Site Updated : 27 December, 2009

The Young Academic, by John Arthur Lomax (b. 1857, d. 1923).

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 Of Interest~

Taking Care

 A Proactive Approach to Breast Cancer Prevention For High Risk Women

by Rebecca Sweat

Breast cancer. What other words strike as much fear in women’s hearts? With one in eight women developing the disease, chances are, you or someone you know will be affected by breast cancer.

The American Cancer Society estimates that about 213,000 women in the United States will be diagnosed with invasive breast cancer this year. They estimate that another 40,970 women will die from breast cancer during the same12-month period. Breast cancer is second only to lung cancer as a cause of death for women, and it’s the leading cause of death for women between the ages of 35 and 54.

What’s worse, for some women, the risk of developing breast cancer is even greater than normal. Researchers have studied general patterns of breast cancer in the population to learn what factors may increase our chances of developing the disease. Although some of the risk factors for cancer can’t be avoided, there are some things you can do about others.

Funmi Olopade, MD, director of the Cancer Risk Clinic at the University of Chicago Medical Center, says the two most important risk factors are age and having a family history of breast cancer. “In terms of age, a high-risk factor would be any woman over age 60,” she says. “A family history of breast cancer would be if you have at least two first degree relatives (mother, maternal grandmother, daughters or sisters) with the disease.”

When breast cancer runs in families, often it’s a matter of a faulty gene being passed down to the generations. All of us—men and women alike—are born with BRCA1 and BRCA2 genes (BRCA stands for “breast cancer”); mutations in either one of the genes are related to development of the disease. In other cases, when breast cancer runs in families, it’s not a BRCA 1 or 2 mutation that’s inherited, but some other type of genetic defect which can lead to breast cancer.

So what if your mother had breast cancer and also had an inherited mutation in BRCA 1 or 2 gene or some other genetic flaw—does that mean you’ve inherited the faulty gene? Maybe, but not necessarily, says Sharon Goldish, MD, medical director at the Center for Breast Health at Swedish Covenant Hospital in Chicago. “You get half your genes from your father and half your genes from your mother, so you have a 50-50 chance of inheriting that mutation,” she explains. Of course, even if your mother’s side of the family doesn’t have the faulty gene, you could still inherit the BRCA mutation if it’s on your father’s side of the family, Goldfish added: “If women on your father’s side are affected with breast cancer, you can inherit it from your father’s side even if your father doesn’t display the trait himself. On the converse, even if your mother or her side of the family has it, you may not have inherited the gene.”

Even if you do carry the faulty gene, however, that doesn’t mean you are definitely going to do develop breast cancer. The BRCAs are basically breast cancer susceptibility genes. Those with the gene have somewhere between a 37 percent and 85 percent lifetime risk of developing breast cancer, according to Olopade.

In addition to age and family history, there are other risk factors associated with an increased risk of developing breast cancer. Previous history of other cancers such as ovarian, colon, uterine; the presence of atypical hyperplasia on breast biopsy; radiation to the breast at a young age; beginning to menstruate at an early age; starting menopause at a later age; having your first child after the age of 30—all increase a woman’s risk of developing breast cancer.

If a number of the above factors describe you, you will be at greater risk of developing breast cancer than the female population as a whole. But the key word here is “risk.” Whether or not you actually develop the disease may depend to a great degree on what steps you do—or don’t—take.

Although there are no guarantees of total protection against breast cancer, it’s important to take whatever precautions you can to try to lower your odds of getting the disease. Here are some strategies from cancer experts:

* Exercise regularly

Exercise, especially in young women, may decrease hormone levels and contribute to a decreased breast cancer risk. A recent study of women matched for age at onset of menstruation, race, number of children born, history of breast feeding, and family history of breast cancer, found that the risk of breast cancer decreased as the number of hours of exercise increased. Those women who exercised four hours a week—or 35 minutes a day—had over 50 percent less breast cancer than sedentary women. The physical activities considered as exercise in the study included participation on a sports team, dance or exercise classes, swimming, gymnastics, workouts at gyms, running/jogging, and walking for exercise.

