via christi 50+ lunch and learn: can i prevent breast cancer?
TRANSCRIPT
Can I Prevent Breast Cancer?Can I Prevent Breast Cancer?
Patty Tenofsky, MD FACSVia Christi 50+ Lunch and Learn
Wednesday, Oct. 17
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TopicsTopics
Breast cancer risks
Breast cancer prevention
Breast cancer screening
Improving breast cancer outcomes
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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk Factors
Breast density
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Risk Factors — Small 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk FactorsRisk 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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Risk ReductionRisk 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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Risk ReductionRisk Reduction
Tamoxifene results Dark circles —
tamoxifene Open circles —
placebo Left — invasive Right —
noninvasive Risk decrease by
1/2
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Risk FactorsRisk 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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Risk ReductionRisk 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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Risk ReductionRisk 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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ScreeningScreening
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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ScreeningScreening
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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ScreeningScreening
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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ScreeningScreening
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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Improving OutcomesImproving 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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Improving OutcomesImproving 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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SummarySummary
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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SummarySummary
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.