BREAST CANCER: RISKS, DETECTION AND PREVENTION
Many patients can survive their cancer
Breast cancer is one of the most common cancers to affect women in the United States. Almost one in every eight women will get breast cancer at some point in their lifetime. This means that many people know a friend or family member who has had breast cancer. Fortunately, through early detection and modern treatment, many breast cancer patients have excellent results and survive their cancer. However, one of the most critical factors in this is early detection.
Breast cancer is often detected in one of two ways. In some cases, a patient may notice a change in her breast, such as a new lump, skin changes or a change in the size or shape of the breast. This change may lead her to see her doctor, who can order tests that may find cancer. However, breast cancer screening is another way to detect cancer, often before the patient notices any changes in her breast.
Catching breast cancer early is especially important, as women with a small, early breast cancer typically have better survival results than those with more advanced cases. This is how breast cancer screening improves survival among breast cancer patients – by catching it before we would have otherwise known it was there.
For many years, breast cancer screening has consisted of a mammogram each year once a woman turns 40. A mammogram is an X-ray of the breast that can detect small nodules, large masses and other abnormalities related to cancer. Modern technology allows mammograms to pick up tumors smaller than a Mardi Gras bead. For many women, an annual mammogram is still the recommendation for breast cancer screening. However, some women may be at higher risk for breast cancer and may benefit from additional screenings, such as an annual breast MRI study and annual mammograms.
Many factors can affect a woman’s risk for breast cancer. Some of these factors are called “non-modifiable,” meaning that women cannot change or adjust that factor. Non-modifiable risks include a woman’s age, family history, genetics and breast density. Breast cancer is more common as women get older.
Also, if a woman’s family member or multiple family members have had breast or ovarian cancer, she is more likely than other women to develop breast cancer. Similarly, some women may have a genetic mutation that increases their risk. Lastly, different women have different types of breast tissue; women with denser tissue (usually seen on a mammogram) are also at higher risk for breast cancer.
While some risk factors cannot be changed, some risk factors may be adjusted to lower a patient’s overall risk. These risk factors are called “modifiable.” Modifiable risk factors provide opportunities for a patient to reduce her risk of breast cancer. These include exercising regularly, eating a healthy diet and limiting alcohol intake, among others.
Many people know that a healthy diet and exercise can lower the risk of heart disease, which is the most common cause of death in women in the United States. However, in addition to reducing the risk of heart disease, exercising 150 minutes each week can also lower the risk of breast cancer. This includes moderate exercise, such as walking 30 minutes five to six times per week. A lowfat, healthy diet with fruits and vegetables can also lower the risk.
Alcohol is also a modifiable risk factor for women. Drinking three or more alcoholic beverages a week has been shown to increase the likelihood of breast cancer. Avoiding or limiting alcohol to rare occasions is another way to lower one’s risk of breast cancer. These lifestyle modifications together (healthy diet, exercise, avoiding alcohol) can decrease a woman’s risk of breast cancer by as much as 60% – a significant risk reduction.
Some women have additional considerations that may lower their risk. For new mothers, breastfeeding has been shown to lower the risk of developing breast cancer later in life. For post-menopausal women, hormone replacement has been shown to increase breast cancer risk. Avoiding hormone replacement or taking the lowest dose for the shortest time period is recommended from a breast cancer standpoint. However, the decision to start or stop hormone replacement can be complex. It should be discussed with a woman’s doctor, balancing risks from the hormones against the menopausal symptoms a woman may have.
For women who are at very high risk for breast cancer, medical options exist that a patient may wish to consider. This includes medications that target estrogen levels to lower risks and the option for risk-reducing surgery. Women who face the highest levels of risk may decide to undergo a bilateral mastectomy, a surgery that removes almost all the breast tissue on both sides. Both the medication and surgery risk-reducing options should be discussed thoroughly with a woman’s physician.
It is also important to note that although it is very rare, men can also get breast cancer. This means that if a man notices changes in either breast, such as a hard mass, skin changes or other abnormalities, he should see his doctor. Like in women, catching a breast cancer when it is early and small gives better treatment results in men.
Early detection matters for any woman, whether she is high-risk for breast cancer or low-risk. Lifestyle changes focusing on modifiable risk factors will lower risk for many women, but breast cancer screening remains an important part of breast health. Overall, women should lower risks where possible, get their screening mammograms when needed and see their doctor for any changes in either breast or questions.
If there is cancer, finding it is the first step in knowing how to treat it. If the breast changes a patient has noticed are not cancer finding, we are always happy to give good news!
Jane Sugar, MD, MBA, FACS, is an assistant professor of surgery at LSU Health Shreveport.