Breast Cancer: Know Your Risks

Know your risks for breast cancer. (Image credit: Getty Images)

Reported by Dr. Brian Lau for ABC News:

Breast cancer strikes more than 2.7 million women in the United States, according to the National Cancer Institute. One in eight women will be diagnosed with the disease at some point in their lives.

Dr. Richard Besser, chief health and medical correspondent for ABC News, hosted a tweet chat this week on breast cancer prevention to help women understand their risk factors for the disease and what steps they can take to minimize these risks.

Besser was joined by doctors from top hospitals from all over the country, as well as medical experts from the Centers for Disease Control and Prevention, the American Cancer Society and various chapters of the Susan G. Komen Breast Cancer Foundation.

?Click here for the full transcript of the chat. Read on for the highlights.

What are the risk factors for breast cancer?

Most breast cancer patients don’t have any known risk factors. However, the chance of developing the disease increases with age, obesity, increased breast density and history of previous cancer treatments.

Does Breast Size Affect Breast Cancer Risk?

A woman is also more likely to develop breast cancer if an immediate relative is diagnosed with the disease before age 50. Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk. And women who began menstruating early or go through menopause after the age of 55 may have an increased risk, possibly due to a longer lifetime exposure to the hormones estrogen and progesterone.

Overall, white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer.

What gene mutation increased Angelina Jolie’s risk of breast cancer?

BRCA1 and BRCA2 are genes that help suppress tumors. Angelina Jolie was diagnosed with an inherited mutation of the BRCA1 gene, which increased her risk of developing breast cancer and ovarian cancer.

Not all BRCA variants are as dangerous and only about 5 to 10 percent of breast cancer cases are associated with genetic mutations. Additionally, not all children or relatives will inherit those mutations. Doctors recommend genetic testing for high-risk patients like Jolie, who has a strong family history of breast cancer.

Are pre-emptive bilateral mastectomies the only course of treatment in a high-risk situation like Jolie’s?

Jolie chose to have a prophylactic bilateral mastectomy to remove both of her breasts, which has been found to greatly reduce the risk of breast cancer. But it doesn’t entirely eliminate risk, and this isn’t the only choice for someone faced with a similar diagnosis.

Angelina Jolie’s Double Mastectomy Fuels National Debate

Two other options exist for women at high risk of developing breast cancer: They can monitor their health more frequently, alternating a mammogram and MRI of their breasts every six months. Or, they can undergo preventive chemotherapy.

The number of patients opting for prophylactic mastectomy is increasing. A 2008 study in the International Journal of Cancer found that about 36 percent of American women with a BRCA1 or BRCA2 mutations chose to have both breasts removed.

What can the average woman do to prevent breast cancer?

Maintaining a healthy lifestyle through exercise, weight control and limiting alcohol can help prevent breast cancer. For a typical woman who doesn’t have any risk factors for the illness, the American Cancer society recommends a yearly mammography screening after age 40. The U.S. Preventive ?Services Task Force recommends regular mammograms every two years for all women between the age of 50 and 74.

Find Out Which Tests Are Best for Detecting Breast Cancer

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Not All Breast Cancer Has a Lump

Sandra Bishnoi wasn't worried when she went to her gynecologist about some breast soreness in 2011. She was 37 and had just finished breastfeeding her new baby daughter, so Bishnoi, who has a PhD in chemistry, figured she was just experiencing one of the many bodily changes that come with pregnancy and new motherhood.

Bishnoi's gynecologist sent her to a nearby hospital for more testing that day, but Bishnoi never saw a breast cancer diagnosis coming.

"The light bulb never came off that it was serious," said Bishnoi, adding that she never thought to ask her husband to come with her to the doctor's office for support. "A surgeon actually came in to see me and said, 'We need to do a biopsy... Dr. Bishnoi, you can't leave this room without knowing you have breast cancer.'"

The doctor was crying.

Doctors ultimately diagnosed Bishnoi with stage 4 inflammatory breast cancer that had metastasized to her bones.

Bishnoi was not only devastated, she was baffled. Wasn't breast cancer supposed to involve a lump? Wasn't she too young? Didn't she need a family history?

The short answer is that inflammatory breast cancer is different from other breast cancers. Since inflammatory breast cancer only accounts for between 1 percent and 5 percent of breast cancers, patients -- and some doctors -- often don't know what to look for.

"It's often not associated with a lump," said Dr. Mark Kelley, chief of surgical oncology and endocrine surgery at Vanderbilt-Ingram Cancer Center in Tennessee. (Kelley has never met Bishnoi.) "These patients just come in with red, swollen, possibly tender breasts."

It often looks more like an infection than cancer, so some doctors will prescribe antibiotics, giving the cancer more time to grow before it's caught, Kelley said.

Want more breast cancer news? Visit our topic page.

An infection called mastitis is common in women who are breastfeeding and is to blame for breast swelling and discoloration most of the time, said Dr. Sandhya Pruthi, a breast cancer specialist and professor at the Mayo Clinic in Rochester, Minn. Doctors will often prescribe antibiotics for seven to 10 days to see what happens. If the symptoms don't go away, doctors should know it might be more than an infection and request more testing.

"You don't want to miss inflammatory breast cancer," Pruthi said. "Inflammatory breast cancer is uncommon and unfortunately it's not always a classic presentation. That's what makes it challenging. If you haven't seen it several times in your practice to know what you're looking for, you can miss it."

Even if a doctor suspects inflammatory breast cancer, it won't necessarily show up on a mammogram, Kelley said. It might show up on an ultrasound, but the best way to diagnose it is to do a skin biopsy. Unlike other breast cancers, inflammatory breast cancer starts in the milk ducts and spreads quickly via lymphatic vessels in the breast skin.

Read about how men and women communicate through breast cancer.

Bishnoi looked back and realized she actually had symptoms earlier but dismissed them. She remembered that her daughter didn't feed as well from the breast that had cancer, but she figured it was a clogged milk duct. She remembered that the same breast had some redness and dimpling but she thought it was thrush, which is also associated with breastfeeding.

