Breast Cancer Risk

900+ Common Chemicals Linked to Breast Cancer Risk

Posted by

0


A study published Wednesday in Environmental Health Perspectives identified 921 chemicals that increase the risk of breast cancer and found that 90% are ubiquitous in consumer products, food and drinks, pesticides, medications and workplaces.

chemicals breast cancer risk feature

More than 900 chemicals commonly found in consumer products and the environment have been linked to breast cancer risk in a new study.

The study, published Wednesday in Environmental Health Perspectives, identified 921 chemicals that increase the risk of breast cancer and found that 90% are ubiquitous in consumer products, food and drinks, pesticides, medications and workplaces.

The list includes chemicals like parabens and phthalates, which are commonly found in makeup, skin and hair care products; and numerous pesticide ingredients, including malathion, atrazine and triclopyr, which are used on food and in household pest control products in the U.S.

Breast cancer among young women has increased in recent years. Between 2010 and 2019, diagnoses among people 30 to 39 years old increased by 19.4%, and among those ages 20 to 29, rates increased by 5.3%.

This change is too fast to be explained by genetics, so researchers have begun looking more closely at potential environmental causes for the disease.

A 2020 study found that women who used chemical hair straighteners more than six times a year had about a 30% higher risk of breast cancer than those who didn’t use chemical straighteners. Those products typically contain one or more of the chemicals identified in the new study as increasing the chances of getting breast cancer.

Women of color face greater risk. Studies have shown that products marketed to women of color tend to be more toxic and are more likely to contain chemicals associated with increased cancer risk compared to products marketed to white women.

To conduct the new study, researchers at Silent Spring Institute, a nonprofit breast cancer prevention research group, developed a new method to quickly identify compounds that can increase the likelihood of the disease.

“We know there are lots of environmental chemicals that can increase breast cancer risk, but we need more efficient and more effective ways to identify them so they can be regulated and reduced,” Jennifer Kay, a research scientist at Silent Spring Institute and lead author of the study, told Environmental Health News.

Historically, regulators have used animal studies to determine whether chemicals cause mammary tumors in mice to assess whether they could increase breast cancer risk in humans, but these studies are slow and expensive.

In 2016, the International Agency for Research on Cancer published a landmark study outlining 10 ways that carcinogens cause cancer to develop.

Since then, scientists and regulators have begun working to identify chemicals that have those characteristics as a quicker, less expensive way to determine whether exposure to them is likely to increase cancer risk.

“What’s unique about our approach is that we recognized that breast carcinogens tend to increase hormonal activity,” Kay explained. “So for this study, we looked at whether chemicals increase certain hormonal activities that are known to increase breast cancer risk.”

Kay and her team looked specifically for chemicals that activate estrogen receptors in breast cells and for chemicals that cause cells to make more estrogen or progesterone, both known risk factors for breast cancer.

More than half of the chemicals on their list cause cells to make more estrogen or progesterone and about a third activate the estrogen receptor. An additional 278 of the chemicals on the list have previously been found to cause mammary tumors in animal studies.

Kay noted that while there are tens of thousands of chemicals used in commercial products in the U.S., they only had access to data on whether chemicals interact with hormones from the U.S. Environmental Protection Agency (EPA) for about 2,200 chemicals.

“If EPA was more comprehensive about screening chemicals for potential hazards,” she said, “our list would likely be a lot longer.”

Children’s exposure and future breast cancer risks 

Evidence also suggests that children’s exposure to these chemicals during key developmental windows can increase their risk of developing breast cancer later in life and that these types of exposures can even increase the odds of negative outcomes for multiple generations of women.

Many of the chemicals listed in the new study are common in products made for children. For example, many kids’ lotions and shampoos include parabens and phthalates, and the pesticide “malathion” is commonly used as an ingredient in lice treatments for children.

“Kids getting exposed to these chemicals is particularly concerning, because at younger ages kids are very vulnerable,” Kay said.

