Breast cancer is the most feared health problem for women. In a previous blog, I’ve pointed out that women experience more deaths each year from heart disease and strokes than breast cancer. I’ve given you specific data on the absolute risk of breast cancer.
For more information read my post on Relative Risks of Breast Cancer
In this series I want to give you information on ways to prevent breast cancer. My philosophy toward optimal health embraces the concept of engaging patients in their own health because it encourages patient responsibility and accountability.
In medical school, I acquired important clinical skills but it’s from my patients that I learned about life. I learned that one’s perception of life’s challenges can motivate you or paralyze you. As I listen to my patients’ stories, I am in awe of the power of the human spirit and its capacity to overcome adversity. This internal life force makes an individual struggle to get healthy instead of passively becoming a victim. The patients I see who do the best are those who are “fighters.”
Kathy and Les Kerr are personal friends. Kathy, a dancer, gymnast and exercise enthusiast, passed away from breast cancer on July 7th, 2010 but only after a five and one-half year fight during which she inspired her family and friends with her positive, courageous attitude. Kathy’s friends created Kathy’s Divas to provide their support. Les designed a symbol that depicts Kathy’s strength and determination as she faced her disease. I challenge you to adopt this same proactive attitude toward practicing self-care preventive measures. With the right support, your body has an amazing capacity for self-healing. Les has graciously offered the Kathy’s Divas symbol to represent this concept. To inspire and empower women everywhere, I want to dedicate this series as a tribute to Kathy’s fighting spirit.
Marina Johnson, M.D., F.A.C.E.
Considering Breast Cancer: Risk Factors (Mostly) Not Under Your Control
With regard to breast cancer risks, there are factors that are not within your control and those which are modifiable. The latter are the areas where you can have the most impact. Besides being female, the most important risk factor for breast cancer is increasing age. This is understandable because as your immune system ages, it becomes less effective at protecting you against cancer. The widely touted figure of one in eight women having a “lifetime” risk of developing breast cancer does not apply until a woman reaches the age of 85. On the other hand, the chance of never having breast cancer by 85 is seven in eight.
The life-long cumulative exposure of the breasts to estrogen caused by early onset of periods and later menopause is a factor that increases the risk of breast cancer. Having a first pregnancy by age 25 confers a protective effect on the breast and lowers a woman’s risk of breast cancer by 10 percent. However, the general trend is for American women to marry later, and early pregnancy is often not an option. A 2007 study found the relative risk of developing breast cancer in post- menopausal women with dense breasts was 400% higher than in women with fatty, non-dense breast tissue. It used to be thought that the risk of dense breasts was simply a reflection of higher levels of circulating estrogen. However, this study showed that women with dense breasts who also had higher levels of circulating estrogen or testosterone had a 200% further increase in risk of breast cancer suggesting these are two independent factors.
Family History & BRCA
A positive family history of breast cancer is seen in only 15 to 20% of women with breast cancer. The risk is increased if there are multiple first-degree female relatives with breast cancer or if the relative’s cancer occurred before age 40. BRCA are breast cancer genes which pose no risk to a woman when they function normally. If however, the genes transform to BRCA-1 or -2 mutations, cancer risk increases. Although less than 10% of all breast cancers are linked to these genetic mutations, women with these mutations are at very high risk for breast cancer.
According to 2005 guidelines issued by the US Preventive Services Task Force, the following family history patterns are associated with an increased risk of BRCA-1 or -2 mutations: For non-Ashkenazi Jewish women, these patterns include 2 first-degree relatives with breast cancer, 1 of whom received the diagnosis at age 50 years or younger; a combination of 3 or more first- or second-degree relatives with breast cancer regardless of age at diagnosis; a combination of both breast and ovarian cancer among first- and second-degree relatives; a first-degree relative with bilateral breast cancer; a combination of 2 or more first or second-degree relatives with ovarian cancer regardless of age at diagnosis; a first or second-degree relative with both breast and ovarian cancer at any age; and a history of breast cancer in a male relative. For women of Ashkenazi Jewish heritage, an increased-risk family history includes any first-degree relative (or 2 second-degree relatives on the same side of the family) with breast or ovarian cancer.
A blood test to detect BRCA genetic mutations is available but the US Preventive Services Task Force recommends referral for genetic counseling before BRCA testing.
Women with positive BRCA genetic mutations are advised to have clinical breast exams every six months and yearly mammograms. Surveillance for ovarian cancer includes yearly transvaginal ultrasounds and measuring cancer antigen (CA)- 125 blood levels.
Preventive mastectomy (removal of healthy breast tissue) – reduces breast cancer risk by 90% and removal of ovaries reduces ovarian cancer risk by 90%.
While these risks are generally not modifiable, knowing them may enter into your decision about whether to take HRT. It also will make you more diligent about addressing the factors that you can change and monitoring for early detection.
COMING TOMORROW: RISK FACTORS YOU CAN MODIFY TO DECREASE YOUR RISK- CLICK HERE
RECAP CONSIDERING BREAST CANCER -REDUCING YOUR RISK BLOG SERIES
The content of this blog series is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. This blog series may discuss nutritional products and protocols that have not been evaluated by the U.S. Food and Drug Administration. These products or the information contained on this website is not intended to diagnose, treat, cure or prevent any disease. All website content is © Copyright 2012 by Marina Johnson MD – All Rights Reserved
Excerpt from “Outliving Your Ovaries” © 2012 by Marina Johnson MD.
Dr. Johnson has no financial conflicts of interest or ties to any pharmaceutical company.
Her only objective is determining the most effective, safest therapy for patients.