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Breast Cancer Awareness Month:

Oct 24, 2014 12:30PM ● Published by Cate Reynolds

Two topics that illustrate the many facets of breast cancer

Breast cancer prevention: How to reduce your risk

According to the American Cancer Society, about one in eight women in the United States will develop invasive breast cancer. It is the second leading cause of cancer death in women, yet the survival rate continues to improve each year, thanks to earlier detection, increased awareness, and improved treatment.

Recent studies show there are ways to help reduce the risk of breast cancer—especially for women who are at high risk. But before exploring preventive techniques, women should talk with a doctor or health counselor about their personal risk.

Certain risk factors associated with breast cancer cannot be changed. They include:

  • Gender – While men can develop breast cancer, the disease is 100 times more common among women than men, the American Cancer Society says.
  • Age – Risk increase as you age. About two out of every three invasive breast cancers are found in women age 55 or older.
  • Family history – If you have a first-degree relative, such as your mother, sister or daughter, who has had breast cancer, your risk may be increased two to three times.
  • Genetics – The society estimates five to 10 percent of breast cancer cases are hereditary (the rest are sporadic cases or mixed familial and environmental factors). Inherited mutations of the BRCA1 and BRCA2 gene are the most common cause of hereditary breast cancer but other gene mutations can be responsible. Cancers tied to these mutations occur more often in younger women, in both breasts or even in men.
  • Race and ethnicity – Those with Ashkenazi Jewish ethnicity may have a higher risk. White women are slightly more at risk for the disease than African-American women.
  • Milestones – first menstrual period under age 11; First child born over age 30; and Menopause occurring after age 55.

Other risk factors include weight gain, smoking and alcohol use. Women who gain weight or are obese after menopause, as well as women who drink alcohol more than one drink per day or more than seven drinks per week, have a higher risk of the disease. Use of hormone replacement in menopause still remains controversial, but studies point to increased risk after five years of hormone use.

Still, there are ways to reduce your risk and even help prevent breast cancer. These “protective factors” include:

  • Less exposure to estrogen – According to the National Cancer Institute (NCI), decreasing the length of time a woman’s breast tissue is exposed to estrogen can help prevent cancer. This can occur through:
  • Breastfeeding – Women who have breastfed have a lower risk than those who have children but did not breastfeed.
  • Early pregnancy – Women who have earlier full-term pregnancies such as before the age of 20 to 25 have a lower risk than those who have not had children or give birth to their first child after age 30.
  • Late menstruation – Menstrual periods beginning at age 14 or older decreases the years breast tissue is exposed to estrogen (although this is not a factor we can control).
  • Ovarian ablation – Estrogen levels can be reduced by removal of ovaries when it is done before the age of natural menopause.
  • Exercise – Studies show women who exercise four or more hours a week have a lower risk.

Four Medicines

According to the American Cancer Society and National Cancer Institute, (five-year use of) medications like ‘selective estrogen receptor modulators (tamoxifen, or evista [raloxifene], or another class called ‘aromatase Inhibitors’ for prevention includes aromasin [exemastane] or arimidex) can reduce the risk of breast cancer in appropriate/high risk women.

Tamoxifen used for five years has been shown to reduce the breast cancer risk approximately 50 percent with extended benefits reducing risk up to eight years after use in both pre and postmenopausal women. All four medications have been shown beneficial in appropriate postmenopausal women, decreasing breast cancer risk between 38 to 65 percent. Medications can have side effects: some common (including hot flashes) and some uncommon (stroke, blood clots or effects on bone density)—so these choices need to be individualized with the physician.

Use of medications for prevention is common in fields like cardiology with use of drugs like aspirin or statins for lipids and cholesterol. Interestingly it has been estimated that the same numbers needed to treat with a statin drug to prevent one heart attack is the same number of patients needed to treat with a SERM or AI to prevent one breast cancer. In a recent four year update and clinical practice guideline update published by the American Society of Clinical Oncology in July 2013, more scientific support was noted in numerous studies dating back to 1998. The consensus of the experts assigned a “STRONG category” for strength of recommendation and strength of evidence in the use of medication for reduction of breast cancer risk citing the need for more public and physician awareness.

