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Via Christi 50+ Lunch and Learn: Can I prevent breast cancer?
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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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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