It wasn't until Bishnoi stopped breastfeeding and realized that one breast hadn't returned to its normal size and firmness that she even considered going to a doctor.

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Physical Activity Reduces Breast Cancer Risk

Editor's Choice
Academic Journal
Main Category: Breast Cancer
Also Included In: Cancer / Oncology;??Sports Medicine / Fitness
Article Date: 08 May 2013 - 12:00 PDT
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Physical Activity Reduces Breast Cancer Risk

Breast cancer risk can be reduced through physical activity, according to new data published in a journal of the American Association for Cancer Research, called Cancer Epidemiology.

Aerobic exercise may prove to be a very effective means of lowering one's risk of developing breast cancer.

Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16% of all female cancers and 22.9% of invasive cancers in women.

Recently, researchers in the Journal of the National Cancer Institute identified an alteration in a gene, which affects the breakdown of estrogen and is also related to a modest reduction in breast cancer risk in pre-menopausal women.

The authors discovered that one of the ways in which aerobic exercise reduces the risk of developing breast cancer is by altering the way that estrogen is broken down and metabolized.

Aerobic exercise increases the ratio of "good" to "bad" metabolites of estrogen.

Mindy S. Kurzer, Ph.D., professor in the Department of Food Science and Nutrition at the University of Minnesota in Saint Paul, said:

"Observational studies suggest physical activity lowers breast cancer risk, but there are no clinical studies that explain the mechanism behind this. Ours is the first study to show that aerobic exercise influences the way our bodies break down estrogens to produce more of the 'good' metabolites that lower breast cancer risk."

The researchers conducted a clinical trial called "Women in Steady Exercise Research (WISER)". The trial included a total of 391 young and healthy premenopausal women.

They split the women into two groups with matching age and body mass indexes (BMIs).

The control group (179) led a sedentary lifestyle throughout the whole study period, whereas the intervention group (212) did half an hour of aerobic exercise five times a week for a period of 16 weeks.

The researchers made sure that the intensity of the exercise was the same for all the women. As part of their workout routine, the women used treadmills, stair steppers or elliptical machines.

Most of the participants completed the study (86% from the control group and 78 percent from the intervention group).

24-hour urine samples were collected on three consecutive days before the study and on three at the end. The researchers used a novel technique for measuring the estrogen levels, called liquid chromatography/tandem mass spectroscopy, to identify the quantity of three parent estrogens (E1, E2 and E3) as well as nine metabolites.

A reduction of breast cancer risk has been associated with the increased production of a metabolite called 2-hydroxyestrone (2-OHE1) as opposed to one called 16alpha-hydroxyestrone (16alpha-OHE1).

The researchers found that aerobic exercise caused an increase in the amount of 2-OHE1 and a decrease in amount of 16alpha-OHE1, which subsequently meant that their risk of breast cancer decreased.

Kurzer concluded:

"Exercise, known to favor fitness and improve heart health, is also likely to help prevent breast cancer by altering estrogen metabolism. It is very important, however, to decipher the biological mechanisms behind this phenomenon."

A previous study published in the journal CANCER similarly identified a link between physical activity and a reduced risk of breast cancer, which showed that women can reduce their breast cancer risk by exercising and maintaining their body weight.

Written by Joseph Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our breast cancer section for the latest news on this subject. "The Effects of Aerobic Exercise on Estrogen Metabolism in Healthy Premenopausal Women"
Alma J. Smith, William R. Phipps, William Thomas, Kathryn H. Schmitz, and Mindy S. Kurzer
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10 Years On Tamoxifen Halves Breast Cancer Recurrence Risk

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Main Category: Breast Cancer
Also Included In: Cancer / Oncology
Article Date: 03 Jun 2013 - 4:00 PDT
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10 Years On Tamoxifen Halves Breast Cancer Recurrence Risk

Survivors who take tamoxifen for ten years have half the risk of dying from estrogen receptor positive breast cancer, researchers from Cancer Research UK reported at the ASCO Annual Meeting in Chicago, Illinois, USA.

Lead researcher, Dr Daniel Rea reported that the "aTTom" study demonstrated that estrogen receptor positive breast cancer patients who took tamoxifen for longer than five years were much less likely to suffer cancer recurrence or die from the disease. Currently, the recommended period for tamoxifen therapy is five years.

The study involved 6,953 adult females with breast cancer. 580 patients from 3,468 women took tamoxifen for ten years, while 672 of 3,485 patients stopped tamoxifen after five years.

Dr Rea reported that: 25% of the 10-year tamoxifen patients had fewer recurrences of breast cancer than those on just five years of therapyThere were 23% fewer deaths in the 10-year tamoxifen groupDr Daniel Rea, who is based at the University of Birmingham, England, said:

"These results are important as they establish that giving tamoxifen for longer than the current standard of five years significantly cuts the risk of breast cancer returning.

Doctors are now likely to recommend continuing tamoxifen for an extra five years and this will result in many fewer breast cancer recurrences and breast cancer deaths worldwide. Tamoxifen is cheap and widely available so this could have an immediate impact."

Approximately three-quarters of all breast cancers are of the estrogen receptor positive kind. This type of breast cancer benefits from hormone therapy. Estrogen, a female hormone, encourages breast cancers to grow by activating estrogen receptors. Tamoxifen works by blocking these receptors, thus making it much harder for the cancer to recur after surgery or invade the other breast.

Tamoxifen side effects - patients on tamoxifen may experience menopausal-type symptoms, including hot flashes (UK: hot flushes) and night sweats. A Norwegian study found that acupuncture reduces menopausal symptoms in tamoxifen patients by 50%. More rarely, tamoxifen has also been linked to an increased risk of developing blood clots, endometrial cancer and stroke.

Stroke risk did not rise with 10 years of tamoxifen therapy compared to five years, the researchers found. However, the risk of endometrial cancer did increase. Fortunately, endometrial cancer is usually diagnosed in the early stages of the disease, when it can be treated successfully.

According to the researchers, thirty breast cancer deaths would be prevented for every endometrial cancer death due to long-term tamoxifen therapy.

