SIMEDHealth

Breast Cancer with Dr. Jenny Chen

October is Breast Cancer Awareness Month and ​Dr. Jenny Chen with SIMEDHealth Primary Care discusses the risk factors, diagnosis, and treatment for breast cancer.

 

 

1.) What are the risk factors for developing breast cancer? Does age, gender, or race affect risks?

 

Globally, breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer death in women, and in the US, it is the second leading cause of cancer death in women, trailing only lung cancer. While men can also get breast cancer, women are approximately 100 times more likely to get breast cancer than men. The highest breast cancer risk occurs among white women, although breast cancer remains the most common cancer among women of every major ethnicity and racial group. There are many other risk factors for breast cancer, including postmenopausal obesity, aging, family history, alcohol use, smoking, and menopausal hormone replacement therapy. In addition, earlier age at starting periods, and later age of menopause are also associated with an increased risk. Conversely, breastfeeding, increased physical activity and a diet rich in fruits, vegetables, fish and olive oil (Mediterranean diet) are associated with a decreased risk of breast cancer. Lastly, a meta-analysis showed dietary fiber intake was associated with a 12 percent relative risk reduction in breast cancer incidence.

 

2.) What are early signs of breast cancer?

 

A breast lump or mass is a common early sign of breast cancer. In countries with established breast cancer screening programs, most patients present due to an abnormal mammogram. However, up to 15 percent of women are diagnosed with breast cancer due to the presence of a breast mass that is not detected on mammogram. Other signs include breast skin changes such as dimpling and red discoloration, nipple retraction or inversion, localized pain or swelling, or enlarged axillary lymph nodes.

 

3.) Do self-breast exams make a difference in early diagnosis of breast cancer? What about breast exams by physicians?

 

Trials evaluating clinical breast examination (CBE) and breast self-examination (BSE), with or without mammography have not demonstrated efficacy in early cancer detection or improved outcomes. Therefore we no longer suggest using clinical breast examination (CBE) or breast self-examination (BSE) as part of screening of average-risk women. Screening CBE may be helpful, however, in resource-limited settings where there is limited mammogram imaging availability. Mammography is the recommended modality of breast cancer screening for the vast majority of women. The starting age and frequency of screening mammography depends on the individual’s risk, including genetic risk. No screening guideline recommends routine

screening for average-risk women (defined as less than 15 percent lifetime risk) who are under 40 years of age. Most United States expert groups encourage shared decision-making for women in their 40s for average-risk women, although European screening guidelines recommend starting screening at age 45. Regular mammograms are recommended for all women ages 50-75.

 

4.) 1 out of 8 women will develop breast cancer, and most of them survive the disease. What treatments are contributing to breast cancer survival?

 

Breast cancer mortality has dropped dramatically since the 1980s, and both earlier detection through screening and improvements in breast cancer treatment are responsible for this reduction in mortality. Medical treatment of breast cancer using endocrine therapy, and chemotherapy have increased the survival rates of breast cancer patients in the past few decades. For example, estrogen receptor-positive breast cancer patients benefit from the use of endocrine therapy with anti-estrogen drugs. More recently, advancement in genetic testing and immunotherapy are also transforming the way we treat breast cancer. Immunotherapy is a type of cancer treatment that helps our immune system fight cancer. These modern medical treatments, along with advances in surgical technique and radiation oncology equipment have helped more, and more women become breast cancer survivors.

Five Myths About Breast Cancer: Busted

October, most associated with pumpkins, and changing temperatures, is also commonly associated with the color pink for Breast Cancer Awareness Month. According to breastcancer.org, As of January of this year, 3.1 million women have a history of breast cancer in the United States. We talked to SIMEDHealth Gynecologist Dr. Linda Grover about some common myths that still surround this cancer despite the overwhelming amount of pink showcased this month.

1) Finding a lump in the breast means you have breast cancer.

Dr. Grover explains, "Approximately 90% of the palpable breast lumps found in women between the ages of 20-50 are not malignant.”

Breast cancer odds increase with age but what is critical for all ages is a prompt, professional evaluation. While most lumps are not cancer, it isn’t easy to determine this just by palpitations so it’s always a good idea to have them evaluated by your healthcare provider. Never let fear cheat you out of a good outcome. This is to say that if you feel a lump in your breast, don't make assumptions it’s nothing, get it checked out by your physician.

2) Breast cancer is only a women’s issue.

"Interestingly, some reports indicate breast cancer in men has been steadily increasing in frequency in the last 26 years. Most men with breast cancer do not have identifiable risk factors at diagnosis”, says Dr. Grover, “men with known BRCA2 mutations are a higher risk.” Although less than 1% of men receive a breast cancer diagnosis, any apparent breast lump should be evaluated. The classic presentation of breast cancer in a man is a painless firm mass beneath the nipple.

3) If you have a family history of breast cancer, you will get it too.

Having a family history of breast cancer is not a defining risk for developing breast cancer. According to Dr. Grover, "Only 5-10% of breast cancers in women are hereditary. Without any family history of breast cancer, 1 in 8 U.S. women will develop breast cancer. If a patient has one first degree relative (such as mother or sister) with the disease, her risk will increase about twofold. If two first degree relatives have breast cancer, the patient's risk will increase about threefold."

More distant relatives with breast cancer histories have less impact but are useful in formulating recommendations for genetic testing. Other risk factors exist, and it is wise to not only know your family history but how to protect yourself from breast cancer with a healthy lifestyle.

4) A mammogram can cause breast cancer to spread.

So many myths exist about mammograms. Dr. Grover explains, "Mammography screening decreases the breast cancer mortality rate by about 46%, according to studies done on hundreds of thousands of women and seven different statistical models. As multidisciplinary medical management, adjuvant treatment, and additional screening tests (MRI and ultrasound) emerge, these statistics will change and attribute decreased mortality to a broader combination of factors." However, there is no evidence, and under no circumstance should mammography be blamed for the metastasis of breast cancer. Earlier detection and better treatments save lives.

5) If the BRCA1 or BRC2 gene is in your DNA, you will get breast cancer.

“First, it is vital to explain that there is a difference between having the BRCA1/2 gene and having the BRCA1/2 mutation. Everyone has the BRCA1/2 gene, but only about 1 in 400 people have the mutation. Having the mutation carries the risk of developing cancer, but it does not mean you will definitely get it.”

Dr. Grover explains, "by age 70, these specific mutations carry a breast cancer risk of 55-70% for BRCA1 carriers and 45-70% for BRCA 2 carriers. Younger age patients (age30-40) are at risk of earlier-onset disease. Multiple other cancers are also linked to these mutations.

In light of these alarming rates of cancer, national guidelines recommend the removal of the tubes and ovaries by age 35-40 in BRCA 1 carriers and age 40-45 in BRCA2 carriers. Again, it should be noted that less than 10% of women with a familial history of breast cancer carry these specific gene mutations. Before making any decisions, please talk to your doctor about what option would be best for you if you are a BRCA1/2 mutation carrier.

 

Breaking down the myths and knowing the facts is essential to staying healthy and conscious of the signs from your body. Dr. Grover is a gynecologist physician in our Women’s Health Gainesville clinic. Click here to schedule an appointment with her!