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What are some common Myths about breast cancer?
If I don’t have a family history of breast cancer I can’t get it.
Only about 5-10% of breast cancers are believed to be hereditary. The vast majority of people who get breast cancer have no family history. The biggest risk factors are simply being a women and getting older. Over time healthy breast cells can develop mutations on their own , eventually turning into cancer cells. Patients that have a strong family history may qualify for high risk screening. There are some risk factors for breast cancer that are modifiable, these include maintaining a normal weight, limiting alcohol intake, avoiding prolonged estrogen and progesterone therapy, exercising regularly, and following the Mediterranean diet.
Breast cancer always presents with a lump you can feel.
People are sometimes under the impression that breast cancer will cause a symptom or produce a mass that can be felt. Ultimately, we want to detect cancer before it produces symptoms by screening. Regular screening mammograms allow us to have a better chance of detecting cancers at an early stage. Mammography
with attention to change in a patients exam are both needed for cancer detection.
Annual Mammograms will guarantee that breast cancer will be found early.
Although mammograms are a very good screening tool, it isn’t foolproof. It can return a false-negative result meaning that the images look normal even though cancer is present. This is more common to happen in women who have denser breast tissue, which means the more glandular tissue as breast is composed of, as compared to fatty tissue, the harder it is to detect a cancer in that tissue until it is much larger. Younger women tend to have more dense tissue than older women. The location of the cancer is also important. The mammogram does a good job of looking at the center of the breast, but the far edges like next to the sternum or high in the arm pit, these areas many not be captured on a routine mammogram.
Only Middle-aged and older women get breast cancer.
It is true age is an important risk factor, with 27% of cancer being diagnosed in women >60, 23 % in their 50’s and only 4% under 40. Younger women, particularly if they have a strong family history are at higher risk and need risk assessment by a specialist to determine appropriate screening. Breast cancer is rare in men, but it does happen. Routine screening with mammograms is not used in men, so self exam with attention to masses or changes in the nipple are important note.
All breast cancers are pretty much treated the same way
Although breast cancer is treated in a multi-disciplinary fashion, the exact treatment is very dependent on the biology/behavior of the tumor, and the stage of disease process. As more is discovered about the biology of cancer, more directed and targeted therapies can be developed. Non-invasive cancers (those that do not spread elsewhere) are treated differently than invasive cancers (those that have the potential to spread and come back elsewhere in the body). Most patients with invasive cancer need treatment that removes the cancer from the breast and lymph nodes along with whole body therapy to prevent it from coming back. Receptors are very important in breast cancer in determining whole body therapy. Some patients also need radiation therapy to treat the breast and regional lymph nodes. In patients that have metastatic disease (cancer that has moved beyond the breast, ie to bone, brain, lung, liver) the primary focus of therapy is treating the whole body. The goal for treatment of breast cancer is to offer patients a specialized regimen that treats there specific tumor type depending on the disease burden.
Screening tests and recommendations
Screening recommendations have changed over the last 20 years, and are different depending on which medical society or task force is making the recommendation. These recommendations are also based on different outcomes. The United States Preventive Services Task Force makes recommendations based on lives saved and balances that with cost. The 2024 recommendations where to start screening at at 40, and perform exams every other year until 74. Other societies, such as the American Society of Breast surgeons, National Comprehensive Cancer Network and the Soiety of Breast imaging, recommend annual screening starting at 40. This has been shown to increase detection and find cancers at earlier stages but does not change survival. A screening mammogram is for an asymptomatic patient. If a patient has a breast symptom (nipple discharge, nipple inversion, new mass, change in skin color or thickening) a diagnostic mammogram/ultrasound would be performed. This type of imaging takes more pictures and evaluates a specific concern that may represent cancer. For patients who are considered high risk magnetic resonance imaging (MRI) of the breast may be indicated. There is also a new technology that uses contrast while performing a mammogram (contrasted enhanced mammography) that also helps with problem solving particularly in women with dense breast tissue.
High Risk screening
High risk screening is considered for patients who have a lifetime risk of developing breast cancer > 20-25 %. This includes patients that have a Gene mutation ( BRCA, CDH1, ATM, PALB2, CHEK2), chest wall radiation at a young age, biopsies with abnormal cells ( LCIS, ADH, ALH) and a strong family history that leads to risk score of >20%. Depending on a patient’s age and the ages of family members first having cancer, screening should start 5-10 yrs prior to the first cancer, or at 30 years. These guidelines do change as more is learned. A good resource for up-to-date guidelines is www.nccn.org. Screening is usually a combination of mammography and MRI.
For patients that are claustrophobic, adding contrast enhanced mammography
may be an alternative to MRI.
Prevention Strategies
Although there is no way to guarantee you won’t get cancer with healthy living, there are some modifications that can be made with healthy living that can decrease your risk
of breast cancer.
Maintaining a normal Body Mass Index. If you are under 62 years of age your target BMI is 18-25, if you are older than 62 the target is 22-27.
Exercise. The recommended exercise goals for prevention is 150-300 minutes of moderate intensity or 75 minutes of vigorous activity per week. In addition 2-3 sessions strength/resistance training and stretching. Exercise leads to decreased hormone levels, decreased insulin resistance which leads to decreased inflammation and increased immune function.
Diet. The best literature to date suggests that a Mediterranean Diet high in fruits and vegetables, fatty acids for marine fish and fiber may decrease your risk of breast cancer.
Choosing Carbohydrates wisely to lessen your risk of insulin resistance and DM is important as well.
Avoid Alcohol. Alcohol affects how estrogen is metabolized and increases the risk for breast cancer. There is a 32% increased relative risk for women who drink 3-4 drinks/day.Prevention for high risk patient.
Prevention for high risk patient.
For patients who have a significantly elevated risk of breast cancer because of a gene mutation, family history or previous biopsies showing atypical cells, these patients may be a candidates for chemoprevention or surgical risk reduction with mastectomy.
Patients who have had previous biopsies showing atypical ductal or lobular hyperplasia (abnormal cells that are a independent risk factor for the development of breast cancer) can take medications like tamoxifen that block the effects of estrogen on these cells and decrease the risk of developing breast cancer. For patients that have gene mutations like BRCA 1 and 2, TP 52, PTEN, and PALB2 with Family History who have and estimated life time risk of > 50%, these patients may choose to undergo prophylactic mastectomies (removal of the breast tissue) to decrease their risk. This decreases the risk of developing breast cancer to less than 10%. There are however surgical risks, cost and body image/sexual dysfunction issues that can develop, that all needs to be weighed when considering this type of prevention.
Contact:
cCARE Cancer Center ccare.com
(800) 456-5860
