What causes breast cancer? In most cases, it boils down to the number of candles on your birthday cake, genetics and lifestyle choices. Age may be a woman’s biggest risk factor (the disease is most common in postmenopausal women), but even women in their 20s can get breast cancer—though it’s rare, says Susan Brown, MS, RN, director of health education at the Susan G. Komen for the Cure. Changes in genes’ DNA over the years can lead to cancer, and those changes may be triggered by certain lifestyle and environmental factors, such as obesity and secondhand smoke, as well as genetics. However, only an estimated 5 to 10% of breast cancer cases may be linked to the breast-cancer susceptibility genes known as BRCA1 and BRCA2. What are the symptoms of breast cancer? The increase in women being screened has detected many more cancers before symptoms develop, but some are missed. The most common sign of breast cancer is a lump, but this is not always the case. 10% of those diagnosed with breast cancer have no lumps, pain, or other indications of a problem in their breasts. And among lumps that are detected, 80 to 85% are benign. They’re often cysts or noncancerous tumors called fibroadenomas. That said, any lump or breast symptom that does not go away should be checked by a doctor, including discharge. Other signs of breast cancer may be a change in size or shape of the breast or nipple, and tenderness. Which tests are best for detecting breast cancer? Mammograms offer our best means of early detection—for current guidelines on when to get them, see Mammograms: Who Needs Them?—but they’re not perfect. Research shows they can miss up to 20% of breast cancers in women who don’t have any symptoms. And just because one exam comes back normal doesn’t mean breast cancer won’t develop later—which is why current guidelines call for mammograms annually. To be safe, do self breast exams, paying particular attention to any changes in how your breasts look or feel. Also, digital mammograms are more effective than traditional film mammography at spotting cancer in younger women. In a large, multi-center study, digital scans found 15% more cancers than standard mammograms in women under age 50. Another new development that recently received FDA approval is the digital tomosynthesis, which offers a three-dimensional picture of the breast by combining multiple, thinly-sliced digital x-ray images. How can I treat breast cancer? Cancer treatment depends on many factors, including what stage of breast cancer you may have. Treatment options include: Surgery. A lumpectomy removes part of the breast affected by cancer, while a mastectomy may remove the entire breast as well as other areas such as lymph nodes. Antiestrogens. Drugs that block the activity of estrogen in the breast, which may stop the growth of some breast tumors that need estrogen to grow, such as Tamoxifen. Tamoxifen comes as a tablet to take by mouth. Chemotherapy. Cancer-killing drugs that can either be taken intravenously or by mouth, such as cyclophosphamide and 5-fluorouracil. In most cases, chemo is most effective when combinations of more than one drug are used. Radiation. High-power X-rays kill the DNA of cancer cells to keep them from dividing and spreading and to help shrink tumors. Cancer Vaccines. Researchers are working on ways to recruit the body’s defenses to be an ally in the fight against breast cancer. These so-called cancer vaccines will be unlike traditional vaccines in that they are designed not to ward off disease but to prevent its return by training the immune system to seek out cancer cells that have survived chemotherapy. The vaccines will program the immune cells with precise directions, almost as if they had an address and a GPS, to find the rogue cells. William Gillanders, MD, professor of surgery at Washington University School of Medicine in St. Louis, is on a team working on this. He says that in theory, once chemotherapy is over and the cancer is inactive, a vaccine might spur an immune response robust enough to attack any leftover malignancy. Breast cancer vaccines are in the earliest stages of testing, so their effectiveness in humans is not known. New tests are also being developed that can search a tumor’s genetic profile for hallmarks of aggression in order for doctors to come up with treatment plans tailored to individual women. Here are two of the latest tests: Oncotype DX. This test is for early stage (Stages I and II) breast cancer. It logs the activity of 21 different genes, allowing doctors to know which women will most benefit from chemotherapy. The test, available to any oncologist, provides a “recurrence score” to give women their odds that cancer will come back. Oncotype DX DCIS Score. This test will be widely available by year’s end. It will identify which patients with ductal carcinoma in situ, the most common type of noninvasive breast cancer, can be best treated with surgery alone. Some research to hone treatment aims at better predicting which women will respond to tamoxifen and other drugs that lower the risk of recurrence in women whose tumors are fed by estrogen, information that might help with choosing medications that can prevent relapse. What are some ways I can help prevent breast cancer? Stay at a healthy weight. One study found that women who gained 55 pounds or more after age 18 had a 50% higher risk of breast cancer compared to those who maintained their weight. Working out regularly, as well as the number on the scale, has also been linked to a lower risk of breast cancer. Research suggests you should aim for 45 to 60 minutes of vigorous exercise (such as jogging or aerobics) five days a week. Don’t go overboard at happy hour. Overdoing it on the cocktails ups your odds of breast cancer down the road. In fact, having just two drinks a day boosts your breast cancer risk by 21%, according to a meta-analysis of more than 40 studies. Even a modest three to 14 drinks a week could raise your breast cancer risk. If you want to imbibe, limit yourself to one drink a day. Breastfeed if you can. If you happen to have children in your 20s, research finds that breastfeeding at this age may help protect you from breast cancer later in life. “A possible protective effect might be because breast ducts seem to mature further when you breastfeed in your 20s as compared to later in life when your breasts have already undergone age-related changes that sometimes lead to cancerous gene mutations,” says Kala