My two most daunting tasks, when I moved to the States 18 years ago, were to find a new doctor and a new hairdresser, in that order. Coming face to face with a medical system I was wholly unfamiliar with, I was greeted with little patience, bordering on disdain, by the doctors I was “interviewing”. Little did I know that my interviewing process was not something they could quite bill to my insurance company. It took nearly a year, after a case of horrendous hives that wouldn’t go away and that doctors kept on treating with cortisone, that I finally found my current primary physician, a wonderful and caring man who hasn’t prescribed me a single antibiotic in 17 years, who has taught me the importance of prevention but, above all, of taking charge of my health by being pro-active and informed. We made a pact that he cannot retire while I am still alive.
As a life long hypochondriac, I am the kind of patient who needs to know everything. I also made it a point to stop consulting the internet at every symptom or diagnosis. Every body is different while medical risk is statistical and a lot of lay information out there is outdated and, sometimes, plainly wrong. I still read the occasional medical paper (because I am a nerd that way) and sometimes attend medical outreach events that translate in plain English confusing or contradicting information.
With October being “Breast Cancer Awareness Month”, I thought I would share with you some of the information discussed during a lecture given on October 17 at the Santa Monica Public Library by three doctors from St. John’s Medical Center and John Wayne Cancer Research Institute in Santa Monica, CA. You will find the details of the doctors in question at the end of the post.
When it comes to breast cancer, few of us are untouched. If we haven’t gone through it, we surely know someone who has and, nowadays, in most cases this is far from a fatal disease. In my circle of friends, I can think of 4 women who have dealt with it in the last few years. I thought I was pretty informed; I submit to a mammogram and ultrasound every year and I went to the lecture expecting the usual mammogram recruitment speech, early detection etc. What I came away with was a plethora of information I wasn’t aware of and some debunked myths.
The 2 hr lecture contained a multitude of graphs, percentage and sources I will not go into here but, for more in-depth coverage, I am listing a number of sources at the bottom of the post.
We all know that early detection is indeed important, that a mammogram a year starting at age 40 should be part of our medical check-ups and that, unless you are diagnosed with a stage IV cancer, 98% of breast cancer caught early is curable.
There is a set of risks, some modifiable and some that are not, we should all be aware of. Each risk carries an increased percentage and, when I am talking about percentages, unless specified, we are talking in the order of 1 to 2% increased risk
NON MODIFIABLE RISKS
Gender – Although boys can get breast cancer too, we are girls and have inherently more breast tissue
Age – The older we get, we more at risk we are. A woman in her 70’s is more at risk than one in her 50’s so it’s important to keep ourselves checked.
Menstrual History – The younger the period starts (before 12) and the later menopause sets in (over 55) the higher the risk as we are exposed to estrogens for a longer period of time
Family History – The more people affected by cancer in our immediate family, the more at risk we are
Genetics – Some of us can be born with a predisposing genetic mutation inherited from our parents (genes BRAC 1 and 2). Typically, in this case, cancer presents itself earlier in life. Genetic testing has come a long way and if someone in your immediate family (parents or siblings) was diagnosed with breast or ovarian cancer early in life (before 50) there is a chance they were tested for gene modification. Bear in mind that ONLY 5% of breast cancer diagnosis fall into this category. 15% are due to family history and the remaining 80% occur for random causes.
Weight – There is a correlation between fat cells and cancer as fat cells generate estrogen and increase our glucose levels (which are cancer stimulating) The heavier our weight, the higher the risk – 56% higher! Sudden large weight gains/losses have also an incidence.
Environment – We are constantly walking around bombarded by free radicals that damage our DNA and prevent sick cells from being expelled from our bodies. Free radicals, for example, interfere with our DNA repair machine which cause our cells to be conducive to DNA mutation.
Alcohol Consumption – Nobody is suggesting you let go of your daily glass of wine (grapes have anti-oxidant properties anyway) or the occasional cocktail but alcohol generates free radicals.
Hormone Replacement Therapy – Again, we are exposing ourselves to more estrogens. The real damage comes from taking hormone replacements drugs for 5 years or more. If taken for only two years, within a year of stopping the risk is neutralized.
WHAT WE CAN DO TO INCREASE OUR BODY DEFENSES
There are a number of some common sense steps, and other lesser known, we can take to offset some of the risks.
