1. Can I Prevent Breast Cancer?
Patty Tenofsky, MD FACS
Via Christi 50+ Lunch and Learn
Wednesday, Oct. 17

2. Topics
Breast cancer risks
Breast cancer prevention
Breast cancer screening
Improving breast cancer outcomes
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3. Risk Factors
Risk factors that cannot be reduced
 Being a woman
 Getting older
 Family history
 Breast density
 Age at first menstrual cycle
 Age at first pregnancy
 Breast biopsies
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4. Risk Factors
Being a woman
 For every 99 women who get breast cancer there is
one man who gets breast cancer
Getting older
 The media has a tendency to focus on younger
women with breast cancer, but that is actually rare.
 Odds
 30-39 0.43% (1 in 233)
 40-49 1.45% (1 in 69)
 50-59 2.38% (1 in 42)
 60-69 3.45% (1 in 29)
 Overall lifetime risk 12.1% (1 in 8)
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5. Risk Factors
Family history
 Having one first-degree relative doubles your risk
 Lifetime risk is around 20%
 Two first-degree relatives give you a risk that is 5
times higher
 Lifetime risk is 30-40%
 Second and third-degree relatives most likely affect
risk, but not as significantly as first degree relatives
 Lifetime risk between 10-15%
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6. Risk Factors
Family history
 Rare for a woman to have a breast cancer
gene
 Only 5-10% of families have multiple women with
breast cancer
 There are usually a significant number of women
(and men) with breast or ovarian cancer,
especially under age 50
 Lifetime risk of breast cancer — 80%
 Gene can be tested for if criteria is met
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7. Risk Factors
Breast density
 Having a higher amount of breast tissue and
connective tissue (the tissue between the breast
tissue) compared to fat increases risk
 Relatively new risk factor
 Increases risk 4-5 times
 Harder to screen with mammograms
• Definitely need digital mammograms
• Possibly sonogram and MRI as well — being studied
 Probably inherited
 Cannot be determined by breast size or exam — it’s a
mammogram finding
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8. Risk Factors
Breast density
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9. Risk Factors — Small
Menstrual cycle/pregnancies/biopsies
 Women who are exposed to less estrogen in their
lifetime have a lower risk of cancer
 Girls who start their menstrual cycle at a later age (15-16)
(This rarely happens anymore.)
 Women who bear children at a young age (less estrogen
when pregnant)
• Women who have children late or do not have children have a
higher risk
 Women who breast feed for more than six months (less
estrogen when breast feeding)
 Studies show a slightly higher risk if a woman has
biopsies even if they are benign. The reason is
unknown.
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10. Risk Factors
Options for women with risks that cannot be
reduced
 Digital mammograms
 Additional testing depending on your risk,
such as sonograms or MRI
 Medications that can lower your risk — such
as tamoxifen or raloxifene (Evista)
 Try to minimize risks that may be reduced
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11. Risk Factors
Risk factors that can potentially be reduced
 Maintaining a healthy weight
 Exercise
 Limiting alcohol
 Avoiding hormone replacement medications
or staying on them for only a short period of
time
 Environmental factors
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12. Risk Factors
Weight
 Being overweight increases the risk of breast cancer,
especially after menopause
 Both an increase in body weight as an adult and
gaining weight as you age increases risk
 Most likely because fat produces low levels of estrogen and
stores it, making estrogen levels higher in heavier women
 Higher weight also increases the risk of recurrence of
breast cancer once diagnosed and decreases survival
if the breast cancer is sensitive to hormones (most
are)
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13. Risk Factors
Exercise
 Women who exercise have a lower risk of breast
cancer
 Possibly because it reduces weight or it may decrease it
simply on its own
 Estrogen levels tend to be lower with regular exercise
 150 minutes of moderate exercise or 75 minutes of
vigorous exercise/week at a minimum to reduce risk
 Strength training may also be beneficial
 Women who exercise are also better able to tolerate
the treatment of breast cancer if they are diagnosed
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14. Risk Factors
Limiting alcohol
 The more you drink, the higher your risk
 Try to limit yourself to one drink per day or
less to lower your risk
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15. Risk Factors
Hormone replacement medications
 Long term combination therapy (estrogen &
progesterone) increases the risk of breast cancer.