Visvanathan, M.D., associate professor and co-director of the Breast and Surveillance Service at John Hopkins. The same protective effect has not been shown for women who don’t start breastfeeding until their 30s or older. Assess your odds. It’s especially important in your thirties to be aware of any risk factors you may have—such as a family history of breast cancer, age of your first period, and obesity—so that you can decide with your doctor early on how aggressive your preventative and screening strategies should be. “If you think you might be at high risk for breast cancer, it’s a good idea to visit a high-risk cancer clinic for a risk assessment as well as a prevention and screening plan,” says Dr. Visvanathan. Most comprehensive cancer clinics offer risk assessments, such as The Breast and Ovarian Surveillance Service and Genetic Testing at Johns Hopkins. Take a pill if you’re at high risk. “Many women don’t know there are pills available that you can take every day for five years to help prevent breast cancer,” says Dr. Visvanathan. “Yes, there are side effects, such as blood clots or joint pain, but they might be worth it if you’re at high risk.” Raloxifene, already approved for preventing and treating osteoporosis, was okayed for postmenopausal women at high risk of breast cancer. Like tamoxifen, the first effective preventive for the disease, it also bolsters bones. Most recently, a third drug has been added to the preventative pill list for postmenopausal women: the aromatase inhibitor known as exemestane, which also works by lowering estrogen levels to help slow the growth of cancers. It’s still undergoing FDA approval, but studies show it may cut breast cancer risk by 65% compared to women taking a placebo pill. Are there any natural ways to prevent breast cancer? Your kitchen may contain powerful cancer fighters. Stock up on these healthy food staples: Go green with your tea. Green tea is rich in compounds called polyphenols, including catechins (and particularly EGCG), which reduce the growth of new blood vessels that feed tumors. It’s also a powerful antioxidant and detoxifier (activating enzymes in the liver that eliminate toxins from the body), and it encourages cancer cell death. In the laboratory, it has even been shown to increase the effect of radiation on cancer cells. Japanese green tea (sencha, gyokuro, matcha, etc.) contains more EGCG than common varieties of Chinese green tea, making it the most potent source on the market; look in Asian groceries and tea shops. Black and oolong teas, commonly used to produce popular tea blends such as Earl Grey, are less effective because they’ve been fermented, which destroys a large proportion of their polyphenols. Decaffeinated green teas, which retain the polyphenols despite the process of decaffeination, are also an option if you’re sensitive to caffeine. Sip 2 to 3 cups a day within an hour of brewing. Green tea must be steeped for at least 5 to 8 minutes–ideally 10–to release its catechins, but it loses its beneficial polyphenols after an hour or two. Try some ginger. Fresh ginger, or gingerroot, is a powerful anti-inflammatory that combats certain cancer cells and helps slow tumor growth. A ginger infusion can also alleviate nausea from chemotherapy or radiotherapy. Add grated fresh ginger to a vegetable stir-fry or fruit salad. Or, make an infusion by slicing a 1-inch piece of ginger and steeping it in boiling water for 10 to 15 minutes; drink hot or cold. Spice things up. Found in curry powder, tumeric is the most powerful natural anti-inflammatory available today. It encourages cancer cell death, inhibits tumor growth, and even enhances the effectiveness of chemotherapy. Some research shows that turmeric is most effective in humans when it’s mixed with black pepper and dissolved in oil (olive or canola, preferably). In store-bought curry mixes, turmeric represents only 20% of the total, so it’s better to obtain ground turmeric directly from a spice shop. Mix a teaspoon of turmeric powder with a teaspoon of olive oil and a generous pinch of ground black pepper and add to vegetables, soups, and salad dressings. Use a tablespoon if you already have cancer. Stock up on veggies. Brussels sprouts, bok choy, Chinese cabbage, broccoli, and cauliflower all contain sulforaphane and indole-3-carbinols (I3Cs), two potent anticancer molecules. These molecules help the body detoxify certain carcinogenic substances and can help prevent precancerous cells from developing into malignant tumors. They also promote the suicide of cancer cells and block tumor growth. Prepare by covering and steaming briefly or stir-frying rapidly with a little olive oil. Avoid boiling cabbage and broccoli, which destroys their cancer-fighting compounds. Eat your soy au natural. Compounds called isoflavones (including genistein, daidzein, and glycitein) prevent tumor growth and block the stimulation of cancer cells by sex hormones (such as estrogens and testosterone). There are significantly fewer breast cancer cases among Asian women who have eaten soy since adolescence, and when they do have breast cancer, their tumors are usually less aggressive with higher survival rates. Isoflavone supplements (in pill form) have been associated with an aggravation of certain breast cancers, but whole soy, eaten as food, has not. Replace conventional milk products with soy milk or soy yogurts for breakfast. Also, use tofu, tempeh, and miso in soups and stir-fries. Go fish. The risk of several cancers is significantly lower in people who eat fish at least twice a week. Several studies discovered that the anti-inflammatory long-chain omega-3s found in fatty fish (or in high-quality purified fish-oil supplements) can help slow cancer cell growth in a large number of tumors (lung, breast, colon, prostate, kidney, etc.). Have a seafood-based meal two or three times a week. Choose small fish, such as anchovies, small mackerel, and sardines (including canned sardines, provided they are preserved in olive oil and not in sunflower oil, which is too rich in pro-inflammatory omega-6 fats). Small fish contain fewer environmental toxins such as PCBs and mercury. Wild salmon is also a good source of omega-3 fats, and the level of contamination is still acceptable. Choose fresh over frozen whenever possible, because omega-3 content degrades over time. Where can I go to find out more? Susan G. Komen for the Cure National Breast Cancer Foundation American Cancer Society National Cancer Institute
