What’s Your Risk? Breast Cancer in the News Again

I was pleasantly surprised to learn how much damage occurred at the Susan G. Komen Foundation in response to its astonishingly wrong-headed decision to cut off funding to Planned Parenthood. Women (and smart men) around the country were rightly outraged that money earmarked for the breast cancer screening of low-income women–not for family planning or abortion–had been blocked by the highly paid executives at Komen.

There was some talk that Komen’s CEO, Nancy Brinker, a powerful Republican party backer, was stepping down, but this was not the case. In fact, she got the board to bump up her annual salary 64% to $684,000.

Former Komen executive and vocal pro-life advocate Karen Handel, who was responsible for spearheading the Planned Parenthood cut-off, is now running for the Senate.

But the damage to Komen has been done. Donations are down by nearly 40%, the three-day walk on Washington has been officially cancelled for 2014, and races in seven other major cities, including Chicago, have been cancelled for lack of participation. Although Komen blames the economy for this precipitous decline, other organizations (like the Avon walk, American Cancer Society, and Planned Parenthood) haven’t seen any substantial revenue changes.

Stoking fear

Before the Planned Parenthood debacle, my issue with the Komen Foundation and similar charity organizations that focus on a single disease was they’re all a bit too alarmist. The fear they’ve managed to stoke in women didn’t match the statistics.

Although I’m certainly not arguing that breast cancer isn’t a significant health issue, it seemed that all the hoopla, ribbons, t-shirts, and funny hats were supporting a single disease and those who profit from it—oncologists, radiation therapists, cancer hospitals, and the pharmaceutical industry. Yet when I look at photos of a Komen event, I mainly see white women, the very group that actually has a lower breast cancer risk than black, Hispanic, or Asian women.

Women’s awareness of their breast cancer risk was the subject of a paper presented just last Saturday and published online. It turns out that most women, 90% in fact, are simply wrong when asked about their own personal risk of developing the disease. Of these 90%, fully half overestimate their risk. These were generally the white, pink-ribbon group, and as they tried to be proactive in regard to breast cancer likely spent a lot of unnecessary worry time, with too many mammograms, too much struggle with breast self-examination, and far too many negative breast biopsies.

The other half, the “under-estimators” of breast cancer risk, are mainly black, Hispanic, and Asian women, who did not get the screening they needed and deserved. And their situation was not helped as Komen cut funding to Planned Parenthood. The numbers are interesting: 45% of women overestimate their breast cancer risk, 45% underestimate, and just 10% get it right.

What’s your risk?

It’s fairly straightforward to approximate your personal lifetime risk for developing breast cancer. Here’s a link to a brief risk assessment tool. After you’ve walked through it we’ll move on to the new recommendations for breast cancer screening and prevention. For the many patients who have asked me about this, a history of using birth control pills does not–repeat not–increase your breast cancer risk.

Here’s the latest in breast cancer screening

The US Preventive Services Task Force (USPSTF) is recommending sweeping changes in its breast cancer screening guidelines, as follows:

• Routine screening of average-risk women should begin at      age 50, instead of 40.
• Routine screening should end at age 74.
• Women should get screening mammograms every two years      instead of every year.
• Breast self-exams have little value, based on the findings      of several large studies.

These recommendations weren’t universally agreed upon by all physicians and were most vocally opposed by radiologists, who, in the name of “patient safety,” could anticipate a big income loss with this drop in mammogram traffic.

I emphasize to my patients that the guidelines aren’t written in stone. If you feel a suspicious lump, you should definitely act on it. If you have a strong family history of breast and/or ovarian cancer, consider getting tested for the BRCA gene and mammograms should definitely begin in your 40s. What everyone does agree on: don’t bother with the monthly breast self-exams that continue to be recommended by some organizations.

On to breast cancer prevention

Here’s what we know:

• Women who smoke are at increased risk.
• Women who drink more than one or two drinks daily are at risk.
• Being overweight increases your risk.
• Regular aerobic exercise decreases your risk.
• Breastfeeding may (but won’t necessarily) decrease your risk.
• Exposure to radiation and environmental pollutants increases your risk (you’ll be wise to reduce the number of MRIs you have and avoid excessive exposure to exhaust fumes).
• Low vitamin D levels increase breast cancer risk. Taking 2,000 IU daily will reduce risk.

Here are a few more ideas that seem to be panning out as good preventive measures:

• Eating a diet rich in high-antioxidant fresh fruits and vegetables.
• Eating a diet low in saturated (animal-based) fats.
• The following foods contain ingredients that (at least in the laboratory) have specific cancer-preventing and cancer-fighting properties: broccoli, curcumin (turmeric), garlic, green tea, fish, apples, berries, soybeans, pomegranates, walnuts, flaxseed, and orange fruits and vegetables.
• Calcium D-glucarate has undergone no human studies to date, but has been shown to prevent breast and other cancers in lab animals. Several of the active ingredients listed above, including Calcium D glucarate, can be found in Healthy Cells Breast, available in our apothecary.

Be well,
David Edelberg, MD