Breast Cancer Awareness Month

October is Breast Cancer Awareness Month and only a few years ago, my own mother was diagnosed with this heart-breaking disease. The good news was that her doctor caught it in the very early stages and she only had to have a partial mastectomy.

A couple of years ago, a very dear friend of mine was diagnosed with a much more aggressive type of breast cancer and, sadly, we lost her about a year later ...

 A beautiful pic of our friend Laurie Kurtz-Miller taken on her wedding day

... and Laurie (on left) posing with a couple of friends at a Breast Cancer Poker-Run Benefit held for her only two years ago.

In honor of this very special month, I have decided to share with you all a bit of information I had found on the American Cancer Society's website page about breast cancer awareness.

What are the Risk Factors for Breast Cancer?

  

Some risk factors, like a person's age or race, can't be changed. Others are linked to cancer-causing factors in the environment. Still others are related to personal behaviors, such as smoking, drinking, and diet. Some factors influence risk more than others, and your risk for breast cancer can change over time, due to factors such as aging or lifestyle.

Risk Factors You Cannot Change

Gender:
 
Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer, but this disease is about 100 times more common among women than men. This is probably because men have less of the female hormones estrogen and progesterone, which can promote breast cancer cell growth.

Aging: Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older. 

Genetic Risk Factors:

About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene defects (called mutations) inherited from a parent. 

BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. If you have inherited a mutated copy of either gene from a parent, you have a high risk of developing breast cancer during your lifetime. 

Although in some families with BRCA1 mutations the lifetime risk of breast cancer is as high as 80%, on average this risk seems to be in the range of 55 to 65%. For BRCA2 mutations the risk is lower, around 45%. 

Breast cancers linked to these mutations occur more often in younger women and more often affect both breasts than cancers not linked to these mutations. Women with these inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer. 

Changes in other genes: Other gene mutations can also lead to inherited breast cancers. These gene mutations are much rarer and often do not increase the risk of breast cancer as much as the BRCA genes. They are not frequent causes of inherited breast cancer.

ATM: The ATM gene normally helps repair damaged DNA. Inheriting 2 abnormal copies of this gene causes the disease ataxia-telangiectasia. Inheriting 1 mutated copy of this gene has been linked to a high rate of breast cancer in some families. 

TP53: The TP53 gene gives instructions for making a protein called p53 that helps stop the growth of abnormal cells. Inherited mutations of this gene cause Li-Fraumeni syndrome (named after the 2 researchers who first described it). People with this syndrome have an increased risk of developing breast cancer, as well as several other cancers such as leukemia, brain tumors, and sarcomas (cancer of bones or connective tissue). This is a rare cause of breast cancer.

CHEK2: The Li-Fraumeni syndrome can also be caused by inherited mutations in the CHEK2 gene. Even when it does not cause this syndrome, it can increase breast cancer risk about twofold when it is mutated. 

PTEN: The PTEN gene normally helps regulate cell growth. Inherited mutations in this gene can cause Cowden syndrome, a rare disorder in which people are at increased risk for both benign and malignant breast tumors, as well as growths in the digestive tract, thyroid, uterus, and ovaries. Defects in this gene can also cause a different syndrome called Bannayan-Riley-Ruvalcaba syndrome that is not thought to be linked to breast cancer risk. Recently, the syndromes caused by PTEN have been combined into one called PTEN Tumor Hamartoma Syndrome.

CDH1: Inherited mutations in this gene cause hereditary diffuse gastric cancer, a syndrome in which people develop a rare type of stomach cancer at an early age. Women with mutations in this gene also have an increased risk of invasive lobular breast cancer.

STK11: Defects in this gene can lead to Peutz-Jeghers syndrome. People with this disorder develop pigmented spots on their lips and in their mouths, polyps in the urinary and gastrointestinal tracts, and have an increased risk of many types of cancer, including breast cancer.

PALB2: The PALB2 gene makes a protein that interacts with the protein made by the BRCA2 gene. Defects (mutations) in this gene can lead to an increased risk of breast cancer. It isn’t yet clear if PALB2 gene mutations also increase the risk for ovarian cancer and male breast cancer.

