I’m often asked if there are preventive steps people can take to cut their breast cancer risk. And the answer is yes!
For starters, avoid hormone-replacement therapy and get mammograms and other screenings as recommended by your doctor.
But you can also protect yourself with lifestyle changes — maintaining a healthy diet and body weight, getting exercise, and drinking alcohol in moderation or not at all.
According to the latest statistics, one in eight women will develop breast cancer in her lifetime. The American Cancer Society estimates that more than 250,000 American women will be diagnosed with an invasive breast cancer this year, as will about 2,400 men.
While the mortality associated with breast cancer has decreased, the disease still claims more than 40,000 lives a year in the United States.
Breast cancer is characterized by a solid tumor that originates in the tissue of the breast as the result of DNA mutations. And we are increasingly realizing that breast cancer is not just one disease — there are multiple subtypes, which have different causes and require different treatments.
A host of factors contribute to your risk of breast cancer. While some DNA mutations can be inherited at birth, the majority are acquired later in life. That’s why age is the No. 1 risk factor for breast cancer. The longer you live, the more opportunity there is for the DNA of your breast tissue to develop a mutation. The most common age of diagnosis is 65.
We’ve also discovered that breast cancer risk is tied to certain other health factors: Being obese or overweight, living a sedentary lifestyle, not having given birth to children, and taking hormone-replacement therapy are all risk factors for breast cancer, as is excessive alcohol intake.
According to the American Cancer Society, women’s risk increases by 20% or more if they consume more than one alcoholic drink a day. For a small number of patients, having a history of radiation to the chest wall is also a contributing factor.
While most women do not have an inherited form of breast cancer, those who have a strong family history can be at much higher risk. In these cases, including people who have inherited the BRCA1 or BRCA 2 gene, additional screening, genetic testing, and sometimes preventive treatment is recommended, like having a mastectomy even before cancer is found.
Most of the time, breast cancer does not cause symptoms until the disease is quite advanced. For that reason, we aim to detect the cancer long before symptoms, like discharge, swelling, or a lump, appear. Most women should begin to receive annual mammograms at age 40. Higher-risk patients, especially women with a mother or sister who had cancer at an early age, may start getting mammograms much earlier.
There are two main pathways to diagnosis. Either screening picks up an abnormality, or the patient or health care provider discovers a lump. Either way, the first step is further imaging, followed by a biopsy that takes a tissue sample from the suspicious area.
If the tumor is malignant, we first determine whether it is early-stage or advanced. Then, the patient and doctor will discuss her treatment options.
For most patients, treatment for breast cancer will follow a multimodality approach that includes some combination of surgery, radiation, and systemic treatments — which affect the entire body — like anti-estrogen therapy, chemotherapy, antibodies, and, more recently, immunotherapy.
Usually, the first step will be removing the tumor, either via lumpectomy (surgery that removes only the affected tissue and a surrounding margin) or mastectomy (which removes the entire affected breast).
The doctors will also evaluate the axillary, or armpit, lymph nodes to make sure the cancer cells have not spread.
After surgery, the course of supplementary treatments will depend on which of the three subtypes of breast cancer the woman has. The most common is the estrogen-receptor-positive and/or progesterone-receptor-positive subtype, which has been stimulated by hormones in the patient’s body.
We treat cancers in this subtype by changing the hormonal environment, usually with a drug like tamoxifen or an aromatase inhibitor.
The second subset is called HER2-positive breast cancer, in which patients have an overabundance of the HER2 receptor on the outside of their cancer cells. The excess HER2 receptors can lead to the cancer cells’ uncontrolled growth. We can treat these cancers with antibody treatments like Herceptin and Perjeta. The third subtype is called triple-negative breast cancer, due to the absence of estrogen, progesterone, and HER2 receptors. These patients are most commonly treated with chemotherapy.
We have excellent treatments for breast cancer, especially when we can catch it early. And thankfully, the high public awareness of breast cancer means that a lot of reliable information is available. On the web, I direct patients to the American Cancer Society (cancer.org) and the National Cancer Institute (cancer.gov).
And remember, with a healthy lifestyle and regular screening, you have control over a significant part of your breast cancer risk.
Paula Klein, MD, Associate Professor of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Women’s Cancer Program, Mount Sinai Chelsea.
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