Cancer Prevention

Breast Cancer Video Presentation by Dr Gily

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Breast Cancer Risk Factors and Prevention

Some Breast Cancer Statistics

• breast cancer is the most common cancer among women
• breast canceris the second leading cause of cancer death in women
• 1 in 8 (13% of women) will develop invasive breast cancer
• 1 in 33 (3% of women) will die of breast cancer
• 178,480 new cases of invasive breast cancer will be diagnosed in 2007 among women in the United States
• over 2 million breast cancer survivors in the United States
• women living in North America have the highest rate of breast cancer in the world
• death rates from breast cancer are declining

Breast Cancer Risk Factors

Modifiable Risk Factors

1. Not having children
   • Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer
   • Being pregnant more than once and at an early age reduces breast cancer risk
2. Birth control pills
   • Studies have found that women now using birth control pills have a slightly greater risk of breast cancer than women who have never used them
   • Women who stopped using the pill more than 10 years ago do not seem to have any increased risk
3. Hormone replacement therapy
   • Long-term use (several years or more) of combined HRT (estrogens together with progesterone) after menopause increases the risk of breast cancer (as well as the risk of heart disease, blood clots, and strokes)
   • The BCs are also found at a more advanced stage, (HRT seems to reduce the effectiveness of mammograms)
   • Five years after stopping HRT , the breast cancer risk drops back to normal
4. Breast-feeding and pregnancy
   • Breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1.5 to 2 years
   • Having more children and breast-feeding longer could reduce the risk of breast cancer by half
5. Alcohol
   • Women 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
6. Obesity and high-fat diets
   • Being overweight is linked to a higher risk of breast cancer, especially
     • for women after menopause
     • if the weight gain took place during adulthood
   • Risk is higher if the extra fat is in the waist area
   • Women's Intervention Nutrition Study (WINS) study in 2005:
     • women who followed a low-fat diet experienced a 24 percent reduction in breast cancer recurrence risk
     • women on the low-fat diet whose breast cancer was not sensitive to the hormone estrogen (i.e., estrogen receptor-negative breast cancer) achieved a 41 percent reduction in their risk of cancer recurrence
7. Exercise
   • As little as 1 hour and 15 minutes to 2 and a half hours per week of brisk walking reduced the risk by 18% Walking 10 hours a week reduced the risk a little more

Non-Modifiable Risk Factors

1. Gender
   • breast cancer is 100 times more common in women
2. Age
   • 8 out of 10 breast cancers are found in women age >50 years of age
3. Genetic factors
   • responsible for 5% to 10% of breast cancers
   • most common genes affected: BRCA1 and BRCA2
     • Jewish women of Ashkenazi (Eastern Europe) origin, African-American and Hispanic women
     • Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes
4. Family history
   • higher risk is women whose close blood relatives have this disease
     • Having a mother, sister, or daughter with breast cancer about doubles the risk
5. Personal history of breast cancer
   • A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast
6. Race
   • White women are slightly more likely to get breast cancer than are African-American women
   • African American women are more likely to die of breast cancer
7. Abnormal breast biopsy
   • proliferative lesions without atypia double the risk of breast cancer
   • proliferative lesions with atypia increase the risk to 4-5 times
8. Previous chest radiation
   • Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer
   • Up to 12x increase in risk
9. Menstrual periods
   • Women who began having periods early (before 12 years of age) or who went through the menopause after the age of 55 have a slightly increased risk of breast cancer
10. Treatment with DES
    • Women treated with DES (and their daughters exposed to DES while in the uterus) have a slightly increased risk of getting breast cancer

Factors With Uncertain, Controversial, or Unproven Effect on breast cancer Risk

1. Antiperspirants
   • One small study recently found trace levels of parabens (used as preservatives in antiperspirants), which have weak estrogen-like properties, in a small sample of breast cancer tumors
   • A recent large study of breast cancer causes found no increase in breast cancer in women who used underarm antiperspirants
2. Underwire bras
   • no scientific or clinical basis
3. Induced abortion
   • no overall effect on the risk
4. Breast implants
   • silicone breast implants can cause scar tissue to form in the breast
   • make it harder to see breast tissue on standard mammograms
   • do not increase breast cancer risk
5. Environmental pollution
   • Currently, research does not show a clear link between breast cancer risk and exposure to environmental pollutants, such as the pesticide DDE (chemically related to DDT), and PCBs (polychlorinated biphenyls)
6. Tobacco smoke
   • Both mainstream and secondhand smoke contain about 20 chemicals that, in high concentrations, cause breast cancer in rodents
   • The evidence regarding secondhand smoke and breast cancer is "consistent with a causal association" in younger, mainly premenopausal women
7. Night work
   • Several studies have suggested that women who work at night may have an increased risk of developing breast cancer
   • More studies needed to confirm this
8. Soy (Isoflavones)
   • It has long been suggested that high soy intake among Asian women may be why they have a lower risk of breast cancer than American women
   • Phytochemicals (genistein) in soy increased breast cancer cell growth in laboratory animals
   • Possible mechanism of protection by soy:
     • When genistein is given to rats at the pre-pubertal stage, it appears to activate a tumor suppressor gene called BRCA-1. This gene can repair DNA damage and keep breast cancer from developing.
     • Genistein exposure before puberty can induce a process called differentiation. Breast cancer usually develops in specific cells - called terminal end buds - in the breast. However, early genistein exposure causes these cells to differentiate, meaning that they are converted to lobular-like structures that are less likely to give rise to malignant tumors. But if genistein is given later in life, it's probably too late for this differentiation process to be of any help. Instead, the breasts of older women are likely to have acquired precancerous cells. Genistein may make those cells grow and transform into breast cancer cells.
   • Read more about soy and breast cancer

Estimate Your breast cancer Risk

Early breast cancer Detection

Mammogram

• Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health
• While mammograms can miss some cancers, they are still a very good way to find breast cancer
• To find the mammogram facility nearest you, call 1-800-4-CANCER

Clinical Breast Exam (CBE)

• Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, preferably every 3 years
• After age 40, women should have a CBE by a health expert every year
• Have the CBE shortly before the mammogram - you can use the exam to learn what your own breasts feel like

Breast awareness and Breast Self-Exam (BSE)

• BSE is an option for women starting in their 20s
• Have your doctor or nurse check your method to make sure you are doing it right
• See your doctor right away if you notice any changes
• Don't rely on finding breast cancer yourself! Breast self-exams may be helpful, but they don't take the place of mammograms and clinical breast exams

Women at high risk

• talk with your doctor about the best approach
  • starting mammograms earlier
  • having extra tests
  • having more frequent exams
• A person who is considering genetic testing should talk with a professional trained in genetics before deciding whether to be tested. For more information on genetic testing or for a referral to centers that have health care professionals trained in genetics, call the National Cancer Institute's Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), or visit online at www.cancer.gov.

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