Researchers believe that exercise protects against breast cancer by reducing the frequency of menstrual cycles or by reducing the length of the luteal phase (the latter part of the menstrual cycle). This in turn leads to a reduction in the cumulative exposure to progesterone and estrogen. There is now strong evidence that breast cancer risk is directly related to the cumulative exposure to ovarian hormones.

* Watch your weight

Avoiding obesity is another important step in preventing breast cancer. “Obesity is harmful because fat cells produce estrogen in addition to what the ovaries also produce,” notes David Elbert, MD, founder of Whole Health Chicago, one of the country’s largest centers of integrative medicine, and assistant professor of medicine at Rush Medical College. While some estrogen is necessary for strong bones and a healthy heart, excessive amounts increase your risk for breast cancer.

* Modify your diet

A low-fat, high-fiber diet can go a long way in decreasing your risk of breast cancer, Elbert says. “Women who are frequently constipated, which is often a result of low-fiber diets, may be more apt to get breast cancer as well as colon cancer, he notes. The rationale behind this, he says, is that “when you are constipated, the toxins found in food have more time to be absorbed in your body and the effects of these toxins are not limited just to the colon.”

He recommends foods rich in vitamins A, C and E, and suggests five to six servings of fresh fruits and vegetables a day. Whenever possible, you should avoid foods that are notoriously high in hormones, he says. “Look for milk or dairy products that say no added hormones on the package, and try to buy hormone-free meats,” advises Elberg. While the effects of hormones in meat and dairy products have not yet been proven safe or unsafe, he says you shouldn’t take any chances and should reduce every possible exposure to carcinogens.

Include a high-potency general multiple vitamin in your diet, as well as an antioxidant supplement, Elberg adds. A good antioxidant may include a combination of any of the following ingredients: green tea extract, grape seed extract, lipoic acid, and coenzyme Q10. “The current thinking on antioxidants is a variety is better than taking a single antioxidant,” he says. “If you take a single antioxidant, it actually seems to block the absorption and the effect of the others. So taking a variety seems to have a better impact.”

Elberg also recommends that women who are at high risk for breast cancer take a supplement called calcium d-glucarate (available in health food stores). “Calcium d-glucarate helps the liver process excess estrogen in your body, and by reducing the excess estrogen, it apparently reduces your breast cancer risk,” he says.

* Limit alcohol intake

Various studies over recent years have linked the consumption of alcoholic beverages with an increased risk of breast cancer. Even moderate drinking may be too much. Your risk of breast cancer rises 11 percent if you regularly have one drink a day, 24 percent with two drinks and 40 percent with more than two, according to research by Lenore Kohlmeier, a professor of epidemiology and nutrition at the University of North Carolina at Chapel Hill. You don’t need to avoid alcohol altogether, though. Limit yourself to three drinks a week, Kohlmeier recommends.

* Consider medication

The drug tamoxifen has been shown to reduce breast cancer by 50 percent in a study of high-risk women—specifically those whose mother or sister got breast cancer, those who have never been pregnant, and those who have had pregnancies in their 30s or later.

Tamoxifen is a drug that blocks the effect of estrogen on breast cancer cells. It has been used for more than 20 years to treat patients with advanced breast cancer. It has also been used as adjuvant, or additional, therapy following surgery or radiation therapy for early stage breast cancer.

But taking tamoxifen as a tool to prevent breast cancer is not without risks. The drug may increase the risk of getting some other serious diseases, including endometrial cancer, stroke, and blood clots in veins and in the lungs. Women who are concerned that they may be at an increased risk of developing breast cancer should talk with their doctor about whether to take tamoxifen to prevent breast cancer.