Professor Richard Gray, who is based at the University of Oxford and was also presenting the aTTom trial results at ASCO, said:

"Five years of tamoxifen is already an excellent treatment but there have been concerns that giving it for longer might not produce extra benefits and could even be harmful. The aTTom study establishes that the benefits of taking tamoxifen for longer greatly outweigh the risks.

Kate Law, director of clinical research at Cancer Research UK, said: "Large clinical trials like aTTom are vitally important to understand how drugs such as tamoxifen work and how best to use them. We need these sorts of studies so we can be sure the benefits from cancer drugs outweigh the side-effects that they may have."

The aTTom trial was funded by the Medical Research Council, UK.

A trial led by Oxford University's Clinical Trial Service Unit reported in The Lancet (December 2012 issue) that taking tamoxifen for ten years after breast cancer surgery is more effective than five years. The study was called ATLAS.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our breast cancer section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

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Nordqvist, Christian. "10 Years On Tamoxifen Halves Breast Cancer Recurrence Risk." Medical News Today. MediLexicon, Intl., 3 Jun. 2013. Web.
5 Jun. 2013. APA

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'10 Years On Tamoxifen Halves Breast Cancer Recurrence Risk'

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Delay in Radiation Therapy Increases Risk of Breast Cancer Recurrence

Among older women who undergo breast-conserving surgery (lumpectomy) for early breast cancer, a longer interval between surgery and the start of radiation therapy increases the risk of local cancer recurrence. These results were published in the British Medical Journal.

Surgery for early-stage breast cancer involves either a mastectomy or a lumpectomy. A mastectomy involves removal of the entire breast, whereas a lumpectomy involves removal of the cancer and some surrounding tissue.? Because a lumpectomy alone is associated with a higher rate of cancer recurrence than mastectomy, patients who elect to have a lumpectomy are also treated with radiation therapy. The combination of lumpectomy and radiation is referred to as breast-conserving therapy. Breast-conserving therapy and mastectomy produce similar rates of long-term survival.

Among women who undergo breast-conserving therapy, prompt treatment with radiation therapy after surgery may result in better outcomes than delayed radiation therapy. To explore this issue, researchers evaluated information from a large U.S. database that links cancer registry data with Medicare claims data. Information was available for more than 18,000 women over the age of 65 who had undergone breast-conserving therapy for Stage 0-II breast cancer. The study was restricted to women who did not receive chemotherapy.

The primary outcome of interest was the rate of local cancer recurrence (cancer recurrence within the breast).

The median time from surgery to start of radiation therapy was 34 days. Thirty percent of women started radiation therapy more than six weeks after surgery.

Longer intervals between surgery and the start of radiation therapy were linked with an increased risk of local cancer recurrence. For example, women who started radiation therapy more than six weeks after surgery were 19% more likely to experience local cancer recurrence than women who had a shorter interval between surgery and radiation.Women were more likely to have a longer interval between surgery and the start of radiation therapy if they had positive lymph nodes, other health conditions, a history of low income, or were of Hispanic ethnicity or non-White race. Longer intervals were also more common in regions of the United States that had higher rates of breast-conserving therapy, suggesting that busy treatment facilities may have longer wait times.

These results suggest that starting radiation therapy as soon as possible after lumpectomy may reduce the risk of local cancer recurrence.

Reference: Punglia RS, Saito AM, Neville BA, Earle CC, Weeks JC. Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis. British Medical Journal [early online publication]. March 2, 2010.

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Decline in Use of Menopausal Hormones Linked with Lower Breast Cancer Rates

According to the results of a study conducted in Canada, the sharp drop in use of combined (estrogen plus progestin) hormone therapy that occurred between 2002 and 2004 was accompanied by a decrease in breast cancer incidence. These results were published in the Journal of the National Cancer Institute.

As women reach menopause and beyond, more than 80% will experience symptoms such as hot flashes, night sweats, sleep disturbance, and vaginal dryness. Estrogen, with or without progestin, is an effective treatment for many of these symptoms. Over the last several years, however, studies have raised important concerns about the health effects of menopausal hormone therapy.

In 2002, a report from the Women’s Health Initiative indicated that combined hormone therapy increased the risk of breast cancer, heart disease, stroke, and blood clots.? Use of combined hormone therapy decreased the risk of fractures and colorectal cancer, but these benefits were thought to be outweighed by the risks for most women.

After this report, use of combined hormone therapy declined markedly. Studies from several countries—including the United States—suggest that this decline in hormone use was followed by a decline in breast cancer incidence rates.

To evaluate trends in hormone use and breast cancer in Canada, researchers collected information about women between the ages of 50 and 69 who participated in the National Population Health Survey between 1996 and 2006.

Between 2002 and 2004, the percent of women who used combined hormone therapy decreased from 12.7% to 4.9%. During this same period, the rate of breast cancer declined.Since 2005 there has been some rebound in breast cancer rates. This suggests that avoidance of hormone therapy may act primarily by slowing the growth of breast cancer (rather than preventing breast cancer). Mammography rates remained stable throughout the study period.The study did not have information about the hormone receptor status of the breast cancers that were diagnosed, nor was information available about duration of hormone use.

The researchers conclude that between 2002 and 2004, a decline in hormone therapy use in Canada was accompanied by a decline in breast cancer incidence.

Additional research is warranted to determine the biologic link between hormone therapy and breast cancer. The results of the current study suggest that combined hormone therapy may speed the growth of breast cancers.

Reference: De P, Neutel I, Olivotto I, Morrison H. Breast cancer incidence and hormone replacement therapy in Canada. Journal of the National Cancer Institute [early online publication]. September 23, 2010.