Long term is considered more than 5 years
 Combination is given to women who still have a uterus
because estrogen alone increases the risk of uterine cancer
 Estrogen alone probably does not increase the risk of breast
cancer too much, especially if on it fewer than 10 years
 No research studies on bio-identical hormones and
their risk
 Do not assume they are safer (American Cancer Society)
 Birth control pills — no link to breast cancer
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16. Risk Factors
Environmental pollution
 Possible link to polycyclic aromatic
hydrocarbons (vehicle exhaust, air pollution)
 No real research shows this
 Water bottles: Polyethylene terephthalate
(PET)
 No real research linking this either
 Deodorant — no link
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17. Risk Factors
Miscellaneous risk factors
 Diet
 What you eat doesn’t seem to be as important as
weight control
 No particular food seems to increase or decrease
risk
• Soy is okay
 Birth control pills
 No increased risk of breast cancer
 Does lower risk of ovarian cancer
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18. Risk Reduction
Chemoprevention medications, given to help
prevent cancer from occurring, can lower
risk
 SERMS — Selective estrogen receptor
modulators
 Tamoxifen and raloxifen (Evista)
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19. Risk Reduction
Tamoxifene results
 Dark circles —
tamoxifene
 Open circles —
placebo
 Left — invasive
 Right —
noninvasive
 Risk decrease by
1/2
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20. Risk Factors
Risk for invasive breast cancer reduced by
49% when using tamoxifen
 At 69 months: incidence was 43.4 vs. 22 per
1000 in placebo vs. tamoxifen
 19% reduction in hip, radius and spine
fractures
 Adverse affects:
 Increased risk of uterine cancer
 Increased risk of pulmonary embolism, DVT,
stroke and cataracts
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21. Risk Reduction
Raloxifen: Only for postmenopausal women
 As effective as tamoxifen for preventing
invasive cancer and probably not as effective
for noninvasive cancer
 Used for osteoporosis and breast cancer
reduction
 Side effects are probably not as severe as
tamoxifen
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22. Risk Reduction
Who are candidates for these medicines?
 Strong family history
 Previous biopsy showing lesions (such as
Atypical cells, Papillomas, or LCIS) that make
your risk higher
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23. Screening
Early detection and treatment
 Best strategy since lifestyle methods are not
easy and only reduce the risk slightly
 98.4% five year survival when cancers are
detected early
 Before they can be felt on exam
 Cancers are detected earlier and our treatment is
better
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24. Screening
Normal risk women
 Mammograms starting at age 40
 Continue if the woman is in good health
High risk women
 Strong family history; BRCA positive; radiation
to chest wall
 Mammograms starting 10 years before
youngest affected family member
 Mammogram MRI screens for very high risk
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25. Screening
10 year survival for
mammogram detected
lesions: 95%
 Women 50-69 have
decreased mortality
with screening (30%
fewer deaths)
 Women 40-49 with
less benefit, but most
(not all) studies show
17-24% decreased
mortality
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26. Screening
MRI screening
 BRCA
 Lifetime risk of
20-25% (Gail or
other models)
 History of
radiation to the
chest between
ages 10 and 30
 Evaluates breast
implants for
rupture
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27. Improving Outcomes
Screening is the key to detecting cancer early
when it is most curable
 Mammograms started in the 1980s — they aren’t
perfect, but they are a good screening tool because
they are inexpensive, have low risk and have been
shown to work
 Improvements:
 Digital
 CAD detection
 Addition of sonograms to test suspicious areas
 Screening rate: 65-70%
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28. Improving Outcomes
Mortality rates from breast cancer in women under
age 70 have shown a sharp and sustained fall
 Improving outcomes linked to:
 Good screening regimens
 Minimizing delay in treatment
 Multidisciplinary teams working together
• Surgeons, medical oncologist, radiation oncologist, plastic
surgeons, radiologists, pathologists, research cooperatives
 Follow up to identify and treat local recurrences and adverse
effects of therapy
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29. Summary
Best advice to lower your risk:
 Regular, intentional physical activity
 Reduce your lifetime weight gain by limiting
calories
 Avoid or limit your alcohol intake
 If you require hormone replacement
medication for menopausal symptoms, try to
take it for a short period of time at the lowest
possible dose.
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30. Summary
Best advice to improve your outcome:
 GET YOUR MAMMOGRAMS — it is the BEST way to
detect cancer at it’s smallest, most curable stage,
especially over age 50
 Women at high risk (strong family history; BRCA
gene; radiation to chest wall) should:
 Consider additional screening (MRI)
 Consider risk reducing medications
 Remember — 95% of women will be alive at 10 years
post-treatment if their breast cancer is not able to be
felt and is detected only by a mammogram.
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