“It is important for each individual to consider both the benefits and risks of taking tamoxifen for breast cancer prevention,” says Kathy Albain, MD, professor of medicine at Loyola University Medical Center in Maywood, Illinois. “What’s right for one woman may not be for another.” For instance, if a woman has a very strong family history of heart disease and stroke and her risk level for breast cancer is just at that borderline level, tamoxifen may not be right for her. However, Albain said, “the woman who is at a much higher risk—who, for example, has many family members with breast cancer and has no problems in her family with stroke or blood clot, then for her the balance tips strongly towards using the drug. It has to be an individual decision.”

* Explore genetic counseling

If breast cancer seems to run in your family, you may want to consider genetic testing. “The benefit of testing is knowing for sure whether or not you have inherited a mutation,” Olopade says. “If you find out you haven’t inherited the gene, this would be very reassuring. If you do have the gene, knowing you do will allow you to think about preventive options and feel more empowered to do something about the risk, rather than just be like a sitting duck.”

The main reason many people don’t want to get genetically tested, Olopade adds, is that they are concerned about genetic discrimination. “Sometimes people worry that if they get tested and find out they have the gene, that it will become a preexisting condition with their insurance company,” she says. So far, such worries seem be unfounded, according to Opolade. She knows of no case where someone had been genetically confirmed to be at risk for breast cancer and was as a result categorized as having a preexisting condition with her insurance company.

“There are federal laws and laws in many states that try to at least clarify the language to say that because you are at risk doesn’t mean you have a preexisting condition,” Opolade explains. “With the human genome project we are all going to have several genes that don’t work right and by the time we start discriminating, everybody is going to be uninsurable.”

One other aspect of genetic testing that’s important to point out is that testing is only available for the BRCA 1 and 2 mutations. “Understand that most women who develop breast cancer don’t have the breast cancer gene. They have some other genetic problems that lead to breast cancer, but it’s not what we can test for in the blood with BRCA 1 and 2,” Albain says. So even if you “passed” the test for BRCA 1 and 2, you could still have inherited some other genetic mutation in your DNA that makes you more susceptible to breast cancer, and there presently is no test for this.

* Consult your physician
Talk to your doctor about methods of preventing breast cancer that might be effective for you. Get his or her perspective regarding what your risks are in getting the disease. “Many cancer centers such as ours now have multidisciplinary teams where women can make an appointment and come in and talk with medical professionals from several specialties at the same sitting about their risks of getting breast cancer in the future, as well as the preventions open to them now,” says Albain.

Following cancer risk assessment and counseling, the removal of both breasts (prophylactic mastectomy) may be an option for women with a strong family history of breast cancer. For women who are finished childbearing, the removal of one or both ovaries (hysterectomy) can also reduce the risk, since hormones produced by the ovaries appear to increase a woman’s risk for developing breast cancer.

“Right now, prophylactic mastectomy is primarily considered in a discussion with women at extremely high risk of breast cancer, such as those with known mutations in one of the breast cancer genes,” Albain says. “That is the ultimate prevention step to take and it is an option for only a few. But for those women with the breast cancer gene mutation who have watched many family members get diagnosed with breast cancer, they’d often rather lose both of their breasts and have nice reconstruction, rather than live in fear, wondering when it will be their turn.”

Studies show that women who do under prophylactic mastectomies have an over 90 percent chance of preventing breast cancer. “There’s still a small chance that breast cancer could develop because it could occur in a little bit of the breast tissue that is left behind,” Goldish says. “As thorough as we try to be as surgeons, it’s impossible to remove every tiny bit of breast tissue, even in the very best of hands. And breast cancer can develop in any cell that’s left behind.”

Finally, keep in mind that even if you’re at high risk for breast cancer, that doesn’t necessarily mean you’re going to develop the disease. Doctors don’t always know why one person develops breast cancer and someone else doesn’t. But they do know that a proactive approach to your health is always the best choice.

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Rebecca Sweat is a freelance magazine journalist specializing in health, pets and family topics. She lives in the Dallas/Ft. Worth area with her husband and two sons.