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BRCA1/2 Mutations Linked with Better Outcome in Triple-negative Breast Cancer

According to the results of a small study, approximately 20% of women with triple-negative breast cancer are carriers of a BRCA1 or BRCA2 gene mutation. Triple-negative breast cancer patients with these mutations appear to have better survival than patients without these mutations. These results were recently presented at the 2010 Breast Cancer Symposium.[i]

Some breast cancers display different characteristics that require different types of treatment. The majority of breast cancers are hormone receptor-positive, meaning that the cancer cells are stimulated to grow by exposure to the female hormones estrogen and/or progesterone. These cancers are typically treated with hormonal therapy that reduces the production of these hormones or blocks their effects.? Other cancers are referred to as HER2-positive, which means that they overexpress the human epidermal growth factor receptor 2, part of a biologic pathway that is involved in replication and growth of a cell. HER2-positive breast cancers account for approximately 20-25% of breast cancers and are treated with agents that target the receptor to slow growth and replication.

Triple-negative breast cancer refers to cancers that are estrogen receptor-negative, progesterone receptor-negative, and HER2-negative. Triple-negative breast cancers tend to be more aggressive than other breast cancers and have fewer treatment options. Research is ongoing to determine prognostic factors such as gene mutations that may impact prognosis and help to individualize care.

In the current study, researchers from the M. D. Anderson Cancer Center evaluated the frequency and effects of BRCA1 and BRCA2 gene mutations among 77 women with triple-negative breast cancer. Inherited mutations in these genes can be passed down through either the mother’s or the father’s side of the family and greatly increase the risk of breast and ovarian cancer.

15 of the 77 patients (20%) had a BRCA1 or BRCA2 mutation. Five-year relapse-free survival was 86% for patients with a BRCA mutation compared with 52% for patients without a BRCA mutation.

The researchers concluded that triple-negative breast cancer patients with BRCA mutations experienced a significantly lower recurrence rate. These findings were unexpected because previous studies had not shown a difference in recurrence rates.

Patients with triple-negative breast cancer may wish to speak with their healthcare team regarding the risks and benefits of genetic testing.

It should be noted that other studies have not found as high a rate of BRCA mutations in women with triple negative breast, so it is possible that the results of this study represent an overestimate.

[i] Gonzalez-Angulo M, Chen H, Timms K, et al. Incidence and outcome of BRCA mutation carriers with triple receptor-negative breast cancer (TNBC). Presented at the 2010 Breast Cancer Symposium, Washington, DC, October 1-3, 2010. Abstract 160.

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Metastases from Breast Cancer May Differ from Primary Tumor

It appears that in metastatic breast cancer, the biologic characteristics of liver metastases sometimes differ from those of the primary tumor. This finding may affect treatment choices for metastases. Results of this retrospective study were presented at the 2010 annual meeting of the American Society of Clinical Oncology.

Three key biologic markers are used to determine treatment for breast cancer. These are estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status. These markers are expressed as positive or negative and affect the way the cancer grows. Because certain drugs are designed to stop the growth of cancer according to these markers, ER, PR, and HER2 status guide treatment choices.

The treatment of metastatic cancer (cancer that has spread to other parts of the body), is often based on the biologic markers of the primary tumor. Metastatic cancer is not always biopsied to determine its own biologic markers. If, however, metastatic cancer, such as liver metastases, has markers that differ from those of the primary tumor, the original treatment plan may not be as effective.

To evaluate the extent to which characteristics between primary breast tumors and metastases to the liver may differ, researchers in Italy compared tumor biopsies from 255 women.

Changes in ER status (from ER-negative to ER-positive and vice versa) were observed in 14.5% of liver metastases.Changes in PR status were observed in 48.6%.Changes in HER2 status were observed in 13.9%.Changes in tumor characteristics from primary to metastatic tumors resulted in changes in treatment plan for 12.1% of women.

The researchers concluded that because biologic markers of liver metastases may differ from those of primary breast tumors, biopsy of liver metastases should be considered. Accurate classification of secondary tumors by these markers may influence treatment choices.

Reference: Locatelli MA, Curigliano G, Fumagalli L, et al. Should liver metastases of breast cancer be biopsied to improve treatment choice? Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract CRA 1004.

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Additional Lymph Node Removal May Not Improve Survival in Breast Cancer Patients with Small Amounts of Cancer in Sentinel Node

Among women with early-stage breast cancer and small amounts of cancer (micrometastases) in the sentinel lymph node, removal of additional lymph nodes (completion axillary lymph node dissection) does not appear to improve overall survival. The results of this study were presented at the 2010 annual meeting of the American Society of Clinical Oncology.

For women with early breast cancer, determining whether the cancer has spread to the axillary (under the arm) lymph nodes is an important part of cancer staging. Evaluation of the axillary nodes may involve either an axillary lymph node dissection (ALND), in which many lymph nodes are surgically removed and evaluated or a less extensive procedure known as a sentinel lymph node biopsy.

The sentinel nodes are the first lymph nodes to which cancer is likely to spread. If the sentinel nodes are free of cancer, no further lymph node evaluation is performed. If the sentinel nodes contain cancer, however, most women then undergo ALND to remove additional nodes. This additional lymph node surgery has been shown to help control cancer locally, but the effect on survival has been controversial. Establishing the benefits of completion ALND is important because it can cause significant side effects such as pain, discomfort, and swelling (lymphedema).

To evaluate the effects of ALND in breast cancer patients with micrometastases in the sentinel node, researchers conducted a Phase III study among 991 women. Half the women underwent completion ALND, and half did not.

Five-year overall survival was 91.9% among women who underwent ALND and 92.5% among women who did not undergo ALND.Disease-free survival was 82.2% among women who underwent ALND and 83.8% among women who did not undergo ALND.The rate of local/regional recurrence (recurrence in or near the breast) was 4.3% among women who underwent ALND and 3.4% among women who did not undergo ALND.

In a prepared statement, the lead author of the study explained, “Our findings suggest that there may not be a benefit to removing more lymph nodes than the sentinel node only, and that women can avoid the risk of additional side effects that come with more extensive lymph node removal. Axillary lymph node dissection will still be needed in some cases, but these findings show it may be necessary for far fewer women.”

Reference: Giuliano AE, McCall LM, Beitsch PD et al. ACOSOG Z0011: A randomized trial of axillary node dissection in women with clinical T1-2 N0 M0 breast cancer who have a positive sentinel node. Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract CRA 506.