Avoiding cancer-causing chemicals 

In the absence of meaningful regulations, numerous nonprofit organizations have developed resources aimed at helping consumers avoid chemicals that could raise their cancer risk, including Silent Spring Intitute’s Detox Me app, the Anticancer Lifestyle Program, the Environmental Working Group’s Healthy Living App, the Made Safe database and Clearya.

Kay said she hopes that as a result of the study, this method will be used to screen chemicals for other types of cancer risk and that regulatory agencies like the EPA will use the research to more quickly identify and regulate chemicals that could be hazardous.

“We have now found hundreds of chemicals that could increase breast cancer risk,” she said.

“We’re actively working on translating this research for regulators, epidemiologists and cancer researchers so we can all work together to advance breast cancer prevention.”

Everyday Habits to Lower Breast Cancer Risk

Posted by

0


Medically Reviewed by Jabeen Begum, MD on August 28, 2023

Written by Shawna Seed

Balance Your Diet

Balance Your Diet

1/13

Your food choices may help cut your odds of having breast cancer, though scientists are doing more research to learn how diet affects the disease. Focus on vegetables, fruits, beans, and whole grains, which should make up two-thirds of your plate. Reserve the other third for lean protein such as poultry or fish. More than 5 cups a day of plant-based fare is a good guideline.

Limit Alcohol

Limit Alcohol

2/13

If you’re a woman who has two or three servings a day of wine, beer, or liquor, your risk is 20% higher than one who doesn’t drink at all. Experts say if you want to imbibe, have no more than one drink a day. That only slightly raises your chances of getting breast cancer.

Don’t Smoke

Don’t Smoke

3/13

Tobacco use is linked to a higher risk of breast cancer, especially in younger women who haven’t gone through menopause. How much you smoke, the age when you started, and how long you continue all affect how likely you are to get the disease. If you’re a smoker, ask your health care provider about ways to help you quit.

Know Your Tissue Type

Know Your Tissue Type

4/13

The makeup of all breasts is different. If yours have less fatty flesh and more milk glands and supportive tissue, they’re called “dense.” That can raise your breast cancer risk and make abnormal cells harder to spot on scans. Mammograms are one way to measure your tissue type. If you have dense breasts, take other steps to lower your odds for breast cancer. You may need to get screened more often or use more advanced screening tests.

Get Your Workouts In

Get Your Workouts In

5/13

Regular physical activity can lower your breast cancer risk. Experts say you should get either 150 minutes of moderate exercise or 75 minutes of harder, vigorous workouts over the course of a week. You can also do a bit of both.

Watch the Scale

Watch the Scale

6/13

When you eat a balanced diet and exercise, that can help you stay at a healthy weight, which also lowers your chance of breast cancer. Extra pounds, particularly if you put them on as an adult, are linked to a higher risk of the disease. That’s especially true for women who have been through menopause.

Consider Your Birth Control

Consider Your Birth Control

7/13

Hormonal forms of contraception — such as pills and some IUDs — are linked to a slightly higher chance of breast cancer. But they can also protect you against other types of tumors. Your doctor can help you think about how the things that raise your odds of having breast cancer compare with the reliability and health benefits of different types of birth control and decide what’s best for you.

What About HRT?

What About HRT?

8/13

Some women take hormone replacement therapy to ease menopause symptoms or prevent bone fractures. But your risk of breast cancer rises when you take the combination type (estrogen and progesterone) or if you take the estrogen-only type for many years. If menopause seriously affects you, talk to your doctor about your options. If you decide to take this medication, you’ll want the lowest effective dose for the shortest amount of time.

Make Sure You Get Fiber

Make Sure You Get Fiber

9/13

You can find this nutrient in whole grains, vegetables, fruits, and beans. Women who eat plenty of these foods had a lower risk of breast cancer, according to several studies. Scientists aren’t exactly sure how it works to prevent tumors, but they’re doing more research to understand why. A fiber-rich diet can also help your health in other ways, like lowering your odds of diabetes and heart disease.

