Reducing the Risk
Today, women have a 13% risk — or 1 in 8 — of developing breast cancer in their lifetime. For men, that risk is exponentially lower at about 1 in 800.
October is National Breast Cancer Awareness Month and a time for women to know their risk factors and what they can do to minimize their chances of developing breast cancer. It is also a time to recognize how Baystate Health’s Rays of Hope (ROH) has supported researchers to delve into salient questions around what makes an individual susceptible to breast cancer.
“Every woman is at some risk for breast cancer, with the biggest risk being her age. Women who are 50 or older account for over 70% of all breast-cancer diagnoses. While some risk factors can be reduced simply by lifestyle changes, others cannot be changed. Not everyone with risk factors will develop the disease, and many women with no known risk factors still get breast cancer,” said Dr. Grace Makari-Judson, associate director of Cancer Services at Baystate Health and co-director of the Rays of Hope Center for Breast Cancer Research.
Rays of Hope scientists, clinicians, and advocates have prioritized questions around why some women develop breast cancer and others don’t. The ROH Breast Research Registry includes a tissue repository, overseen by Dr. Sallie Smith Schneider, that provides a unique opportunity to study these questions.
While some risk factors can be reduced simply by lifestyle changes, others cannot be changed. Not everyone with risk factors will develop the disease, and many women with no known risk factors still get breast cancer.”
Estrogen is one key to the development of breast cancer. It can cause damage to DNA, which in turn may lead to cancer. Dr. Joseph Jerry, co-director of the Rays of Hope Center for Breast Cancer Research, and collaborators have studied estrogen exposure from the environment and how individuals respond differently. Specifically, they studied exposure to propylparaben and benzophenone-3 (compounds used in cosmetics and sunscreens) and how individual tissues differed in their sensitivity to these environmental estrogens.
Dr. Jerry often asks why seven out of eight women do not get breast cancer. What protects these women? ROH researchers have looked at genomic polymorphisms — small changes in an individual’s DNA that may lead to variable responses to both one’s own estrogen and environmental estrogen exposures. The search to understand what protects some women and to identify women who may be more vulnerable is a recurring theme.
As the research continues to move forward, prevention and screening are key. “If women pay attention to their lifestyle, such as eating a healthful diet, exercising regularly, limiting alcohol intake, not smoking, and maintaining a close to ideal body weight after menopause, their breast-cancer risk could be reduced by 30% to 40%,” Makari-Judson said.
“We do know that women who have regular screening mammograms reduce their risk of death from breast cancer,” she added. “While noting breast-cancer screening does not prevent breast cancer, studies have shown women undergoing regular screening reduce their risk of dying from breast cancer by 60%.”
Makari-Judson offers the following 10 ways to reduce the risk of being diagnosed with breast cancer:
- Avoid weight gain after menopause. Although obesity throughout life has its health risks, weight gain after menopause is specifically associated with a higher risk of breast cancer. After menopause, women may tend to lose muscle mass and gain belly fat. Weight gain after menopause appears to especially be concerning in women who are not taking hormone replacement.
- Exercise started anytime in life reduces risk. Rigorous exercise in the premenopausal years can reduce the risk of breast cancer by 72%. Even moderate exercise, as little as one or two hours per week, can reduce risk in postmenopausal women by 18%.
- Limit alcohol. It doesn’t matter what type — beer, wine, or hard liquor — the more alcohol consumed, the higher the risk. Some women may be especially susceptible as they may metabolize alcohol differently, leading to higher risk with lesser amounts.
- Don’t smoke. Although smoking impacts less on breast-cancer risk than other cancers, it is still a contributing factor, especially in women who started smoking before age 20 or five years before their first pregnancy.
- Breastfeed your children. Cumulative nursing time of at least one year reduces risk of premenopausal breast cancer. Having children prior to age 30 also reduces risk, but this may not be a practical suggestion for many.
- Minimize estrogen use after menopause. Studies show a higher risk of breast cancer with higher doses, the combination of estrogen and progesterone, and more prolonged use. Consider estrogen replacement if you have bothersome menopausal symptoms for a few years, but try not to stay on indefinitely.
- Know your family history. You can’t pick your family members, but you should know about any medical conditions they may have had and at what ages they were affected. Find out if relatives have had breast cancer, especially any men with breast cancer, ovarian cancer, pancreatic cancer, or metastatic prostate cancer. If so, ask your doctor for information about genetic counseling and testing. There are specific risk-reducing strategies for women who may have inherited susceptibilities.
- Know your breast density. Half of all women undergoing screening mammography have breast tissue described as ‘heterogeneously or extremely dense.’ This may be related to estrogen exposure, family history, or other factors and may warrant a personalized approach to screening.
- If you have had a breast biopsy, know the result. Certain benign breast conditions can be associated with higher risk of breast cancer. Breast biopsy results described as ‘atypical’ generally are associated with a 15% to 20% lifetime increase in risk of breast cancer. Women with these types of benign breast disease may be considered high-risk.
- Know if you are high risk and consider a medication for breast-cancer prevention. One way breast-cancer risk can be assessed is by computerized models which take into account risk factors, benign breast disease, and family history. Tamoxifen, aromatase inhibitors, or raloxifene (Evista) taken for five years reduce the risk of breast cancer in high-risk women by 50%.
Dr. Makari-Judson recommends that anyone with any risk factors for developing breast cancer should talk to their doctor about ways to lower those risks and a personalized plan for breast-cancer screening.