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Additional Research on Menopausal Hormone Therapy and Breast Cancer

A recent study of menopausal hormone therapy and risk of breast cancer reported that risk may vary by body weight and the type of hormone therapy. These results were published in Cancer Epidemiology, Biomarkers, & Prevention.

As women reach menopause and beyond, more than 80% will experience symptoms such as hot flashes, night sweats, sleep disturbance, and vaginal dryness. Estrogen, with or without progestin, is an effective treatment for many of these symptoms. Over the last several years, however, studies have raised important concerns about the health effects of menopausal hormone therapy.

Use of estrogen plus progestin has been linked with an increased risk of heart disease, breast cancer, stroke, and blood clots and a decreased risk of fractures and colorectal cancer. Use of estrogen alone, which is generally reserved for women who have had a hysterectomy, has been linked with an increased risk of strokes and a decreased risk of fractures.

Although it is now well established that menopausal hormone therapy with estrogen plus progestin increases the risk of breast cancer, researchers continue to explore the question of which subgroups of women are at greatest risk. This information would help personalize messages about the risks and benefits of hormone therapy.

The current study evaluated information from the California Teachers Study. Of the more than 56,000 perimenopausal or postmenopausal women in the study, 2,857 developed invasive breast cancer during 10 years of follow-up.

Compared with women who had never used hormone therapy, women who had used estrogen alone for 15 years or longer had a 19% increased risk of breast cancer (A 19% increase in risk means that if a woman has a 5% risk of getting breast cancer in the next 20 years, the risk goes up to 6%.). Women who had used estrogen plus progestin for 15 years or longer had an 83% increased risk of breast cancer (An 83% increase means that if a woman has a 5% risk over 20 years, the risk goes up to approximately 9%).For users of estrogen plus progestin, risk varied by the specific type of regimen used. Continuous regimens (progestin every day of the month) appeared to increase breast cancer risk to a greater extent than sequential regimens (progestin only some days of the month).The increased risk of breast cancer among users of hormone therapy was most apparent among thinner women.Use of hormone therapy increased the risk of cancers that were estrogen receptor-positive and progesterone receptor-positive.

These results provide additional evidence regarding the links between menopausal hormone therapy and risk of breast cancer. Women who are considering hormone therapy to manage menopausal symptoms are advised to talk with their doctor about the risks and benefits.

Reference: Saxena T, Lee E, Henderson K et al. Menopausal hormone therapy and subsequent risk of specific invasive breast cancer subtypes in the California Teachers Study. Cancer Epidemiology, Biomarkers, & Prevention [early online publication]. August 10, 2010.

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Alcohol Linked with Lobular Breast Cancer

Although alcohol is a well-established risk factor for breast cancer, it may be more strongly linked with lobular breast cancer than with ductal breast cancer. These results were published in the Journal of the National Cancer Institute.

Research suggests that each 10 gram (slightly less than one drink) increase in daily alcohol consumption increases the risk of breast cancer by roughly 7%-10%.[1] [2] This is a fairly modest increase in risk, but breast cancer is a common cancer; even a small increase in risk may translate into many additional cases on a population level.

Several studies have suggested that the relationship between alcohol and breast cancer varies by the hormone receptor status of the breast cancer. Alcohol tends to be more strongly linked with hormone receptor-positive breast cancer than with hormone receptor-negative breast cancer.

Fewer studies have explored whether the relationship between alcohol and breast cancer varies by type of breast cancer (ductal or lobular). Ductal carcinomas account for roughly 70% of invasive breast cancers in the United States, and lobular carcinomas account for 15%-20% of invasive breast cancers.???

To assess the relationship between alcohol and type of breast cancer, researchers evaluated information from the Women’s Health Initiative (WHI) Observational Study.[3] Among more than 87,000 postmenopausal women enrolled in the study, 2,944 developed breast cancer during follow-up.

Information about alcohol intake was collected by questionnaire at the time of study enrollment. ?

As expected, alcohol intake was more strongly linked with hormone receptor-positive breast cancer than hormone receptor-negative breast cancer. Compared with never drinkers, women who consumed seven or more drinks per week had an almost two-fold increase in risk of hormone receptor-positive breast cancer, but no significant increase in risk of hormone receptor-negative breast cancer. When looking at type of breast cancer, alcohol increased the risk of lobular carcinoma but did not appear to significantly increase the risk of ductal carcinoma. The rate of hormone receptor-positive, lobular breast cancer was 5.2 per 10,000 women per year among never drinkers and 8.5 per 10,000 women per year among current drinkers. By comparison, the rate of hormone receptor-positive, ductal carcinoma was 15.2 per 10,000 per year among never drinkers, and 17.9 per 10,000 per year among current drinkers.

An important limitation of the study is that information about alcohol intake was collected only at the time of study enrollment. The analysis did not account for changes in alcohol intake that may have occurred after study enrollment.

The researchers conclude “Although one of the well-known risks of alcohol is an increased risk of breast cancer, this study suggests that alcohol primarily increases risk of lobular and hormone receptor-positive breast cancer.”

References:

[1] Collaborative Group on Hormonal Factors in Breast Cancer. Alcohol, tobacco and breast cancer – collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 without the disease. British Journal of Cancer. 2002;87:1234-1245.

[2] Key J, Hodgson S, Omar RZ et al. Meta-analysis of alcohol and breast cancer with consideration of the methodological issues. Cancer Causes & Control. 2006;17:759-70.

[3] Li C, Chlebowski RT, Freiberg M et al. Alcohol consumption and risk of postmenopausal breast cancer by subtype: the Women’s Health Initiative Observational Study. Journal of the National Cancer Institute. Early online publication August 23, 2010.

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Social Interaction Can Help Relieve Breast Cancer Symptoms

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Main Category: Breast Cancer
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Article Date: 12 May 2013 - 0:00 PDT
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Social Interaction Can Help Relieve Breast Cancer Symptoms

Breast cancer patients who have lots of friends and social relationships tend to cope with the pain and other symptoms associated with the disease better than those who are more isolated, according to new research published in the journal Breast Cancer Research and Treatment.