Keep It Dark

Keep It Dark

10/13

Women exposed to a lot of light at night — whether because they do shift work or they live in well-lit areas — may have a higher risk of breast cancer. Researchers think the link is a hormone called melatonin, which your body makes when darkness falls so that you’ll feel sleepy. If you can, try to control how much light you’re around at night. Tools like blackout shades, a sleeping mask, and low-watt bulbs in your bathroom can help.

Do You Get Vitamin D?

Do You Get Vitamin D?

11/13

Your body makes its own vitamin D when sunlight hits your skin. But a more reliable way to get enough is through foods like salmon, oysters, sardines, and fortified foods like milk and orange juice. When you don’t get enough of this nutrient, your risk of breast cancer may go up. You can also get it in supplement form, but talk to your doctor before you take it.

Check Your Toiletries

Check Your Toiletries

12/13

Many cosmetics, lotions, and hair products have parabens, which can act like a weak estrogen in your body. Some scientists think these chemicals might be able to trigger hormone-positive breast cancer, but the research is far from clear. If you’re worried about the risk, you can buy items made without this substance.

Be Informed

Be Informed

13/13

There’s a lot of misinformation about breast cancer out there. To address some common myths: A mammogram is an important screening tool, and it will not cause a tumor to spread. You will not raise your risk if you shave your underarms or use antiperspirant. Wearing a bra — underwire or other types — does not affect your odds.

All types of hormonal birth control may increase breast cancer risk, study finds

Posted by

0


  • Progestin-only birth control pills are a common form of hormonal contraceptive, yet knowledge on their association with breast cancer risk was limited. In a new study, researchers investigated the link between hormonal contraceptive use and breast cancer risk.
  • They found that progestin-only contraceptive use increases breast cancer risk similarly to combined contraceptive use.
  • They say that physicians should weigh the benefits and risks to patients of hormonal contraceptive use. Experts say the findings are broadly in line with known risks, which overall are small.

Between 2017 and 2019, around 65% of womenTrusted Source aged 15- 49 used some sort of contraception, and 14% of them used the pill. Contraceptive pills come in two forms: the progestin-only pill and the combined pill containing both progestin and estrogen-based ingredients.

Progestin, or progestogen, is a synthetic version of progesterone, a naturally occurring hormone.

A meta-analysis from 1996 found that people taking combined contraceptives have a slightly increased risk for breast cancer within 10 years of usage.

In recent years, progestin-only methods of contraception — including pills, injectables, implants, and intrauterine devices (IUDs) — have become more popular. In England, drug prescriptions increased from 1.9 million in 2010 to 3.3 million in 2020.

Until now, however, there has been limited research on the impact of progestin-only contraceptives on breast cancer risk.

Recently, researchers investigated the link between hormonal contraceptive use and break cancer risk.

Like combined pills, they found that progestin-only contraceptives slightly increase breast cancer risk.

The study was published in PLOS Medicine.

Breast cancer and hormonal contraceptives

For the study, the researchers analyzed health records from a UK primary care database. They included data from 9,498 women aged under 50 years old with breast cancer and 18,171 women without.

Altogether, 44% of women with breast cancer and 39% of those without had a prescription for hormonal contraceptives. About half of these were for progestin-only preparations.

Ultimately, the researchers found that combined contraceptive pill use increased breast cancer risk by 23%.

They also found that oral progestin-only contraceptive pills increased breast cancer risk by 29%.

Other progestin-only formulations, including injectables, implants, and intrauterine devices (IUDs), increased breast cancer risk by 18%, 28%, and 21%, respectively.

The researchers added that five years of oral contraceptive use was linked to breast cancer incidence in 8 per 100,000 users aged 16 to 20 years old and an incidence of 265 per 100,000 users aged 35- 39 years old.