- Keeping our weight stable, through diet and EXERCISE. In case you were not paying attention over the last few years of food debates, a low-fat, plant-based diet is preferable. Dr. DiNome, Chief of General Surgery at St. John’s, went so far as suggesting a vegan diet. A skeptic until two years ago, she converted, not to yield to some LA fad, but because the evidence of a correlation between animal proteins and cancer is mounting (regular red meat consumption increases the chances of breast cancer by 17%). While following a strict vegan diet might be too difficult or unappealing to many of us, cutting down on animal proteins indisputably has health benefits beyond preventing breast cancer.
- Eating cancer fighting foods –Free radicals can be neutralized by anti-oxidants. Excellent sources of anti-oxidants are the usual suspects, packed with vitamins E and C (Broccoli, Cauliflower, Brussels Sprouts, Sweet Potatoes, Carrots, Berries, Spinach, Tomatoes, Grapes.
Consuming phytoestrogens (estrogen contained in plants) can also help. Soy products in moderation (tempeh, tofu) and flax seeds (that can easily be sprinkled on cereals or in smoothies) are some examples. Other great anti-oxidants are garlic and black and green teas.
If you would like to read more about food and cancer, you can read The China Study or watch the movie Forks over Knives (which I just watched and pretty much converted me from staying away from meat from the rest of my life).
And now for some common questions, myths that have lived on and off the internet and other breast cancer sundries:
Do deodorants and antiperspirants cause breast cancer? They both contain parabens and aluminium which had led some quarters to believe they could cause cancer but studies on the subject have proven wholly inconclusive.
Which race is more likely to get breast cancer? Caucasian by far, followed by African-Americans, Hispanics and Asians. The incidence of breast cancer in Asia is far lower but scientists do not know whether it’s determined by a diet factor or because Asian women tend to have smaller breasts.
Are women with large breasts at higher risk? Yes, for the sheer fact that they have more breast tissue
Do mammograms expose you to so much radiation to possibly cause breast cancer? Radiation exposure through mammogram is minimal. To compare:
a mammogram delivers 13 millirem
a dental panoramic x-ray 2 millirem
a chest x-ray 10 millirem
a CT scan 400 millirem
an airport scanner 0.01 millirem
(danger threshold is 10,000 millirem) Source: MIT
Can wearing an underwire or tight bra lead to cancer? No
How about breast implants? Again, there is no correlation between implants and cancer. If you are required to have a biopsy and are worried your implants might be ruptured, they now perform image guided biopsies with very small needles.
Do hair straighteners/relaxers cause cancer? The answer is no but, although there are no studies done on the matter, it is common sense to stay away from those Brazilian relaxers that contain formaldehyde (known to harm humans)
Is breast cancer the leading cause of death of women in the US? Absolutely not. The main cause of death is heart disease (no wonder, with an estimated 1/3 of the population overweight). The second cause is all types of cancer combined, with lung cancer taking the top spot (followed by breast).
Does not having children increase the risk of breast cancer? Yes, slightly as we never experience an interruption in estrogen exposure. Also having children later in life could be a factor.
New legislation – For US residents of California, Virginia, Connecticut, Texas and New York Starting next January, together will the result of your mammogram, you will also receive an additional notice should you be a woman with dense breast tissue. The notice is just to inform you that you have dense tissue and that you might want to discuss further diagnostics with your doctors. It doesn’t mean there is anything wrong. While it’s easy to detect cancer in a fatty breast, women with dense or very dense tissue sometimes require an ultra-sound. I am one of them and my radiologists always follows my mammogram with an ultra-sound. I am told by sofagirl that, in South Africa, women are routinely informed if they do have dense breast tissue.
Stay healthy and get checked! Above all, don’t ever be afraid to ask questions of your doctors, as inane as you think they might be (the questions, not the doctors!). It’s your health and we should be feeling comfortable interacting with those we have charged to take care of it.
If you need to learn how to perform a breast self-exam, start here
The much more exhaustive program was presented by
Jane Dascalos, MD
Breast Radiologist at St. John’s Health Center
Maggie DiNome, MD, FACS, FSSO
Associate Director, The Margie Petersen Breast Cancer Center
Chief, General Surgery St. John’s Health Center
Maureen Chung, MD, PhD, FACS
Medical Director, The Margie Petersen Breast Cancer Center
Director, Breast Surgical Oncology Fellowship Program
Director, The Margie and Robert Petersen Breast Cancer Research Program at John Wayne Cancer Institute, St. John’s