Lead author of the study Candyce H. Kroenke, ScD, MPH, staff scientist with the Kaiser Permanente, Division of Research, said:

"This study provides research-based evidence that social support helps with physical symptoms. Social support mechanisms matter in terms of physical outcomes."

Breast cancer is a kind of cancer that develops from breast cells. Malignancy usually starts off in the inner lining of milk ducts or the lobules that supply them with milk.

Breast cancer accounts for 16% of all female cancers and 22.9% of invasive cancers in women.

As the first study of its kind to assess the effects of social interaction among cancer patients, the researchers were able to identify the benefits of having friends and engaging in social interaction with them.

In conclusion, the researchers found that breast cancer patients who engaged in more conversation and interaction in general, were able to cope with their symptoms better than those who didn't.

In addition, they found that women who had help around the house were also more able to cope with their symptoms.

Korenke said:

"While hundreds of studies have examined the role of factors influencing cancer risk and prevention, this study is one of a small but growing number that focus on quality of life after a breast cancer diagnosis."

A total of 3,139 women who were diagnosed with breast cancer participated in the study conducted by researchers at the Kaiser Permanente Division of Research in California. They analyzed what effect social interaction had on the participants' ability to cope with symptoms that are associated with the breast cancer.

Participants were asked about their social networks such as the number of friends they had, the support they received from relatives and social and community ties.

The authors found that those who had more contact with their friends or family were at a better position to deal with their symptoms. Being able to do fun things with friends helped the patients in many ways. Apart from giving them moral support, the interaction was found to help alleviate physical symptoms of the disease.

Women with the largest social networks or personal relationships reported the best overall quality of life during their breast cancer treatment. Higher levels of support was associated with better emotional well-being too.

Of the types of social interaction, positive social interaction in particular (such as the availability of other people to do fun things with) was associated with the best quality of life.

Women with little social interaction were more likely to report a low quality of life.

Kroenke and co-authors wrote:

"Positive social interaction was significantly related to every quality-of-life measure. Given that this dimension was determined by the availability of someone with whom to have fun, relax and get one's mind off things for awhile, it is possible that positive social interaction may enable women to forget for a while the distress of being a cancer patient, and the physiologic effects last beyond the actual interaction."

Women who didn't receive tangible support, which included doing chores or providing food, were 2.74 percent more likely to report a lower quality of life compared to those who did.

As more women are being cured of breast cancer, it is imperative that their quality of life following treatment improves too.

A previous study published in Cancer Prevention Research, a journal of the American Association for Cancer Research, revealed that social environment can play an important role in the biology of disease, including breast cancer, and can lead to significant differences in health outcome.

Written by Joseph Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our breast cancer section for the latest news on this subject. "Social networks, social support mechanisms, and quality of life after breast cancer diagnosis"
Candyce H. Kroenke et al
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Aspirin May Reduce Risk of Breast Cancer Recurrence and Death

Among women who are at least one year beyond a diagnosis of early-stage breast cancer, regular aspirin use may reduce the risk of breast cancer recurrence and death. These results were published in the Journal of Clinical Oncology.

Nonsteroidal anti-inflammatory drugs (NSAIDS) include drugs such as aspirin and ibuprofen. These drugs are commonly used to reduce inflammation and relieve pain. Studies conducted in the lab suggest that these drugs may have the ability to reduce breast cancer growth.

To explore the relationship between aspirin use and breast cancer outcomes, researchers conducted a study among more than 4,000 participants in the Nurses’ Health Study. The women included in the analysis had been diagnosed with Stage I-Stage III breast cancer between 1976 and 2002, and were observed until 2006.

Because women undergoing cancer treatment may need to avoid aspirin, information about aspirin use was not collected until at least one year after breast cancer diagnosis.

Compared with women who reported no aspirin use, risk of breast cancer death was reduced by 71% among women who used aspirin 2-5 times per week and by 64% among women who used aspirin 6-7 days per week.? Risk of distant recurrence was also reduced among aspirin users.The effect of aspirin on risk of distant recurrence and death did not appear to vary by cancer stage, menopausal status, body mass index, or estrogen receptor status.

These results suggest that among women living at least one year after a breast cancer diagnosis, regular aspirin use may reduce the risk of cancer recurrence and death. However, there are significant limitations of the study and aspirin should not be considered a standard treatment to prevent breast cancer recurrence.? In addition, there are risks associated with regular aspirin use.? Women with a history of breast cancer should talk to their doctors if they have further questions.

Reference: Holmes MD, Chen WY, Li L et al. Aspirin intake and survival after breast cancer. Journal of Clinical Oncology [early online publication]. February 16, 2010.

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BRCA1-2 Mutations Increase Risk of Cancer in Opposite Breast

Among women with breast cancer, those with a BRCA1 or BRCA2 gene mutation are much more likely than other women to develop a second breast cancer in the opposite breast. These results were published in the Journal of Clinical Oncology.

Some women who have been diagnosed with breast cancer will eventually develop a second breast cancer in the opposite breast. This is referred to as a contralateral breast cancer. The risk of a second breast cancer among women who have already had breast cancer is higher than the risk of a first breast cancer among women in the general population.

A factor that may influence the risk of contralateral breast cancer is the presence of BRCA1 or BRCA2 gene mutations. Inherited mutations in these genes—which can be passed down through either the mother’s or the father’s side of the family—have been found to greatly increase the lifetime risk of developing breast and ovarian cancer.

To evaluate the relationship between BRCA1 or BRCA2 mutations and risk of a subsequent contralateral breast cancer, researchers conducted a study among more than 2,000 breast cancer patients, some of whom had been diagnosed with a contralateral breast cancer and some of whom had not. Women were only included in the contralateral breast cancer group if their contralateral cancer was diagnosed at least one year after their initial cancer. All of the women had been diagnosed with their first breast cancer before the age of 55.