Increased cancer risk is relatively small

Dr. Irene M. Kang, medical director of women’s health medical oncology at City of Hope Orange County, not involved in the study, told Medical News Today:

“All medications have risks and benefits, which is why discussing concerns with your provider is essential. Negative effects of oral contraceptives include strokes, heart attacks and blood clots. Research has shown that oral contraceptives can impact an individual’s risk of certain types of cancer – in some cases upwards, and in some cases, such as ovarian and endometrial cancers, downwards – through changing the levels of estrogen and progesterone. Additional benefits are family planning and more regulated menstrual cycles.”

Dr. Lilian Harris, a medical oncologist at Novant Health Cancer Institute, not involved in the study, agreed that hormonal contraceptives have risks and benefits:

“For example, they can protect against pelvic inflammatory disease and help with menstrual pain, […] fibroids, endometriosis and acne. They have also been shown to decrease the risk of […] uterine cancers. Conversely, there are also potential risks with any medication. For oral contraceptives, these risks can range from nausea, headaches, and breast tenderness to […] increased risk for breast cancer.”

The researchers concluded that current or recent progestin-only contraceptives are linked to a slight increase in breast cancer risk.

They say that such risks must be balanced against the benefits of contraceptives in childbearing years.

Study limitations 

When asked about the study’s limitations, Dr. Kang noted that due to the study design, it only explains short-term risk associations as opposed to long-term risk.

Dr. Kristina Shaffer, breast surgical oncologist at Novant Health Cancer Institute, not involved in the study, also told MNT:

“In addition, the study included premenopausal women, an age group where breast cancer incidence is lower, meaning that other factors may have been driving the slightly higher risk demonstrated in the study. For example, while the study did account for some of the factors known to be related to breast cancer risk, it did not account for family history, genetic predisposition, or history of atypical breast cells which are well-established to impact breast cancer risk.”

Implications for contraceptives use

MNT also spoke with Dr. Parvin Peddi, board certified medical oncologist and director of Breast Medical Oncology for the Margie Petersen Breast Center at Providence Saint John’s Health Center and Associate Professor of Medical Oncology at Saint John’s Cancer Institute in Santa Monica, CA, not involved in the study.

“[The] main take home message is that this study finds that women do not need to choose a progesterone only containing birth control medication because of perceived lower risk of birth cancer.”

– Dr. Peddie

“On the other hand, it’s important to note that the absolute increased risk of breast cancer from any of these medications is quite low and this study should not dissuade women from using hormone-containing birth controls,” Dr. Peddie explained. “Risk of breast cancer was seen in less than 0.5% of women age 35-39 years old due to use of these medications and in even fewer women who used these medications at a younger age.”

Dr. Schaffer agreed that while the increase in risk may sound high at 20-30%, it is relatively small.

“For instance, if the risk of a 30-year-old female developing breast cancer is 5%, then a relative increase of 20% would bring her risk to 6%. And this is why the study concludes that there is a slight increase in breast cancer risk,” she explained.

Dr. Kang also noted:

“As with all cancers, your breast cancer risk increases with age, and in this case, also with the length of time that hormonal contraceptives are used. If you are at a higher risk for breast cancer, switching to a hormone-free birth control may be a more beneficial option for you. If you are diagnosed with breast cancer, seek care from an expert who specializes in your type of cancer.”

“Finding breast cancer early is one of the most important factors in successful treatment of this disease — and that’s why self-exams and screenings are so vital,” Dr. Kang concluded.

Study of trans men suggests that androgen hormone therapy can lower breast cancer risk

Posted by

0


androgen receptor
An androgen receptor

When transgender men transition, their risk for breast cancer tends to plummet and look more like the breast cancer risk for cisgender men, excluding those with high-risk mutations like BRCA1 or BRCA2. Many researchers thought the main reason for this was probably breast removal during chest reconstruction surgery, but recent research suggests that the androgens during hormone replacement therapy may also play a crucial role in reshaping transgender men’s breast cancer risk.

That’s hinted to researchers that androgens, the male sex hormones, might offer new paths to develop powerful therapies to treat or prevent breast cancer.

