Breast Cancer Causes, Risk Factors and Prevention

By Dr. Julianne Childs DO, FACOI
Founder, Hope Community Cancer Center (A Division of RCCA)
October is Breast Cancer Awareness month. Wear your pink ribbons and get the message out!
Breast cancer affects 1 in 8 women.  Fortunately, the death rate from breast cancer has continued to drop since 1993.  Early detection with mammography has been one of the most important ways that we save women from mortality from breast cancer.
What are the causes of breast cancer?
Genetic factors can play a role.  If you have a family history of breast cancer, ovarian cancer, pancreatic cancer, prostate carcinoma, gastric cancer or colon cancer there may be a genetic link that could increase your risk for breast cancer. If someone in your family developed breast cancer before the age of 50 or any of the above malignancies at a younger age, this would also be a red flag indicating a genetic role may be in play.  If any of your male family members were diagnosed with breast cancer, this would be another red flag indicating a possible genetic risk.  About 10 to 12% of all breast cancers diagnosed have an associated genetic mutation such as BRCA-1 or 2, or others.  If you are of Ashkenazi Jewish heritage, that risk might be higher.  Oncologists, those who take care of people with cancer, or genetic counselors are able to request genetic panels that test not only for the well-known BRCA1 and BRCA2 genes, but other genetic mutations that might contribute to cancer.
Other factors that increase your risk for breast cancer include:
1) Age: As we age, our risk for breast cancer increases it does not decrease.  We tend to continue screening mammography in older women until they reach a point in their health when other issues are more of a concern for example, healthy 85-year-old with no other medical issues would be a reasonable person to continue screening, while a 75-year-old female with end-stage Alzheimer’s disease would probably not benefit from screening in terms of her overall life expectancy.
2) A history of prior breast biopsies, even if benign, but particularly if “atypical ductal hyperplasia” or “atypical lobular hyperplasia” is found.  These 2 pathology findings are felt to be markers for increased risk of “invasive” breast cancer.
3) Early-onset of your menses i.e. prior to age 12
4) Late-onset of menopause i.e. after age 50
5) First pregnancy after age 30 or no history of pregnancy
These last 3 factors are felt to be significant because they increase our overall lifetime exposure to estrogen, which is felt to promote breast cancer.
There have been a lot of advances in the treatment of breast cancer. We have targeted agents such as trastuzumab and pertuzumab, which fight against the Her 2 Neu receptor found on breast cancer cells.  We have a variety of endocrine therapies to fight against the Estrogen/Progesterone receptors on the cancer cells, and when those stop working, we have pills to fight the “resistance” that cancer cells develop in metastatic disease.
Twenty years ago many women received chemotherapy, in an effort to prevent a recurrence, who may not have needed it, because we could not tell who would benefit and who would not. At that time, we only knew that if the cancer came back we could not cure it. Now, we can perform a test on breast cancer tissue called the Oncotype Recurrence Score, or other similar tests, which can tell us who will and who will not benefit from chemotherapy, thus avoiding exposing patients to side effects from unnecessary treatment.
We have a test that can tell us who requires 5 years versus 10 years of therapy with endocrine therapy, like the drug tamoxifen or newer drugs called Aromatase Inhibitors. We are also  making gains in the treatment of “triple negative” breast cancer (cancers without Estrogen, Progesterone or Her2Neu receptors).Newer regimens are being investigated, including a newly approved regimen combining chemotherapy with immunotherapy for metastatic “triple negative” disease..
We can even limit the amount of lymph nodes taken from the axilla (armpit) in most women, which decreases their likelihood of lymphedema.
All of these advances help women go on to join the thousands of other Breast Cancer Survivors, while avoiding excess side effects or treatments.
What we can do to decrease our risk of breast cancer?
1) Maintain our weight as close to her ideal body weight as possible.  Body fat has the ability to produce hormones including estrogen, a major driver in the development of breast cancer. Eat healthy fresh fruits and vegetables, limit red meat to once a week or less, eat whole grains and less processed foods with white sugar and flour. Obesity is a major risk factor for developing many malignancies of the uterus, colon, and breast.
2) Exercise regularly.  This helps to maintain our ideal body weight
3) Limit alcohol consumption.  One alcoholic beverage a day is considered to be excessive for females and it is recommended that our intake be less than 1 ounce of liquor or less than 4 ounces of wine i.e. less than 1 full serving of alcohol per day.  Some researchers feel that any consumption of alcohol could be detrimental.
4) Don’t smoke!  Smoking increases her risk for a multitude of malignancies such as lung cancer, bladder cancer, esophageal cancer, head, and neck cancer as well as breast cancer.
5) Consider genetic counseling if your family history is suspicious. Knowledge is power! If you find out that you or a family member carries a genetic trait that increases your risk for breast cancer, you can be more proactive in prevention whether that be by increased screening or more aggressive steps like Angelina Jolie, who was BRCA positive, with prevention mastectomies and removal of the fallopian tubes and ovaries.
And last but not least:
Get your screening mammograms! Start at age 40, or earlier if advised by your physician, and go every year. There is an argument as to whether every 2 years would be sufficient, but for now, every year is considered the standard and should be covered by insurance.
If you are told you have “dense breasts” ask your physician to request a mammogram with “3-D tomography” or “computer-assisted detection” which can better evaluate denser tissue.
If you cannot afford a mammogram, as you have no insurance, many counties have access to programs to assist you. Ask your local hospital to direct you to a program.
Make October not just Breast Cancer Awareness Month, make it Breast Cancer Prevention Month, too!
Cape Regional’s Thomas & Claire Brodesser Jr. Cancer Center is a comprehensive cancer care center accredited by the American College of Radiology and the Commission on Cancer (CoC) of the American College of Surgeons. Only 1 in 4 hospitals that treat cancer receive the CoC’s recognition for high-quality care.  Support groups, a certified Breast Navigation team, 3D mammography, the latest TrueBeam technologies and a diverse team of providers and surgeons are available within Cape Regional’s Cancer Care Program. The Jane Osborne Center for Women’s Health provides patients with personalized care and access to these services and providers.   Cape Regional Health System is a Penn Cancer Network member, which gives our patients access to many promising new treatments being studied in clinical trials.  For more information on services and for a healthier life call 609-463-CAPE.