All of the study participants were tested for BRCA1 and BRCA2 mutations.

Compared with women without a BRCA1 or BRCA2 mutation, risk of a subsequent contralateral breast cancer was 4.5 times higher among women with a BRCA1 mutation and 3.4 times higher among women with a BRCA2 mutation.

Among women with a BRCA1 mutation, a younger age at the time of initial breast cancer diagnosis increased the likelihood of a subsequent contralateral breast cancer.

Information about risk of a subsequent contralateral breast cancer may help guide breast cancer management among women with BRCA1 or BRCA2 mutations.

Reference: Malone KE, Begg CB, Haile RW et al. Population-based study of the risk of second primary contralateral breast cancer associated with carrying a mutation in BRCA1 or BRCA2. Journal of Clinical Oncology. [early online publication]. April 5, 2010.

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Acupuncture Reduces Hot Flashes in Breast Cancer Patients

Among women treated with hormonal therapy for breast cancer, acupuncture and EffexorR (venlafaxine) were similarly effective at reducing the frequency of hot flashes. These results were published in the Journal of Clinical Oncology.

The majority of breast cancers are hormone receptor-positive. These cancers are stimulated to grow by the circulating female hormones estrogen and/or progesterone. Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen (NolvadexR) as well as agents known as aromatase inhibitors. Tamoxifen acts by blocking estrogen receptors, whereas aromatase inhibitors suppress the production of estrogen in postmenopausal women.

Common side effects of hormonal therapy include hot flashes and night sweats. Antidepressants such as Effexor have shown some effectiveness in managing these symptoms but can produce side effects and may not be acceptable to all women.

Acupuncture is a form of traditional Chinese medicine that aims to improve health by stimulating specific points of the body. [1] Because acupuncture has shown some promise in reducing hot flashes in breast cancer patients, researchers conducted a study to compare it to Effexor. [2] The study involved 50 women with Stage 0-III breast cancer who were experiencing hot flashes during hormonal therapy. Half the women received acupuncture for 12 weeks, and half the women were treated with Effexor for 12 weeks.

Both groups (acupuncture and Effexor) experienced significant decreases in hot flash frequency. Acupuncture appeared to be as effective at reducing hot flashes as Effexor.By two weeks after completing treatment with acupuncture or Effexor, hot flash frequency increased in the Effexor group but remained at low levels in the acupuncture group.Side effects among women treated with Effexor included nausea, dry mouth, dizziness, and anxiety. Acupuncture did not produce any negative side effects.

These results suggest that acupuncture may be as effective as Effexor at reducing the frequency of hot flashes in breast cancer patients treated with hormonal therapy.

References:

[1] National Center for Complementary and Alternative Medicine. Acupuncture: An Introduction. Available at: http://nccam.nih.gov/health/acupuncture/introduction.htm. Accessed January 4, 2010.

[2] Walker EM, Rodriguez AI, Kohn B et al. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. Journal of Clinical Oncology [early online publication]. December 28, 2009.

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Micrometastases Affect Breast Cancer Prognosis

Among women with early breast cancer, those with very small areas of cancer (micrometastases) in the axillary lymph nodes tend to have a higher risk of recurrence than those whose lymph nodes are completely free of cancer. These results were published in the Journal of Clinical Oncology.

Evaluation of the axillary (under the arm) lymph nodes for the presence of cancer is an important part of breast cancer staging. To assess the axillary lymph nodes, a surgeon will perform either an axillary lymph node dissection, in which many lymph nodes are surgically removed and evaluated, or a less extensive procedure known as a sentinel lymph node biopsy.

For some women, evaluation of the lymph nodes will reveal very small areas of cancer. Areas of cancer that measure between 0.2 mm and 2.0 mm are referred to as “micrometastases.” Even smaller areas of cancer are referred to as “isolated tumor cells.” The clinical significance of lymph node micrometastases and isolated tumor cells has been uncertain but was evaluated in a study conducted in Sweden.

The study collected information about the treatment and outcomes of 3,369 breast cancer patients. A total of 2,383 were node-negative, 107 had isolated tumor cells in the axillary lymph nodes, 123 had micrometastases, and 756 had macrometastases (larger areas of cancer in the lymph nodes).

Five-year survival without cancer recurrence was 87.1% among women with no lymph node metastases, 88.9% among women with isolated tumor cells, 79.6% among women with micrometastases, and 80.1% among women with macrometastases. Compared with node-negative women, overall survival was not significantly worse among women with micrometastases or isolated tumor cells, but was worse among women with macrometastases.

These results suggest that women with lymph node micrometastases have a higher risk of breast cancer recurrence than women with cancer-free lymph nodes. Isolated tumor cells in the lymph nodes did not appear to affect outcomes in this population.

Reference:?

Andersson Y, Frisell J, Sylvan M, de Boniface J, Bergkvist L. Breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. Journal of Clinical Oncology [early online publication]. May 10, 2010.

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Male BRCA2 Carriers Have Increased Lifetime Risk of Breast Cancer

Men who carry the BRCA2 genetic mutation have a 7.1% chance of developing breast cancer by age 70 and an 8.6% chance of developing the disease by age 80, according to the results of a study published early online in the Journal of Medical Genetics.[1]

Inherited mutations in two genes—BRCA1 and BRCA2—have been found to greatly increase the lifetime risk of developing breast cancer (as well as ovarian cancer in women). Alterations in these genes can be passed down through either the mother’s or the father’s side of the family. Research is ongoing to determine the level of risk presented by these genetic mutations; however, very few studies have focused on male BRCA carriers.

In only the fourth study to do so, researchers from the UK assessed the lifetime risk of breast cancer among men with the BRCA2 mutation. Previous studies have suggested that the BRCA2 mutation places men at higher risk of breast cancer than the BRCA1 mutation.

Using a database that included all male first-degree relatives of BRCA2 carriers over the age of 20, the researchers identified 321 families with proven mutations and 905 male first-degree relatives of proven BRCA2 carriers. Performing a retrospective and prospective analysis of the data, the researchers ascertained that the risk of male BRCA2 carriers developing breast cancer by age 70 was 7.1% and by age 80 was 8.6%.

