More Answers From Dr. Claudia Harsh

breast cancer prevention

I am ending this month by returning to our expert, Dr. Claudia Harsh, who offers us all more good information about breast cancer and women 55+.

Q. Can breast cancer ever be cured? What is the percentage of return if contracted before menopause? After menopause? 

Dr. Harsh: Using the word “cure” is problematic because it doesn’t answer the question of WHY the cancer developed in the first place. A better way to look at this is “what do we know about preventing breast cancer recurrence?”

The number of breast cancer survivors in the United States continues to increase. A review article quoted that there were 2.5 million breast cancer survivors in the United States in 2012 and showed the number expanded to 3.4 million in 2015. This is happening because of improved early detection, improved chemotherapy options both during treatment and after treatment is completed, and a better understanding of hereditary breast cancer with the use of proactive “prophylactic” surgeries.

If breast cancer is detected before menopause, we know there is an increased risk of a second cancer – whether it is in the same breast in the same location (considered a recurrence) or in a different location in the same breast or in the opposite breast (considered a second primary cancer) over that patient’s lifetime.

Why is this? Again, as I said before, one of the biggest risk factors is age. Increasing age will increase the risk of cancer. The percentages of recurrence or, a second primary cancer, is difficult to pin down. We know that one in five women will develop either a recurrence or, a second primary cancer, after completion of five years of post-treatment adjuvant therapy (tamoxifen for example).

Breast cancer recurrence rates are related to:

  • The initial stage of cancer (how far it had spread) 
  • The type of breast cancer or grade (what the cells look like or what part of the breast tissue is involved)
  • The family history or presence of a gene associated with increased risk
  • Other treatment related factors such as radiation therapy
  • Post treatment anti-estrogen therapy
  • The use of granulocyte colony-stimulating factors (such as Neupogen™, Granix™ etc.) during treatment 

BUT NOW let’s talk about what we know that reduces the risk of recurrence!

L.J has covered the most important tips for breast cancer prevention in her blog post these last few weeks, so to recap: 

  • Increasing good carbohydrates (fruits, vegetables, legumes, beans/lentils, whole grains, and natural soy products) and good fats (flaxseed, omega-3 fatty acids and nuts) are associated with improved survival.
  • Conversely, decreasing animal protein such as beef and pork along with trans-fats used in fried food will decrease your risk.
  • Increased exercise of 30 minutes, five days a week is protective.
  • Stress management techniques such as heart rate variability training (HeartMath™), meditation and decreasing body weight to less than 30 kg/m2 is protective.
  • Avoiding tobacco use completely (both smoking and “vaping”) and limiting alcohol consumption to one drink/day is also protective. 

Q. Are there any symptoms to watch for? 

Dr. Harsh: Screening for breast cancer comes down to knowing your body and taking advantage of the technology that exists for screening.

Watch for a lump in the breast or chest wall or armpit area. I often use the analogy of a grain of rice dried and stuck to the countertop when I teach women to detect their own cancer with their fingertips.

Cancer is often (but not always) fixed or “stuck”, irregular to touch and associated with a skin dimple where it is pulling on the supportive ligaments of the breast. Nipple retraction, nipple discharge either clear or bloody, redness, scaling or thickening of the nipple can also be found. A rash on the breast that is unresponsive to antibiotics should be evaluated.

Symptoms of recurrence can be new-onset localized bone pain, persistent chest pain, persistent cough, persistent abdominal pain, unintended weight loss, persistent headache, personality changes, new-onset seizures or loss of consciousness. 

Q. Does contracting breast cancer before menopause increase the risk of getting it again after menopause? 

Dr. Harsh: The short answer is yes. Cancer incidence increases with age – likely due to a cumulative effect of cell damage and less efficient repair.

Q. Breast cancer rates are increasing. Why? Is that for both pre- and post-menopausal women?

Dr. Harsh: Actually, the risk of being diagnosed with breast cancer in the United States began decreasing in the year 2000 after increasing for the previous two decades. The risk dropped by 7% from 2002 to 2003.

One theory is that this decrease was partially due to the reduced use of hormone replacement therapy by women after the results of the large study called the Women’s Health Initiative that showed a connection between hormone therapy use (specifically conjugated equine estrogen or Premarin™ and synthetic progestagens Provera™) that was published in 2002. 

Reasons for the increased rates in the 1980’s and 90’s is likely related to improved screening techniques and increased numbers of women receiving screening.

Q. Is post menopausal breast cancer hereditary? 

Dr. Harsh: Although post-menopause breast cancer can be hereditary about 10% of the time, most women with a genetic mutation causing breast cancer develop the tumor statistically earlier in their lives.

I am very grateful to Claudia for her thoughtful answers to some of the most pressing questions women have regarding breast cancer. I hope you have found them helpful; I know I have.

Until next time…Be Vibrant!