarily the traumatic event but how one reacts to these types of events. However, there is no clear definitive proof that stress and anxiety can explitictly increase breast cancer risk. Regardless, anything one can do to reduce stress and enhance daily comfort, joy, and satisfaction can have a major effect on quality of life. Stress management techniques and relaxation exercises such as meditation, yoga, visualization exercises, and prayer may be valuable additions to a stressful routine. Some research suggests that these types practices can strengthen the immune system and overall resilience to stress.
- Is there a link between oral contraceptives or hormone replacement therapy (HRT) and breast cancer?
Yes. Essentially, limiting one’s exposure to excess estrogen is key to reducing breast cancer risk; just like excess testosterone expedites prostate cancer risk among men. Because the estrogen stimulates breast cell growth, exposure to estrogen over long periods of time can potentially increase one’s risk. Birth control pill use for longer than 5 years might increase risk, but due to the low quantities of hormones in contemporary medications the risk remains relatively small. Taking a one-year break every 5 years may be implemented to reduce this risk. HRT was added to the carcinogenic list by the American Cancer Society in the early 2000s, so it is recommended that women with known risk factors not use HRT to control menopausal symptoms. Safer alternatives should be sought out.
- Are there any other environmental risk factors to consider?
There are a few other potential environmental risk factors to consider; with the exception of radiation exposure these are not conclusively proven but investigations are currently ongoing:
- Radiation exposure to the face or chest before age 30 to treat another cancer, such as Hodgkin's disease or non-Hodgkin's lymphoma, increases breast cancer risk.
- Some research suggests that low levels of vitamin D increases risk. Vitamin D may play a role in controlling normal breast cell growth and may prohibit cancer growth. Sunshine and supplements can be used to increase Vitamin D synthesis/intake.
- More evidence is needed but several studies indicate that women who work night shifts, such as factory workers, doctors, nurses, and police officers, have a higher risk of breast cancer compared to women who work during the day. The studies show this causation may be due to a number of factors and the night shift work usually needs to be prolonged (at least 10 years) to create a notable shift in risk.
- Exposure to chemicals in various cosmetics/hygiene products, lawn and garden products such as pesticides, plastic products that contain BPAs (e.g., water bottles) and sunscreen have all been allegedly associated with an increased risk for cancer. Again, in most cases more data is needed to make a definitive conclusion.
- How often should I do a breast self exam (BSE) or be clinically examined?
A BSE should be performed once a month after the age of about 20. Look for any changes in size, lumps, dimpling or puckering of the breast, inversion of the nipple, redness or scaliness of the skin, or discharge from the nipple. If a persistent lump or any changes are discovered, see a physician immediately. Most lumps are benign but all require evaluation to rule out cancer. A yearly physical including a clinical breast and pelvic exams is also important starting in the early 20s.
The answers to the previous common questions will hopefully help lead women of all ages in the right direction for limiting their overall risk for breast cancer. There are various factors outside of one’s control but much personal risk can be mediated by healthy lifestyle decisions related to exercise, nutrition, stress, alcohol, smoking and environmental exposures.