 Family History of Breast Cancer:

Breast cancer risk is higher among women whose close blood relatives have this disease. Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk. Having 2 first-degree relatives increases her risk about 3-fold. The exact risk is not known, but women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, less than 15% of women with breast cancer have a family member with this disease. This means that most (over 85%) women who get breast cancer do not have a family history of this disease.

Personal History of Breast Cancer:

A woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast. This is different from a recurrence (return) of the first cancer.


Dense Breast Tissue:
 
Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Someone is said to have dense breast tissue (as seen on a mammogram) when they have more glandular and fibrous tissue and less fatty tissue. Women with dense breasts on mammogram have a risk of breast cancer that is 1.2 to 2 times that of women with average breast density. Unfortunately, dense breast tissue can also make mammograms less accurate. A number of factors can affect breast density, such as age, menopausal status, certain medications (including menopausal hormone therapy), pregnancy, and genetics.

          Lifestyle-Related Factors and Breast Cancer Risk

Having Children:

Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk overall. Having many pregnancies and becoming pregnant at a young age reduce breast cancer risk overall. Still, the effect of pregnancy is different for different types of breast cancer. For a certain type of breast cancer known as triple-negative, pregnancy seems to increase risk. 

Birth Control:
 
Oral contraceptives: Studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them. This risk seems to go back to normal over time once the pills are stopped. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk. When thinking about using oral contraceptives, women should discuss their other risk factors for breast cancer with their health care team.

Depot-Medroxyprogesterone Acetate (DMPA; Depo-Provera®) is an injectable form of progesterone that is given once every 3 months as birth control. A few studies have looked at the effect of DMPA on breast cancer risk. Women currently using DMPA seem to have an increase in risk, but the risk doesn’t seem to be increased if this drug was used more than 5 years ago.

                             Hormone Therapy After Menopause

Hormone therapy with estrogen (often combined with progesterone) has been used for many years to help relieve symptoms of menopause and to help prevent osteoporosis (thinning of the bones). Earlier studies suggested it might have other health benefits as well, but these benefits have not been found in more recent, better designed studies. This treatment goes by many names, such as post-menopausal hormone therapy (PHT), hormone replacement therapy (HRT), and menopausal hormone therapy (MHT).

The decision to use hormone therapy after menopause should be made by a woman and her doctor after weighing the possible risks and benefits, based on the severity of her menopausal symptoms and the woman's other risk factors for heart disease, breast cancer, and osteoporosis. If a woman and her doctor decide to try hormones for symptoms of menopause, it is usually best to use it at the lowest dose needed to control symptoms and for as short a time as possible. 

Breastfeeding:

Some studies suggest that breastfeeding may slightly lower breast cancer risk, especially if it is continued for 1½ to 2 years. But this has been a difficult area to study, especially in countries such as the United States, where breastfeeding for this long is uncommon.
One explanation for this possible effect may be that breastfeeding reduces a woman's total number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or going through early menopause). 

Drinking Alcohol:
 
The use of alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who consume 1 alcoholic drink a day have a very small increase in risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol. Excessive alcohol consumption is also known to increase the risk of developing several other types of cancer. 

Being Overweight or Obese:
 
Being overweight or obese after menopause increases breast cancer risk. Before menopause your ovaries produce most of your estrogen, and fat tissue produces a small amount of estrogen. After menopause (when the ovaries stop making estrogen), most of a woman's estrogen comes from fat tissue. Having more fat tissue after menopause can increase your chance of getting breast cancer by raising estrogen levels. Also, women who are overweight tend to have higher blood insulin levels. Higher insulin levels have also been linked to some cancers, including breast cancer. But the connection between weight and breast cancer risk is complex. For example, the risk appears to be increased for women who gained weight as an adult but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this.

Physical Activity:

Evidence is growing that physical activity in the form of exercise reduces breast cancer risk. The main question is how much exercise is needed. In one study from the Women's Health Initiative, as little as 1.25 to 2.5 hours per week of brisk walking reduced a woman's risk by 18%. Walking 10 hours a week reduced the risk a little more.

(American Cancer Society, Inc.)