Breast Cancer Prevention

What can I do to prevent the occurrence of breast cancer?

serenity and yoga practicing at sunset, meditation

Unfortunately, breast cancer affects all people, regardless of age, sex, race, or religion.  Breast cancer is caused by many factors, of which many are beyond our control.  When we think about breast cancer prevention, we are really addressing what, is in our control, that we can change, to lower our risk.

Breast cancer prevention are defined by the CDC as: “action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.”


Smoking Cessation

Tobacco use is the most common preventable cause of death. About half of the people who don’t quit smoking will die of smoking-related problems. Quitting smoking is important for your health.

In cancer treatment, smoking has major implications to treatment:

Surgery

Smoking and its contents cause damage to small blood vessels. That is why heavy, long term smokers have skin changes, and a ‘tone’ to the appearance of their skin. Wound healing is affected by these changes, as the healing process depends on good blood flow. In breast cancer surgery, where reconstruction is an options, a history of smoking will ultimately affect the cosmetic outcomes, and, options available. Not to mention the risks of anesthesia, which are also higher in smokers.

 

 

Chemotherapy

Chemotherapy is delivered by the blood stream. As small blood vessels are damaged, their ability to carry blood (and the chemotherapy) is impaired. So, it is theorized that the effectiveness of chemotherapeutic agents in decreased in smokers.  Soon after you quit, your circulation begins to improve, and your blood pressure starts to return to normal. Your sense of smell and taste return, and it’s easier for you to breathe. In the long term, giving up tobacco can help you live longer. Your risk of getting cancer decreases with each year you stay smoke-free.

Quitting is not easy

You may have short-term affects such as weight gain, irritability, and anxiety. Some people try several times before they succeed. There are many ways to quit smoking. Some people stop “cold turkey.” Others benefit from step-by-step manuals, counseling, or medicines or products that help reduce nicotine addiction. Your health care provider can help you find the best way for you to quit.

(Much of this information is taken from the NIH: National Institute of Health)


 

What Can I Do to Reduce My Risk?

Breast cancer is not a preventable disease. However, you can help lower your risk of breast cancer in the following ways:

  • Get screened for breast cancer regularly.
  • Keep a healthy weight.
  • Exercise regularly (at least four hours a week).
  • Limit alcoholic drinks to no more than one per day.
  • If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you.
  • Breastfeed if possible.
  • If you plan to have children after age 30, talk to your doctor about your cancer risk.
  • If you have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you may have a higher breast cancer risk.

Talk to your doctor about these ways of reducing your risk:

  • Antiestrogens or other medicines that block or decrease estrogen in your body.
  • Surgery to reduce your risk of breast cancer
  • Prophylactic (preventive) mastectomy (removal of breast tissue).
  • Prophylactic (preventive) salpingo-oophorectomy (removal of the ovaries and fallopian tubes).

Environmental Influences … or Myth?

Sunlight … good:  vitamin D levels are positively influenced by sunlight/sunshine.  Vitamin D increases calcium absorption in bone and helps regulate cell growth … both favorable affects.  Vitamin D inhibits TACE protein, which is known to activate processes that exacerbate tumor growth, metastases and inflammation, which is why vitamin D is an important supplement in breast cancer patients.

Radiation … bad: related to dose, eg. radiation for Hodgkin’s disease, especially in younger women, pose an increase risk for developing breast cancer.  The risk of high exposure doses of radiation, however, diminishes drastically for women > 35 years.  Radiation does not induce cancers in most women.  Exposure to 2 Gy (200 rads) to the breast is needed to double a women’s risk of breast cancer (0.2 rads/mammogram).  Mammography screening is associated with a 19% overall reduction in breast cancer mortality: 15% decrease in women in their 40s and 32% reduction in women in their 60s.

Air Pollution … bad: related to Total Suspended Particulates (TSP) & Polycyclic Aromatic Hydrocarbons (PAH).  PAH are found in cigarette smoke, steel mills, foundries, automobiles, coal combustion, grilled meats, and forest fires.  Most of these environmental hazards, slightly increase the risk of post-menopausal breast cancer.

Deodorant … not bad … or is it?: two studies have been performed to directly address the issue of underarm cosmetic use and breast cancer.  Neither study confirms a cause/affect of the deodorant and breast cancer development.  There are increasing numbers of component chemicals in cosmetics that are known to possess estrogenic activity.  The active antiperspirant agent is aluminum salts, which has a known genotoxic profile.  The use in antiperspirants is dependent on the inability of these complexes to be absorbed.  However, there has been dermal absorption demonstrated through intact human skin of the underarm, and aluminum was measured in human breast tissue at greater levels in outer quadrants than inner.  Exactly what the consequence is of this, warrants further investigation.

I have a lot of menopausal symptoms and really need estrogen replacement, is it safe?

Women who took estrogen alone as hormone therapy for their menopause experienced decreased rates of breast cancer and death from the disease even after they stopped taking the therapy, while postmenopausal women who took estrogen with progestin experienced increased breast cancer rates, according to long-term follow-up results from two large, randomized, placebo-controlled Women’s Health Initiative (WHI) trials.

The new data, presented at the 2019 San Antonio Breast Cancer Symposium (SABCS), included 27,347 postmenopausal women aged 50 to 79 years with no prior breast cancer, enrolled in one of two randomized clinical trials that took place at 40 different centers in the United States between 1993 and 1998, with follow-up taking place over more than 19 years, through September 2016.

In total, 8,506 postmenopausal women with an intact uterus received conjugated equine estrogens (CEE) with medroxyprogesterone acetate (MPA), while 8,102 women received a placebo treatment. Both groups received their treatment for a median of 5.6 years.

Postmenopausal women who had undergone a hysterectomy received CEE alone (5,310) or placebo (5,429) for a median of 7.2 years.

Among those who only received CEE – the estrogen-only group – 520 cases of breast cancer were diagnosed after 16.1 years of follow-up. These women were 23% less likely to have been diagnosed with breast cancer and 44% less likely to die from the disease when compared with women who had received placebo.

In the group that received both estrogen and progestin (CEE with MPA), there were 1,003 diagnoses of breast cancer after 18.3 years of follow-up, for a 29% increased risk of diagnosis versus those on placebo. This group also saw an increased risk for death from breast cancer in the extended analysis, but this finding did not reach statistical significance.

“Women who are considering estrogen alone should know it’s safer and that there may be a breast cancer benefit associated with its use. I think women considering estrogen plus progestin have a little bit more of a difficult dilemma, because they have to be willing to accept an increased 20-year, and even a lifetime, breast cancer risk,” he said. “Having said that, for a woman with limited symptoms…the absolute risk is very small”  according to Dr. Roman Chlebowski, chief of the Division of Medical Oncology and Hematology at Harbor-UCLA Medical Center, and an investigator at The Lundquist Institute.