Breast cancer is one of the most publicized and misunderstood diseases today. While it is the leading cause of death in women with cancer, overall it’s heart disease that is the #1 cause of death for women. October is Breast Cancer Awareness month, so it’s the perfect time to address some of the misconceptions about causes, risk factors, and some recent innovations in early cancer detection.
The largest and most harmful misconception is that hormones and HRT actually cause women to develop breast cancer. As a doctor and specialist in Women’s Health and Hormonal Health in particular, I can assure you this is FALSE. The Women’s Health Initiative (WHI) released the results of the largest study ever done on synthetic hormones in early 2002. The ongoing media hype ended up scaring the crap out of women and their doctors. The problem is that the WHI study results were skewed, misreported and misunderstood, resulting in doctors and women avoiding HRT for the next decade.
Most women and even worse – their doctors – base their opinions about hormone replacement therapy (HRT) on this study and the hype surrounding it. What most do not realize is that this was just ONE poorly designed and highly flawed study on TWO bad synthetic drugs – Premarin and Prempro, which were largely no longer used by medical professionals. The women in the study were also older than women who would normally be ideal candidates for HRT.
James H. Clark, the author of one of the papers critiquing the study, wrote: “Most reproductive scientists believe that post-menopausal hormones should be used as preventive, not corrective therapy; therefore, treatment should begin during the menopausal transition.”
In fact, the worst estrogen drug in the WHI study, Premarin (a synthetic drug made from the urine of pregnant mares) actually showed a decrease in risk for breast cancer. Prempro, the other drug studied, showed no statistical increase for breast cancer at all. The media and medical professionals got it all wrong and continue to get it wrong, and women’s health has suffered for it.
It was precisely because of the WHI study that doctors become concerned about liability, as they could potentially be sued if a patient on HRT developed breast cancer. There is a large amount of data that shows that many types of HRT are safe and have positive effects on women’s health and actually reduce the risk of breast cancer. Bio-identical hormone replacement therapy carries no increased risk for breast cancer, and their use in women with hormonal deficiencies or symptoms of menopause also offsets many other serious health risks. The hormone testosterone is also used in palliative breast cancer treatment as it lowers the breast density and, best of all, the recurrence rate.
PREVENTION, RISK FACTORS AND EARLY DETECTION
Understanding the overall risk factors for developing breast cancer and the importance of early detection is key. The survival rate for women with breast cancer is 95% at 5 years – if it is caught and treated early. Regular self-examination of the breasts is recommended for all women, as are annual mammograms after the age of 40.
Risk factors for developing breast cancer include gender – as a woman, you are far more likely to develop breast cancer, but it can also occur in men. Aging is another factor – as you get older and your hormone levels fall, your risk increases. According to the American Cancer Society, 1 of 8 invasive breast cancers occur in women younger than 45, while around 2 of 3 invasive breast cancers occur in women older than 55.
Genetics also play a large role. Between 5-10% of invasive breast cancers are thought to be hereditary due to mutations in BRCA1 and BRCA2 genes. This mutation increases the risk of developing breast cancer at a younger age, as well as ovarian cancer. Awareness of this risk factor was highlighted when actress Angelina Jolie, whose mother died of ovarian cancer, revealed she had opted to undergo a preventive double mastectomy in early 2013, and will most likely opt to have a complete hysterectomy in the future. In the US, these mutations are most commonly found in women of Ashkenazi Jewish descent (Eastern Europe) but they can occur in anyone.
Other risk factors to consider are family history of breast cancer in a close relative, mother, sister or aunt, or a male relative, but overall these account for less than 15% of breast cancers. Race and ethnicity also play a role – Caucasian women are slightly less at risk than those of African descent. African American women are more likely to die from breast cancer, but there are a variety of factors that account for this statistic, including higher rates of poverty and access to preventive care. Lifestyle risk factors include smoking, excess alcohol consumption, being overweight or obese, lack of regular exercise, poor dietary habits, long-term use of oral contraceptives and chemical exposure from the environment through pesticides and hormones.
One of the most exciting developments we’ve seen in the field of early detection for breast cancer is the DtectDx Breast test, designed to be used in conjunction with mammography. The blood test detects markers in the patient’s blood that indicate early stages of breast cancer. Test results allow physicians to decide whether a routine mammogram, more extensive imaging or biopsy is appropriate for the patient. While this test is relatively new, it is particularly useful for women under age 50, as results are not affected by dense breast tissue or scar tissue from previous biopsies. Understanding personal cancer risk factors, the truth about the benefits of HRT and the importance of early detection can all help women make the health choices that are right for them.