The researchers concluded that this risk was sufficient to warrant increased awareness about breast cancer among men in BRCA2 families.

Reference:

[1] Evans DG, Susnerwala I, Dawson J, et al. Risk of breast cancer in male BRCA2 carriers. Journal of Medical Genetics [early online publication]. June 28, 2010.

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Updated Guidelines Address Hormonal Therapy for Breast Cancer

Among postmenopausal women with hormone receptor-positive breast cancer, use of an aromatase inhibitor at some point in the course of adjuvant (post-surgery) treatment results in a lower risk of cancer recurrence than use of tamoxifen only. Based on these results, updated guidelines from the American Society of Clinical Oncology recommend consideration of aromatase inhibitor therapy for this group of patients.[1]??

Each year roughly 200,000 U.S. women are diagnosed with breast cancer. Many of these breast cancers will be hormone receptor-positive, meaning that they are stimulated to grow by the circulating female hormones estrogen and/or progesterone.

Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen as well as agents known as aromatase inhibitors. Tamoxifen acts by blocking estrogen receptors, whereas aromatase inhibitors suppress the production of estrogen in postmenopausal women. Aromatase inhibitors include ArimidexR (anastrozole), FemaraR (letrozole), and AromasinR (exemestane).

Several large trials comparing aromatase inhibitors to tamoxifen have established the efficacy of aromatase inhibitors for the treatment of hormone receptor-positive breast cancers among postmenopausal women. Whether aromatase inhibitors are used as initial hormonal therapy or sequentially with tamoxifen, use of an aromatase inhibitor at some point during the course of adjuvant treatment has been shown to reduce the risk of breast cancer recurrence compared with tamoxifen alone.

Based on these results, the American Society of Clinical Oncology recently updated its hormonal therapy guidelines.? As recommended in the latest guideline, the panel recommends that “postmenopausal women with hormone receptor-positive breast cancer consider incorporating [aromatase inhibitor] therapy at some point during adjuvant treatment, either as up-front therapy or as sequential treatment after tamoxifen. The optimal timing and duration of endocrine therapy treatment remain unresolved.”

Potential side effects of aromatase inhibitors that will need to be considered by the patient and her physician include bone loss and joint pain. Aromatase inhibitors also appear to be more likely than tamoxifen to cause increases in blood pressure and cholesterol levels.

Reference:

[1] Burstein HJ, Prestrud AA, Seidenfeld J et al. American Society of Clinical Oncology Clinical Practice Guidelines: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. Journal of Clinical Oncology [early online publication]. July 12, 2010.

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Lapatinib Approved for Initial Treatment of Metastatic Breast Cancer

The U.S. Food and Drug Administration (FDA) has expanded its approval of lapatinib (TykerbR) to include initial treatment of metastatic, postmenopausal breast cancer that is both HER2-positive and hormone receptor-positive. In this setting, lapatinib is approved for use in combination with the aromatase inhibitor drug letrozole (FemaraR).

Twenty to thirty percent of breast cancers overexpress (make too much of) a protein known as HER2. Overexpression of this protein leads to increased growth of cancer cells. Fortunately, the development of treatments that specifically target HER2-positive cells has improved outcomes among women with HER2-positive breast cancer. Drugs that target HER2 include trastuzumab (HerceptinR) and lapatinib.

Lapatinib was initially approved in 2007 for use in combination with the chemotherapy drug capecitabine (XelodaR) for the treatment of HER2-positive advanced or metastatic breast cancer that has progressed following prior therapy with an anthracycline, a taxane, and trastuzumab.

The expansion of lapatinib’s approval to include the initial treatment of metastatic breast cancer was based on a study in 219 postmenopausal women with HER2-positive, hormone receptor-positive, metastatic breast cancer. Women were treated with either letrozole alone or letrozole plus lapatinib. Both drugs are given orally.

Progression-free survival was 5.2 months longer among women treated with letrozole and lapatinib than among women treated with letrozole alone.

The most common side effects of lapatinib include diarrhea, rash, nausea, and fatigue.

Reference: FDA News Release. FDA expands use of approved breast cancer drug. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199374.htm. Accessed February 1, 2010.

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Midlife Weight Gain Increases Postmenopausal Breast Cancer Risk

Women who gain weight in midlife may have an increased risk of developing postmenopausal breast cancer, according to research findings presented at the 2010 Annual Meeting of the American Association for Cancer Research.

Research into lifestyle factors that influence breast cancer risk or prognosis allows us to make more informed decisions about how to manage our own health. Body weight is a factor that appears to influence not only the risk of developing several types of cancer but also cancer survival.

To further understand how weight gain in midlife affects risk of postmenopausal breast cancer, researchers studied the effects of weight gain during two periods: 1) from age 20 to age 50 and 2) after age 50. The study consisted of approximately 72,000 women, age 55 to 74 at the beginning of the study. Results were presented for participants who had never used menopausal hormone therapy, as this group showed the strongest association between midlife weight gain and postmenopausal breast cancer risk.

Between age 20 and the start of the study, 57% of study participants had an increase in body mass index (BMI) of 5 kg/m2 or more. For a woman with a height of 5’4”, this equates to a weight gain of approximately 30 pounds.

Regardless of weight at age 20, weight gain during midlife increased the risk of postmenopausal breast cancer. Women with a BMI increase of 5 kg/m2 between age 20 and study entry (at age 55-74) were almost twice as likely to develop postmenopausal breast cancer as women who maintained a stable BMI. Weight gain during either of the two age periods (20-50 and 50+) increased risk.

The researchers concluded that maintaining weight throughout adulthood may help women decrease their risk of postmenopausal breast cancer.

Reference: Sue LY, Genkinger JM, Schairer C, et al. Body mass index gain throughout adulthood may increase risk of postmenopausal breast cancer. Paper presented at: Annual Meeting of the American Association for Cancer Research; April 20, 2010; Washington, D.C. Abstract 4823.

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