In a study published on Wednesday in Cell Genomics, scientists at Cedars-Sinai Medical Center in Los Angeles analyzed individual cells from breast tissue in trans men and cis women. “The goal was to analyze the impacts of androgen on the normal, healthy breast,” said Simon Knott, a computational biologist at Cedars-Sinai and a senior author on the study.

To do this study, Knott and his colleagues studied breast tissue from trans men that was donated after gender-affirming surgery and breast tissue from cis women that was donated after cosmetic breast surgery. Then, they analyzed the tissue on the single cell level to understand the genetic changes that happen in the breast after androgen therapy.

“One of the key things that popped out when we started to look was many of the changes induced by androgen seemed like changes that were the opposite of what you’d expect to see during malignant transformation,” Knott said.

That suggested that the hormone therapy might actually protect against breast cancer, Knott said. Researchers Wayne Tilley and Theresa Hickey from the University of Adelaide, both of whom worked on this study, had previously published in Nature Medicine work “showing definitively that androgen is a break on estrogen receptor signaling and is suppressive against estrogen receptor positive breast cancer growth,” Knott said. “So, the hint that androgen might be protective against breast cancer was not completely unexpected.”

STAT spoke with Knott about the new study, research on trans health and cancer, and how androgens could help treat breast cancer. This interview has been edited for length and clarity.

How did the study start and how did you do it?

The original impetus came from my collaborator Xiaojiang Cui, who is a breast cancer researcher, and Edward Ray, a surgeon focusing on transgender reconstructive surgeries. They had recognized that while estrogen and progesterone have been studied for their impact on the breast and breast cancer, very little is known about how androgen impacts the breast. So, it wasn’t necessarily initiated as a cancer-specific study. Cui and Ed Ray had this bank of tissues from transgender men and cisgender women, and we decided the time was ripe to apply some of these single-cell technologies to unravel how androgen impacts the breast.

We applied three different molecular assays. We analyzed with something called single nuclei RNA sequencing, which sequences the RNA from each individual nucleus from cells. That allows you to identify all the cell types and the gene expression changes from androgen therapy. We also used single nuclei ATAC sequencing, which also involves extracting individual nuclei but allows you to understand the chromatin architecture. Finally, we used a high multiplex staining assay that allowed us to identify all cell types and how they’re spatially organized from one another and how androgen impacted that organization.

What were some of the key findings?

One of the biggest, most striking changes was that androgen appears to induce almost male characteristics in the breast. For example, one of the transcription factors, which regulate overall gene expression, that was most significantly upregulated is CUX2. This is expressed at highest levels in the male prostate, never really seen in the breast.

We looked at this in many ways. There’s a tissue database called GTEx where they’ve profiled male and female tissues from a variety of organs, and we also found that many of the changes we saw from androgens in the epithelial compartment, fibroblast compartment, vascular compartments were also represented in this male versus female gene expression data. Basically, we saw our changes corresponded to the changes when you compare a cisgender male to a cisgender female. One of the other, very obvious changes was the breast cells that appear to show the highest level of estrogen receptor signaling were reduced dramatically in proportion to the androgen-treated breast.

What impact does that have on the risk — or potential treatment of — breast cancer?

That tells us androgen therapy and activation of androgen receptors counteracts estrogen receptor signaling. ER signaling and an overabundance of it is probably one of the greatest causes of breast cancer. ER+ breast cancers count for the majority of breast cancers, and they’re driven by estrogen receptor signaling. So, that indicates to us that activating the androgen receptor would likely be protective against future breast cancer, particularly for ER+ cancers.

Now people might say, high doses of androgen might be protective but what comes with that are male characteristics that breast cancer patients or women at high risk of breast cancer might be unwilling to deal with. So, we’ve started collaborating with the Tilley and Hickey labs from Adelaide to analyze if we can get good results from a low dose of androgen that would bring about anti-estrogen changes that we think are protective without the male external physical characteristics.

