The Good News about Breast Cancer
When you ask women which health problem they fear most, the overwhelming answer is breast cancer, according to a poll by the Society for Women's Health Research. And who can blame us for being scared? The disease claims more than 40,000 lives every year, and the odds-one in eight women will develop it in her lifetime-defi nitely have a way of sticking in our minds.
But as frightening as these stats sound, there's actually a lot of good news about breast cancer these days. "It's an exciting time," says Leslie Ford, M.D., associate director for clinical research in the National Cancer Institute's Division of Cancer Prevention. "We're starting to understand the molecular and genetic basis of tumors, which is helping us develop better ways to treat the disease and even prevent it in high-risk women." These advances have made a signifi cant impact: Death rates from breast cancer have declined steadily since 1990. When diagnosed and treated early, more than 90 percent of women with breast cancer now survive at least five years.
Raising your awareness of this disease is the first step toward lowering your risk. To keep you in the loop, we've gathered the latest research findings, along with tips from cancer experts and survivors, so you can take control of your breast health today.
Simple everyday strategies to reduce your risk
Okay, there's no getting around it: Certain factors-age, race, family history of the disease, and even your height-can affect your odds of getting breast cancer. In fact, simply being a woman is the number-one trait for developing the disease. Although you can't erase these risk factors, research is yielding promising results about some simple things you can do to offset them.
- Fine-Tune Your Diet
Studies show that breast cancer is less common in countries where the typical diet is low in total fat and saturated fat. Another study found that women who eat a Mediterranean diet rich in fruits and vegetables lower their odds by as much as 15 percent.
- Get Physical
Not only does regular exercise bolster your immune system; it also helps prevent the pounds from piling on as you age. And that's a good thing for your breasts, since excess body fat increases the production of the hormone estrogen, which fuels many types of breast cancer. "Carrying extra weight is a huge risk factor for the disease after menopause, so it's important to learn to control it while you're young," says Marji McCullough, Sc.D., a nutritional epidemiologist at the American Cancer Society. Now a new study has pinpointed the amount of exercise and the intensity level you need to reap breasthealth benefits. Researchers from the University of Wisconsin found that women who regularly worked up a sweat for at least six hours every week were 23 percent less likely to get breast cancer than those who didn't exercise. Estrogen can spur abnormal breast-cell growth, explains Brian Sprague, Ph.D., lead study author and research assistant at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison. "Vigorous exercise shortens the luteal phase of the menstrual cycle (the two or so weeks before you get your period), decreasing your exposure to that hormone." (Read "The Workout That Can Lower Your Breast-Cancer Risk" for a specific exercise prescription.)
- Breast-Feed Your Baby
You've probably heard that waiting until your 30s to give birth increases your risk of developing breast cancer. But new research from the University of Southern California shows that you may be able to counteract some of that effect by breast-feeding. "The breasts may be particularly susceptible to the effects of cancer-causing substances in the environment, such as secondhand smoke or pesticides, between the time you start to menstruate in adolescence and the time you first conceive," says lead study author Giske Urkin, M.D., Ph.D., associate professor in the department of preventive medicine. "Pregnancy seems to alter the breast cells so they're less vulnerable to these factors, and breastfeeding may change them even more."
- Kick Butts
While breast cancer is not considered a smoking- related disease per se, research has linked smoking in younger women to a greater risk of the disease. According to a study of more than 56,000 women recently published in the American Journal of Epidemiology, the breast cancer-promoting effects of cigarette smoking appear to be strongest in young women who have not yet had children. For example, women who had smoked a pack a day for 10 years before they gave birth for the first time were 78 percent more likely to develop breast cancer than women who never smoked. Need some stop-smoking support? Find a free quit plan, educational materials, and referrals to local resources at smokefree.gov.
- Prevent It With A Pill
For women with a greater-than-average risk of developing breast cancer-as a result of heredity, say, or a suspicious biopsy-one of two estrogeninhibiting drug regimens may help keep the disease at bay. Researchers from the National Cancer Institute revealed a nearly 50 percent reduction in occurrences of the illness in women who were given tamoxifen. Meanwhile, in another a large-scale National Cancer Institute study, raloxifene, a pill formerly prescribed for osteoporosis, was found to work as well as tamoxifen, but with fewer risky side effects, like blood clots and uterine cancer. "Raloxifene hasn't been approved for use in premenopausal women," says Ford. "But tamoxifen is still quite underused in young women, which is a shame, because it's one of the best preventive strategies we have available."