The expansion of our aging population, amplifies the importance of prevention strategies and preventive medication in the United States. Estimates say approximately 200,000 women were affected by breast cancer in 2013 and it is one of the leading cancers women face worldwide.

If you or a loved one is at risk for breast cancer or interested in prevention, talk with your primary care physician or a breast cancer specialist for more information.

“Breast cancer prevention: How to mitigate your risk” provided by University of Maryland Baltimore Washington Medical Center.

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Imaging and Tumor Marker Tests for Breast Cancer: When you need them—and when you don’t


When you learn that you have breast cancer, it’s normal to want to do everything you can to treat it and be sure it doesn’t come back. But it’s not always a good idea to get all the tests that are available. You may not need them. And the risks may be greater than the benefits.

Imaging tests, such as CT, PET, and bone scans, take pictures to help find out if the cancer has spread in your body. Another test, called a tumor marker test, is a kind of blood test. Tumor markers are also called biomarkers or serum markers. They are higher than normal in some cancer patients. The tests you need depends on the stage of your breast cancer.

What is breast cancer staging? To determine the stage of your cancer, doctors look at how large your tumor is, where it is, and if it has spread. They also look at your medical history, physical exams, diagnostic tests, and tests of your tumor and lymph nodes.

Early-stage breast cancer includes stages 0, I, II and IIIA (zero, one, two, and three-A).

In stage 0, there are abnormal cells in the ducts or lobes of the breast. They have not broken through the wall of the duct or spread.

In stages I, II, and IIIA, there is a tumor. It may have spread to lymph nodes under the arm, but it has not spread anywhere else.

Later-stage breast cancer is stages IIIB and IV (three-B and four). The cancer has spread beyond the breast and lymph nodes under the arm.

What if you have early-stage breast cancer? If you have early-stage breast cancer but no symptoms to suggest the cancer has spread, you should not get an imaging test to look for cancer in other places in your body. The chance that your cancer has spread is very small. Studies show that breast cancer spreads to the liver and bones in fewer than 6 out of 100 people. And this is usually in patients with stage III breast cancer.

Keep in mind, imaging tests have risks and costs. The biggest risk is that imaging tests expose you to radiation. The effects of radiation add up over your lifetime and can increase your risk of cancer. Imaging tests can also show a “false positive.” This means a test shows something unusual, but after more testing, is not a problem. False positives can lead to stress, more tests, and a delay in getting needed treatment.

Imaging tests can also add thousands of dollars to your treatment costs. Not all insurance companies pay for them for early-stage breast cancer.

What if you have already had breast cancer? If you had early-stage breast cancer and have no signs that your cancer has returned, you may not need imaging or tumor marker tests. It is not likely that your cancer has returned. These tests usually do not help you live longer. And they can lead to a wrong diagnosis and unneeded treatments

Usually, the best way to monitor your cancer is to have a mammogram each year and a physical exam every six months. And watch for symptoms, such as a new lump or pain in the breast. Studies show that most breast cancer that returns is found through symptoms, not imaging tests.

Do you need tests for later-stage breast cancer? If your cancer is stage IIIB or IV, you should get an imaging test to look for cancer in other parts of your body. Treatment can depend on how much and where the cancer has spread.

If you have later-stage breast cancer, your doctor may also use blood tests to look at tumor markers. These tests should be done only when it is known that you have advanced cancer.

If you are diagnosed with breast cancer ask your doctor what tests will be used to determine the stage of your cancer and how will the tests help you decide about your treatment. Additional questions to ask your doctor about cancer can be found at ChoosingWisely.org.

This article is provided by Anne Arundel Medical Center and the ABIM Foundation as part of the Choosing Wisely initiative. Learn more at ChoosingWisely.org.
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