Related: Q&A: Siddhartha Mukherjee on the rapid pace of cancer research and ‘luminous’ life of cells

Or like using a local application of androgens around the tumor area?

That’s a potential possibility, like an intraductal injection of androgen or a topical cream. In an anecdotal way, the Tilley and Hickey labs have shown that a low dose of androgen does not induce male characteristics, but breast density can be reduced. High breast density is a major risk factor of breast cancer.

Does this work tell us anything about whether trans men should get screening for breast cancer or gynecological cancers — and how often?

Screening and incidence and therapeutics for trans individuals is something really being studied and developed at Cedars-Sinai in our trans health center as well as our cancer center. In terms of our study, we can potentially explain the risk of breast cancer in trans men through our findings. The reversal of estrogen receptor signaling and other signaling in the androgen treated breast might indicate a more protective tissue environment.

One thing we saw was a significant increase in activated helper T cells that appeared to be honed in on the breast epithelium. That indicates the adaptive immune system is surveilling that tissue more actively after androgen therapy. We also saw reduced macrophages, which can cause inflammation. Based on this study, a reasonable assessment is to say that trans men should be treated as cis men in terms of breast screening.

How could future studies done with trans people help cancer research and trans health?

The incidence of breast cancer in trans men are extremely low, so studying breakthrough cases — where trans men have actually gotten a breast cancer — would be interesting to understand when this fails and how. I also think it would be worth looking at the breast tissue of trans women who typically receive high doses of feminizing hormones like estrogen to induce the growth of breast. Looking at that tissue where there is an increased incidence of breast cancer and understanding the molecular mechanisms underlying that — and the reciprocal action of androgen might better elucidate how these two hormones interact with one another.

Dense breasts raise breast cancer risk, but many women aren’t aware of that — here’s what to know

Posted by

0


The only way to tell if you have dense breasts is via a mammogram, and not all states require providers to notify women of their breast density.

A woman gets a mammogram at Mt. Sinai Hospital in Chicago

A woman gets a mammogram at Mt. Sinai Hospital in Chicago in 2012.Heather Charles / Chicago Tribune/Tribune News Service

Most women are aware that a family history of breast cancer increases their risk of the disease, but far fewer understand that extremely dense breasts can pose a greater risk.

A survey published Monday in the journal JAMA Network Open found that of nearly 1,900 women who participated, the majority saw breast density as a less consequential risk factor than family history.

But women with extremely dense breasts, which are characterized by minimal fatty tissue, face a risk of breast cancer four times higher than women with the lowest breast densities, according to the study. About 10% of women who get mammograms have this level of breast density. By comparison, having a mother, sister or daughter who’s had breast cancer is associated with double the risk of the disease.

Women who have a substantial amount of dense breast tissue but not to an extreme degree— about 40% of those who get mammograms — have a 20% higher risk of breast cancer relativeto those with average breast density, according to the study.

That’s slightly lower than the risk associated with having a glass of wine each night, according to Dr. Phoebe Freer, chief of breast imaging at the University of Utah’s Huntsman Cancer Institute, who wasn’t involved in the survey.

“Everybody has a different amount of fibroglandular tissue and a different pattern,” Freer said, referring to dense breast tissue. “It’s almost like a patient’s fingerprint.”

The only way to tell if you have dense breasts is via a mammogram, which doctors generally recommend every one or two years for women starting in their 40s or 50s.

The Food and Drug Administration proposed a rule in 2019 that would require mammography facilities to inform patients about their breast density and its significance. In October, the FDA said it was optimistic that the final rule would be published by early 2023.

Thirty-eight states already require providers to give women information about breast density after a mammogram, but not all of them require providers to notify a woman if she herself has dense breasts.

A woman leaves a mammography mobile screening bus in Anaheim, Calif.
A woman leaves a mammography mobile screening bus in Anaheim, Calif. on Oct. 17, 2016.Mindy Schauer / Digital First Media/Orange County Register

Since dense breasts are common, doctors may inadvertently downplay the risks, said Christine Gunn, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice, who conducted the JAMA research.

