Feminity in difficult times

The molecular reasons that lead to the development of breast cancer are still largely unknown. There are, however a number of factors that have been associated with breast cancer and that profoundly increase the risk for developing the disease. One of the most important risk factors is age.  Nevertheless, in at least a third of women who suffer from breast cancer other parameters have contributed to the disease: these include biological factors such as familial predisposition and the number of pregnancies, but also food intake, life-style and environmental factors. Women can do a lot for their health and at the same time actively prevent breast cancer by maintaining a normal weight, by minimizing alcohol intake, and by following a balanced diet.

Breast Cancer and Lifestyle

The vast majority of breast cancer patients, which is approximately 90 to 95% of affected women, develop the disease »spontaneously«. They neither have a family history of breast or ovarian cancer, nor is there any other reason that could serve to explain why cancer has developed. We now think that in these cases a number of different environmental and molecular factors have lead to the disease. The exact reason are, however, still largely unknown. Nevertheless, a number of risk factors have been shown to favour the development of breast cancer.


Among these risk factors are:

 

·      Age: After a women has reached the age of 30, breast cancer risk rises considerably and more than 2/3 of all breast cancer cases develop after the age of 60.

·        Genetic predisposition: (Cases of breast cancer in the family); if, for example, mother and sister of a woman have already developed breast cancer, this results in a 2-.3 fold increase in disease risk.

·      BRCA mutations: Approximately 5% of all breast cancer cases are caused by alterations in one of the two known breast cancer genes. Women with a strong familial background of breast and / or ovarian cancer very often harbour such a mutation and should consult their gynaecologist regarding the possibility to screen for such a mutation.

·      If a female has already developed breat cancer, she is at an increased riskf for developing breast cancer also in the other breast

·      Women who experienced their first menstrual bleeding early in life and who underwent menopause relatively late in life also have an increased breast cancer risk.

·      Women who have never been pregnant or who had their first pregnancy after the age of 35 have an increased breast cancer risk.

 

Life-style associated risk factors for breast cancer are:

 

·      Nutrition: fat-rich foods appear to have a negative impact on breast cancer risk. Roasted meat is also thought to favour the development of breast cancer slightly. Mediterranean fare (olive oil, fresh fruit and vegetable), on the other hand seems to have a protective effect.

·      Regular consumption alcohol consumption

·      Adipositas, especially if developed after menopause

·      Lack of physical activity

·      Hormone therapy (previously also called »hormone replacement therapy« or »HRT«. The degree of risk increase is dependent on the type of hormone and the duration of treatment

·      Oral contraceptives: breast  cancer risk is slightly increased during and in the first years following contraceptive use. After this transient increase, the elevated risk decreases again and becomes similar to that of women who have never used oral contraceptives

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Familial Breast and Ovarian Cancer

Alterations in the genetic code are the reason for breast cancer in approximately 5 of 100 women who develop breast cancer. These alterations, also called »mutations«, can be inherited within a family. While not all affected family members develop the disease, the high number breast cancer cases in an affected family and the young age of patients (most women with breast cancer are younger than 50 years) is usually striking. Often enough, women develop breast cancer in both breasts. The two genes that have most often been associated with breast familial breast cancer are BRCA-1 and BRCA-2. BRCA stands for »BReast Cancer Associated Gene-1 and 2«. Mutations in either of the two genes results in a deficient cell repair system. This, in turn, allows breast cells to transform into malignant cells and to grow without appropriate restrictions. Any female with a mutation in the BRCA-1 or BRCA-2 gene is at a very high risk to develop breast cancer. The risk to develop ovarian cancer is also profoundly increased. A number of other malignant diseases – such as colon cancer or pancreatic cancer - are slightly more common especially in BRCA-2 mutation carriers.


Women who are known to be affected by a mutation in the BRCA-1 oder 2 gene should participate in special breast cancer screening programmes. These programmes offer risk-adapted early detection programmes based on mammography, breast and vaginal ultrasound and MRI. While these strategies aim at detecting a tumor as early as possible, prophylactic surgery allows to effectively lower the risk to actually develop the disease. The prophylactic removal of both adnexes should be considered after completed family planning and reduces the breast cancer risk  by 50%. The risk to develop ovarian cancer is almost abrogated.


The prophylactic removal of both breasts allows to reduce the breast cancer risk by more than 90 %. Most women who undergo this operation also decide to have breast reconstruction during the same procedure. Without doubt, the decision to have both breasts removed has a huge impact on a women´s perception of her own body and must therefore be well-considered. However, it is usually very difficult for non-affected people to comprehend the considerable psychological burden that is associated with a mutation that confers a high degree of certainty to develop potentially lethal breast and / or ovarian cancer later in life. Psychooncological support is therefore critical when a prophylactic operation is considered.

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My Breast Cancer Risk

Most breast cancer specialists think that the following factors have a more or less pronounced effect on breast cancer risk. Some of these factors apply to all, some only to certain women:

 

·          Age and sex (female)

·          Members of the family have already developed breast cancer?

·          Weight and size

·          Physical activity

·          Alcohol

·          Vitamins

·          Birth weight

·          Age at first menstrual period (»Menarche«)

·          Age at first delivery

·          Number of deliveries

·          Breast feeding?

·          Oral contraceptives

·          Age at last menstrual period (»Menopause«)

·          Hormone therapy?

·          History of benign breast disease

There is a number of good reasons why certain drugs such as tamoxifen or Raloxifen have a beneficial effect in women with increased breast cancer risk. However, these drugs can not be recommended unconditionally for their potentially hazardous side effects. Risks and benefits have to be weighed carefully for each individual patient. If medical risk reduction is not for you, you can still lower your breast cancer risk considerably just by altering your life-style: 

·         If you consume alcohol, try to reduce the daily intake or avoid alcohol all together

·         If you are overweight, aim at reducing your weight

·         Try to save some time for physical activity at least 3 times per week

·         If you use hormone therapy for the alleviation of menopausal symptoms for a longer period, try to discontinue the treatment and switch to alternative therapies

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