Reviewing Traditional Risk Factors for breast cancer survivors

Reviewing Traditional Risk Factors

I’m not afraid of storms, for I’m learning how to sail my ship.
—Louisa May Alcott


Learning how to sail your ship is what this book is all about. Amid the troubled
waters of a breast cancer diagnosis or the risk of one, there is great hope, because
every year, we learn more about sailing our ships.

We’ll start by reviewing risk factors that have been well
documented over the past several decades. Except where otherwise indicated, all of
the data contained in this chapter were provided by the National Cancer Institute
(NCI) (2011) and the American Cancer Society (ACS) (2011b). Some of these risk
factors cannot be changed. In subsequent chapters, however, we’ll look at more
recently discovered risk factors and their profound implications. These new
discoveries are especially exciting, because they are modifiable risk factors,
meaning that your own dietary and lifestyle choices can have a profound impact on
your ability to modify your risk level. And that’s great news to anyone with
concerns about breast cancer.

Traditional Risk Factors

This generation of women in the United States faces a greater lifetime risk of breast
cancer than any previous one, with rates having tripled during the past forty years,
according to holistic nurse educator and clinical nutritionist Susan Luck (2010). In
fact, the NCI (2010) estimates that 12.15 percent (one in seven) of women born in
2009 will be diagnosed with breast cancer at some time in their lives. And if you’ve
already had breast cancer, you’re undoubtedly concerned about your risk of
recurrence.

Gender

Being female is, by far, the most substantial risk factor. According to the ACS,
the incidence of breast cancer is about 100 times higher in women than in men. The
explanation for this difference is not the number of breast cells per se, but rather the
contact female breast cells have with the growth-stimulating effects of female
hormones.

Race also plays a role in breast cancer. According to the ACS, Caucasian women
have a higher incidence of breast cancer, although more African American women
die from it. Asian Americans, Hispanics, and Native Americans appear to have a
lower risk of both incidence and death from breast cancer.

Age

Your risk of developing any illness increases with age. It is now estimated that
one in eight invasive breast cancers (cancers that invade surrounding areas) are
found in women who are younger than age forty-five, and unfortunately risk rises
steeply with age. Two out of three cases of breast cancer in women aged fifty-five
and older are considered invasive.

Weight

Prior to menopause, your ovaries produce most of your estrogen, while fat
tissue produces only a small amount. After menopause, the ovaries shut down
production, and most of your estrogen comes from the adrenal glands and fat tissue.
Having more fat increases your estrogen levels, which can raise your chance of
developing breast cancer, and it appears that having more abdominal fat may
increase your risk. What’s more, women who are overweight have higher levels of
circulating insulin. Insulin, being a growth factor, is an independent risk for breast
cancer, a topic we’ll expand on next explain about Glucose, Weight, and Insulin Control.

Lack of Physical Activity

Lack of physical activity not only leads to weight gain but also may be another
factor that increases your risk of developing breast cancer. The Women’s Health
Initiative (WHI) (McTiernan et al. 2003) found that “as little as 1.25 to 2.5 hours per
week of brisk walking reduced a woman’s risk by 18 percent.” The ACS
recommends forty-five to sixty minutes of physical activity, five or more days per
week.

Genetic Factors

Fortunately, only 5 to 10 percent of breast cancers result directly from mutations
due to inherited genetic defects. The much-publicized BRCA-1 and BRCA-2 genes
are examples of these defective genes. If you inherit a mutated copy of either of
these genes, your risk of developing breast cancer escalates to as high as 80 percent.
What’s more, when breast cancer strikes women with these genes, it happens at a
younger age and tends to show up, more often than not, in both breasts (bilateral
presentation). Jewish woman of Eastern European descent have the highest
incidence of this genetic pattern, although it can occur in any race or ethnic group.
Other alterations in genes, such as p53, ATM, CHK2, and CDH1, increase breast
cancer risk as well. Modern technology allows us to identify these aberrant genes
through specialized genetic testing (see appendix B). This testing is not routinely
provided to women with concerns about breast cancer risk, although a doctor can
order it at the patient’s or a family member ’s request at any age.

Hormonal Factors

Cumulative lifetime exposure to estrogen is considered a risk factor for breast
cancer, so early puberty (before age twelve), and late menopause (after age fiftyfive)
each add to your risk. Other hormonal factors include the timing of pregnancy,
breastfeeding, weight, exposure to oral contraceptives, use of hormone replacement
therapies, and use of the synthetic estrogen diethylstilbestrol (DES).

Lack of Physical Activity

Lack of physical activity not only leads to weight gain but also may be another
factor that increases your risk of developing breast cancer. The Women’s Health
Initiative (WHI) (McTiernan et al. 2003) found that “as little as 1.25 to 2.5 hours per
week of brisk walking reduced a woman’s risk by 18 percent.” The ACS
recommends forty-five to sixty minutes of physical activity, five or more days per
week.

Genetic Factors

Fortunately, only 5 to 10 percent of breast cancers result directly from mutations
due to inherited genetic defects. The much-publicized BRCA-1 and BRCA-2 genes
are examples of these defective genes. If you inherit a mutated copy of either of
these genes, your risk of developing breast cancer escalates to as high as 80 percent.
What’s more, when breast cancer strikes women with these genes, it happens at a
younger age and tends to show up, more often than not, in both breasts (bilateral
presentation). Jewish woman of Eastern European descent have the highest
incidence of this genetic pattern, although it can occur in any race or ethnic group.
Other alterations in genes, such as p53, ATM, CHK2, and CDH1, increase breast
cancer risk as well. Modern technology allows us to identify these aberrant genes
through specialized genetic testing (see appendix B). This testing is not routinely
provided to women with concerns about breast cancer risk, although a doctor can
order it at the patient’s or a family member ’s request at any age.

Hormonal Factors

Cumulative lifetime exposure to estrogen is considered a risk factor for breast
cancer, so early puberty (before age twelve), and late menopause (after age fiftyfive)
each add to your risk. Other hormonal factors include the timing of pregnancy,
breastfeeding, weight, exposure to oral contraceptives, use of hormone replacement
therapies, and use of the synthetic estrogen diethylstilbestrol (DES).

EARLY PUBERTY

The rising rate of obesity in our youth may be a contributing factor to early
puberty since body fat can produce the sex hormones that lead to glandular
development. The notion that environmental chemicals that mimic estrogen may
contribute to an earlier onset of puberty has been suggested but remains unproven
(Grady 2010).

PREGNANCY STATUS

The rising rate of obesity in our youth may be a contributing factor to early
puberty since body fat can produce the sex hormones that lead to glandular
development. The notion that environmental chemicals that mimic estrogen may
contribute to an earlier onset of puberty has been suggested but remains unproven
(Grady 2010).