Take extra care with family history of breast cancer
Updated: November 12, 2012 6:03AM
With today’s focus on preventing disease rather than simply treating it once it arrives, many women ask themselves, “How can I reduce my risk for breast cancer?” It’s a valid question. According to the American Cancer Society, a woman living in the United States has a one in eight lifetime risk of being diagnosed with breast cancer.
Unfortunately, some breast cancer tendencies are beyond a woman’s control. Breast cancer is most common in women, but we can’t help being women. Breast cancer increases with age, but we can’t stop getting older.
Clinical risk factors also beyond our control are: high breast density, certain types of benign breast conditions and being a childhood cancer survivor.
Early menarche (before age 12) and late menopause (after age 55) both raise the risk for breast cancer. So does experiencing a first pregnancy after age 30 and never having breastfed a baby. We can’t change our genetic makeup or our family history.
However, certain other risk factors are within our control. According to the American Cancer Society, these include: postmenopausal obesity, use of combined estrogen and progestin menopausal hormones, alcohol consumption and physical inactivity. Nevertheless, awareness of the risk factors, even unchangeable ones, empowers women. For instance, women with a strong family history of breast cancer might consider genetic counseling and aggressive screenings to lower her chances of developing breast cancer.
We now know that certain genetic components suggest an increased risk for certain cancers. For breast cancer, that gene is BRCA1 and BRCA 2. The following increase the suspicion of a genetic basis for breast cancer:
• breast cancer before age 40
• multiple cases of breast cancer in the same family before age 50
• any history of male breast cancer
• any family history of ovarian cancer
• a family history of bilateral breast cancer
• certain nationalities, such as Ashkenazi (Eastern European) Jewish heritage
Rarely, other genes raise the breast cancer risk. For instance, women with Cowden Syndrome may have mutations in the PTEN gene, which may cause breast cancer, as well as tumors in the uterus and thyroid. In Li-Fraumeni Syndrome, women may develop a number of cancers including breast, brain, lung, adrenal and leukemia.
A genetic predisposition for breast cancer is much different from simply having a family history. If your mother, sister or other close relative had breast cancer at age 60 or 70, the most common time a woman receives a breast cancer diagnosis, you would have an increased lifetime risk for developing it but wouldn’t necessarily have a genetic mutation.
Women at high risk for breast cancer may aggressively address that risk. For instance, they may be advised by their physician to have an MRI screening. They may take certain types of anti-estrogen medication, such as Tamoxifen. At the extreme end, they may opt for a bilateral mastectomy and/or removal of their ovaries.
Counseling before any of these procedures, including genetic testing, cannot be overemphasized. Learning you have a strong risk of breast cancer comes with psychological as well as physical ramifications. Some women might not wish to know their exact risk for breast cancer. Others, whether the risk is high or low, feel relief since knowing that risk allows lifestyle changes and modifications. Although testing can provide information about genes that carry an increased risk toward breast cancer, it cannot actually predict which women will eventually develop breast cancer.
Whether your risk is high or low, all women should practice good health habits, as laid out by the American Cancer Society. These are:
• maintaining a healthy weight
• engaging in at least 30 minutes of moderate to vigorous physical at least five days a week
• eating a healthy diet with emphasis on plant sources and whole grains
• eating five or more servings daily of fruits and vegetables
• limiting intake of processed and red meat
• restricting alcoholic beverages to one drink per day
Furthermore, women should continue monthly self-examination of their breasts and annual mammographies. For now, early and consistent screening is a woman’s best defense tool because breast cancer is still largely unpreventable.
Dr. Patricia Madej is medical director of the Breast Cancer Centers at Adventist Hinsdale and La Grange Memorial hospitals.