Many with a diagnosis of breast cancer want to know if there was anything they could’ve done different to prevent it. Cancer grows when a cell’s DNA is damaged, but why or how that DNA becomes damaged could be genetic or environmental, or a combination of the two. The hard part is that some women considered at high risk for breast cancer don’t get cancer, while women who do develop breast cancer have no known risk factors. Since we do know that there are established risk factors associated with breast cancer, we should at be aware of and do our best to lower the risks if possible, and get regular breast cancer screening.
FACTORS THAT INCREASE THE RISK FOR BREAST CANCER:
Gender and direct family history: Men can still get breast cancer, but women are about 100 times more likely than men to get it. Also, having a first-degree relative (mom, sister or daughter) who has breast cancer puts a woman at higher risk.
Genetics: There are two genes responsible for some types of breast cancer: BRCA1 and BRCA2. Having a defect in the BRCA 1 or BRCA 2 gene predisposes a woman to breast as well as ovarian cancer. If a family member has this gene defect, you should be screened for it too.
Activity level: Inactivity puts you at risk. A 2014 study showed that exercise in postmenopausal women lowers the risk of developing breast cancer. If you were not overweight and premenopausal, your risk was even lower. The study showed that even 30 minutes of daily walking is beneficial. No surprise there.
Hormonal exposure: Researchers believe that the longer a woman’s exposure to the estrogen, the more susceptible she is to breast cancer. A woman has more exposure to estrogen if she starts menstruating early (before 12) and stops menstruating (menopause) later (after 55).
Is Hormone Replacement Therapy a risk factor?
- When it comes to hormone replacement therapy (HRT), there is some controversy. Many use HRT for menopausal symptoms like hot flashes, low libido and moodiness. Some studies say the use of HRT increases the risk. However, many don’t know there’s a difference between the two types of HRT out there. Bioidentical HRT is estrogen and progesterone that comes from plant sources (soy and yam), whereas common standardized prescription HRT comes from horse urine. Both types end up being synthetic (processed in a lab).
- However, there’s a very different effect between the two HRTs, which was demonstrated in a 2008 studypublished in the journal Breast Cancer Research and Treatment. 80,000 postmenopausal women using various forms of HRT were followed for more than 8 years. Women who used non-bioidentical estrogen with progestins had a 69% increased risk of breast cancer. But for women who used the bioidentical combination, there was a significant reduction in breast cancer risk.
Obesity: Studies show that being overweight is a risk factor, but mostly in postmenopausal women because obesity alters a woman’s estrogen metabolism.
How does body fat affect postmenopausal risk?
- In premenopausal women, the majority of estrogens are made in the ovaries. In postmenopausal women (ovaries no longer make much estrogen), estrogens mainly come from fat tissue. Fat tissue contains an enzyme called aromatase that converts testosterone to estrogens. So, more belly fat leads to higher blood estrogen levels.
WHEN TO SCREEN:
Cancer.org recommends the following guidelines for when to screen:
- Women starting in their 20s should do monthly self breast exams. Be sure to report any breast changes to your health care provider right away.
- Women in their 20s and 30s should have a breast exam as part of a regular health exam by your health care provider at least every 3 years.
- Starting at age 40, women should have an exam by a health care provider yearly. Women age 40 and older should also have a mammogram yearly.
- Women who are at high risk for breast cancer based on certain factors (e.g., strong family history, BRCA1 and 2 gene mutations), should get a yearly MRI and a mammogram.
Breast cancer is the most common cancer in women, but when breast cancer is detected early, the 5-year survival rate is more than 90%. The key is minimizing risk and early detection. Knowing the risk factors can help you understand your chances of getting breast cancer. Why not lose weight? Why not exercise? Especially if it can lower your risk. October is National Breast Cancer Awareness Month. Start the conversation today about your risk for breast cancer with your health care provider.
Michael Corsilles, ND, PA-C