Better detection tools The earlier cancer is discovered, the more likely you are to beat it. And while the mammogram is still the screening method of choice, detecting 80 to 90 percent of cancers before a lump is even felt, it's not the best test for young women, whose breasts tend to be dense (meaning they have more glands and connective tissue and less fat).
Like tumors, dense tissue shows up as white space on the X-ray, making it more difficult for the radiologist to distinguish between the two. So if you find a lump, your doctor may recommend an ultrasound (which uses high-frequency waves to determine whether it's a benign cyst or a solid mass) or a digital mammogram. "The images are captured on a computer, so you can zoom in to examine suspicious areas more closely-a real benefit in women with dense breasts," says Marisa Weiss, M.D., a breastradiation oncologist in Philadelphia and founder of breastcancer.org. And unlike its film counterpart, the digital device provides immediate results that may be shared on e-mail with other doctors. If your imaging results are inconclusive, ask your ob-gyn about elasticity imaging, a modified version of an ultrasound that measures a lump's firmness. (Harder lumps are more likely to be malignant.) Researchers from Northeastern Ohio Universities College of Medicine reported that the technique, when tested on 72 lumps, was able to correctly identify all 16 that were cancerous.
For young and high-risk women, another diagnostic test is making it easier to find and classify lumps: magnetic resonance imaging, or MRI. "These machines look at blood flow," says Elizabeth Morris, director of breast MRI at Memorial Sloan-Kettering Cancer Center in New York City. "And since tumors create their own blood supply, the test can find them at a very early stage." The American Cancer Society now recommends MRI in addition to a mammogram for all women who carry the breast-cancer genes BRCA1 or BRCA2 (a blood test can detect their presence) or who have a firstdegree relative (a mother, father, sister, or brother) with the gene, or a number of close relatives who have had breast cancer. If you have had precancerous lumps or have extremely dense breasts, you should talk to your doctor about adding MRI to your annual mammog raphy screenings.
Customized Treatments Breast cancers all used to be treated in much the same way, usually with some combination of surgery, radiation, and chemotherapy. "But we've come to realize that breast cancer isn't just one disease," says Clifford Hudis, M.D., chief of the breast-cancer medicine service at Memorial Sloan-Kettering Cancer Center. "We're separating tumors into subsets based on their genetic and molecular traits, and as a result, we're offering women more targeted, effective treatments."
That's been made easier thanks to two new diagnostic tests, the Oncotype DX and MammaPrint. These allow doctors to look at the status of genes in the tumor tissue to determine who will need chemotherapy in addition to surgery and radiation- and to predict a tumor's likelihood of recurrence. "They're wonderful tools because they can tell us how the tumor should behave, and then guide our treatment choices," says Julie Gralow, M.D., associate head of the Breast Cancer Program at the Fred Hutchinson Cancer Research Center in Seattle. "For example, only 15 to 20 percent of women with earlystage estrogen-fueled tumors actually need chemo, but until now it hasn't been easy to tell who does and who doesn't," she says. "So we've erred on the side of treatment, which means that lots of women have undergone unnecessary chemotherapy."
New drugs, used alone or in combination with existing ones, are broadening treatment options and helping us tackle the disease like never before. For example, Herceptin, which has been approved for early- and advanced-stage breast cancer, is still the first choice for women with tumors that test positive for HER-2, a protein that spurs cancer cells to grow and proliferate. But for some women, the drug stops working and the tumor returns. Fortunately for them, there's the newly approved Tykerb. "It's being used successfully in conjunction with oral chemotherapy for women with advanced HER-2 breast cancer," says Halle Moore, R.D., of the Cleveland Clinic.
Next on the horizon for breast cancer researchers: testing the effectiveness of drugs that work on a cellular level, which could significantly shorten the amount of time between trials and FDA approval, says Ford. Preventive vaccines, which use your immune system to extinguish the disease, are also being studied. "Research is very preliminary, but will a vaccine be available at some point in the future?" she asks. "We're all very hopeful."