Combating cancer

PacMed provider answers questions related to breast health and cancer prevention

Breast cancer is an ever-present and unfortunate reality in America. One in eight women are diagnosed with the disease in their lifetime, and it is the second leading cancer-causing death among women in the United States, according to the National Breast Cancer Foundation. With staggering statistics across the board and so many people impacted by its very existence, the reasons to be vigilant about breast health are numerous. In honor of Breast Cancer Awareness Month, Pacific Medical Centers’ Hematologist and Medical Oncologist Atis Barzdins, MD, explains how this sickness affects not only the women diagnosed, but their loved ones, survivors, and men as well.

What biological and environmental factors play a role in developing breast cancer?

The most significant predictors of breast cancer risk are genetic factors, reflected by personal and family cancer history. The risk is significantly higher if breast cancer was previously diagnosed in a person’s first or second-degree relatives before the age of 45, and/or if more than one relative has been affected. Also, the presence of other cancers, especially ovarian cancer, can be associated with hereditary cancer syndromes that also may carry significant breast cancer risk.

While breast cancer is common all around the world, the incidence rates are the highest in the developed Western countries (North America, Europe, Australia and New Zealand) and lowest in Asia and sub-Saharan Africa.

The factors known to be associated with higher risk, which are more prevalent in the industrialized world, include: increased fat intake and weight gain after menopause, earlier start of menstruation, working night shifts, using alcohol, hormone replacement therapy during menopause, having fewer pregnancies, less breastfeeding or a later age at first birth. (In other words, having a baby before the age of 30 is protective).

What routines and exams should women receive on a regular basis to monitor breast health? What day-to-day habits should people adopt to do the same?

Breast cancer screening needs to be tailored in discussion with a doctor, according to a person’s risk factors, specifically family history. Genetic testing for hereditary cancer syndromes may be warranted if there is a strong family cancer history. High-risk patients, such as those with BRCA gene mutations, may need to start screening as early as age 25, and the screening strategy may entail breast MRI and breast exams by a healthcare specialist.

For average-risk women, the American Cancer Society (ACS) recommends the following:

• Women between ages 40-44 have the option to start screening with a mammogram every year
• Women ages 45-54 should get mammograms every year
• Women 55 and older can switch to a mammogram every two years, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and expected to live 10 more years or longer.

Research has not shown a clear benefit to regular breast self-exams. Most often when breast cancer is detected because of symptoms (such as a lump), a woman discovers the symptom during usual activities such as bathing or dressing. ACS recommends women be familiar with how their breasts normally look and feel and report any changes to a healthcare provider right away.

Do you have any suggestions for individuals who are in remission? What can they do to decrease their odds of recurrence?

Many breast cancer patients are recommended further treatments after breast cancer surgery, even when all the known cancer has been successfully removed. These “adjuvant treatments” help to decrease the risk of cancer recurrence and are prescribed by oncologists based on individualized risk assessment and features of the cancer. Because we cannot often be certain that some cancer cells haven’t escaped the surgical treatment, adjuvant treatments are very important for many patients, as they are geared towards reducing the risk of developing metastatic disease, which is cancer that has spread to distant organs.

Today, there is generally no cure for metastatic breast cancer, although the treatments for patients who cannot be completely cured have significantly improved, and many women live for many years, even decades.

Healthy lifestyle choices, especially physical activity, diet and weight control, and minimization of alcohol intake have been linked to improved cancer outcomes, particularly in survivors of breast cancer. Lifestyle modification can be an empowering and effective way to boost physical and mental health in breast cancer survivors.

Although breast cancer primarily affects women, it is also possible for men to be diagnosed. What advice or precautions do you have for men in this regard?

In the United States, between 0.5-1 percent of breast cancer cases are diagnosed in men. As with women, the risk of breast cancer in men increases with age. Men tend to be five to 10 years older than women at the time of diagnosis.

The typical first symptom of breast cancer in men is a firm, painless mass, usually next to or underneath one of the nipples. This always requires immediate attention and evaluation.

Is there anything else you would like to share regarding breast health?

About one in eight U.S. women will develop invasive breast cancer. However, due to great medical advances, around 80 percent of the women diagnosed with breast cancer in the United States will survive it. When breast cancer is found in the early stages and treatment is initiated promptly, the chances for a positive outcome are improved. Over time, treatments have become less invasive and are tailored more accurately to the individual risk. This allows most women today to avoid mastectomy and chemotherapy. Because early detection is so critical, I encourage all women to address their breast cancer risk with a sense of importance and without fear.

Dr. Atis Barzdens is an oncologist at PacMed.