Straight Answers on Breast Cancer
October 7, 2019
This month we join the Pink Wave and talk about breast cancer, but I hope not to rehash the same old lettuce. We will begin by answering some of the most frequently asked questions by women 55+. Since I am a gerontologist, and breast cancer is not an area I can speak about with authority, I went to an expert in the field, Dr. Claudia Harsh.
Claudia Harsh, MD is board certified in ob-gyn, was fellowship trained in integrative medicine through the University of Arizona and is trained in medical acupuncture. She worked in surveillance and survivorship at the Sammons Cancer Center in Dallas, Texas for Texas Oncology until December 2017 and now practices in Charlotte, NC.
Here are some of the most frequently asked questions about breast cancer at mid-life. Dr. Harsh’s answers are in italics.
- Can a woman get breast cancer from going through menopause?
I think this question is asking: does menopause increase our risk of getting breast cancer? We know that our risk of breast cancer increases as we age. About 95% of breast cancers occur in women over age 40. We also know our lifetime risk of getting breast cancer is 1 in 8 but if we break that down by decades it looks like this:
At age 30 we have a 0.44% or a chance of 1 in 227
At age 40 1.47% or a chance of 1 in 68
At age 50 2.38% or a chance of 1 in 42
At age 60 3.56% or a chance of 1 in 28
At age 70 3.82% or a chance of 1 in 26
But, these chances are averaged across all women of all ethnicities. Maybe the question we should be asking is “who doesn’t get breast cancer and why?” and that’s where a lot of the interest in lifestyle medicine and nutrition, can help change the conversation and the risk numbers.
- I don’t have a family history of breast cancer. Why did I get it?
About 10% of people who get breast cancer have a family history of the disease. (Or, put another way, 90% of people with breast cancer do NOT have a family history!) We’ve known for years that some families have an increased risk of breast cancer and once we analyzed the human genome (the genetic “book of life” that resides in our cells – one half from our mother and one half from our father), the first gene associated with breast cancer was BRCA1. This was identified in the early to mid 1990’s and has been shown to be a gene that codes for proteins that repair damaged DNA. For this reason, it is known as a tumor suppressor: if there is a mutation in this gene, it is unable to repair damage and the cell can grow and divide without control and form a tumor. This field of study is exploding with information – now there are dozens of genes that may impact our risk of breast, ovarian, endometrial or colon cancer (to name just a few!). Genetic counseling makes sense if cancer plays a strong role in your family. It is because of this that the term “previvor”[sic] has been developed for someone who found out they have a high risk genetic mutation and took proactive measures such as having a mastectomy or oophorectomy (removal of breasts or ovaries) to reduce their lifetime risk of the disease.
- What are the most important risk factors for breast cancer?
Again, this is an area that is exploding with information. I mentioned before that our risk increases with age. This implies that there is a hormonal association (post menopause vs. pre menopause). Another important risk factor is family history (genetic mutations) – accounting for approximately 10% of all breast cancers. Mammographic breast density is a risk factor. Women with denser breasts (more ducts, glands and connective tissue) have an increased risk of cancer mostly because the tumors are harder to see on mammogram. Personal history of breast cancer increases a woman’s chance of developing a recurrent cancer. Biopsy findings in the ducts can develop into cancer. Previous radiation therapy to the chest prior to age 30 for cancers such as Hodgkin lymphoma has been shown to be a risk factor. Reproductive/menstrual history: Starting menstrual cycles before age 12 and/or concluding menopause after age 55 are both associated with an increased risk of breast cancer. Long-term use (more than 5 years) of postmenopausal hormonal therapy is associated with an increased risk of breast cancer. Ethnicity may be a risk factor for breast cancer. To date more cancer is found in Caucasian women than in African American/black, Hispanic/Latina, Asian/Pacific Islander or American Indian/Alaska Native women. The degree to which this is due to increased screening in the white population is still being determined. Research continues into sleep cycles and their association with breast cancer incidence, nutrition, vitamin and nutritional supplementation (especially Vitamin D), and stress management.
- How does age at menopause effect breast cancer risk?
As mentioned before, our risk of breast cancer increases with chronologic age. Two strong factors are likely the culprits here – increased cell DNA damage over time and a change in our hormonal production. If we look at the hormonal question, we know that reproductive hormones estrogen and progesterone are produced by a woman’s ovaries and serve to stimulate cell growth in her breasts to prepare for nursing and her uterus to prepare for pregnancy. Anything that prolongs the duration and/or levels of exposure to this stimulation (late age at first pregnancy or never having given birth) increases breast cancer risk. On the flip side, anything that shortens the duration of exposure (pregnancy or breast feeding itself for example) reduces breast cancer risks. There is a theory that breast feeding causes the cells in the breast to change or differentiate and they then become more resistant to becoming transformed into cancer cells.
- Will breast cancer show up in a blood test or in blood work?
No. Although there are types of specialized testing that are designed to pick up circulating cancer cells, at this point there is no well-researched commercially available blood test to detect breast cancer. Having said this, there are several measurements called “tumor markers” that can be checked in someone with a cancer diagnosis. Examples such as CA27-29 or CA125 are markers that can be elevated in some cancers. It is the standard of care to measure a variety of markers at the time of diagnosis to see if the blood tests can be used to mark the presence or recurrence of disease. Similarly, some traditional blood chemistries such as calcium level, liver enzymes and electrolytes help point to the health of liver, kidneys and bone both at the time of diagnosis and throughout treatment.
In my next post we will return to answer more questions about breast cancer and some good news about prevention!
Until next time… Be Vibrant!