“There are a lot of conversations with primary care doctors where they say, ‘This is normal.’ For some women, it translates to, ‘Oh, I don’t have to worry about that,'” Gunn said.

In individual interviews as part of Gunn’s survey, six out of 61 women said dense breasts contributed to breast cancer risk. 

There are two reasons dense breasts are linked to a higher risk of breast cancer.

First, the composition of the breast might predispose people to cancer. The reasons for that aren’t clear, but scientists suspect that cancer is more likely to develop in fibroglandular tissue, which is unique to the breast, as opposed to fatty tissue, which is found throughout the body.

Second, because women with extremely dense breasts have almost all fibroglandular tissue, it’s harder to detect cancerous masses or calcium deposits on a mammogram. That makes it easier for cancer to grow or spread undetected rather than being spotted and treated early.

Checking for cancer in a patient with dense breasts is like searching for a white spot on a white wall, according to Dr. Melissa Durand, an associate professor at the Yale School of Medicine Department of Radiology and Biomedical Imaging.

Durand explained that both fibroglandular tissue and cancer show up white on a mammogram, whereas fatty tissue shows up black.

“In a completely fatty breast — so lots and lots of black on the mammogram — we can be as accurate as 98%,” she said. “But our sensitivity can drop really low — in some studies, even as low as 30% — if you have an extremely, extremely dense breast.”

Radiologists said the ideal type of mammogram, especially for women with dense breasts, is a digital breast tomosynthesis, which is often better at detecting cancer than standard mammograms.

From there, doctors might recommend an ultrasound or MRI. Women with dense breasts should probably get supplemental screenings each year, radiologists said.

Ultrasounds are safe and relatively inexpensive, but Freer said they can miss cancer or show false positives, which can be confusing for patients. MRIs are the most sensitive option, but to get insurance companies to cover the cost, patients usually need to show additional risk factors, such as a genetic mutation or family history of breast cancer.

“The more often you get screened, the more likely you are to be called back for additional imaging,” Freer said. “It does create some anxiety and it definitely takes time. Most patients are willing to undergo that risk in order to get the life-saving benefit.”

Women can’t change their breast density, but it can shift with age.

“Typically, younger women will have denser breasts,” Durand said. “As we age, just like other parts of our bodies, we acquire more fat, so your breast tissue can get more fatty tissue in it.”

To lower one’s risk of breast cancer overall, doctors recommend limiting alcohol intake, exercising regularly and maintaining a healthy diet. The Breast Cancer Surveillance Consortium offers an online tool to help people gauge their breast cancer risk based on multiple factors, including breast density.

Everyday Habits to Lower Breast Cancer Risk

Posted by

0


Balance Your Diet

Balance Your Diet

1/13

Your food choices may help cut your odds of having breast cancer, though scientists are doing more research to learn how diet affects the disease. Focus on vegetables, fruits, beans, and whole grains, which should make up two-thirds of your plate. Reserve the other third for lean protein such as poultry or fish. More than 5 cups a day of plant-based fare is a good guideline.

Limit Alcohol

Limit Alcohol

2/13

If you’re a woman who has two or three servings a day of wine, beer, or liquor, your risk is 20% higher than one who doesn’t drink at all. Experts say if you want to imbibe, have no more than one drink a day. That only slightly raises your chances of getting breast cancer.

Don’t Smoke

Don’t Smoke

3/13

Tobacco use is linked to a higher risk of breast cancer, especially in younger women who haven’t gone through menopause. How much you smoke, the age when you started, and how long you continue all affect how likely you are to get the disease. If you’re a smoker, ask your health care provider about ways to help you quit.

Know Your Tissue Type

Know Your Tissue Type

4/13

The makeup of all breasts is different. If yours have less fatty flesh and more milk glands and supportive tissue, they’re called “dense.” That can raise your breast cancer risk and make abnormal cells harder to spot on scans. Mammograms are one way to measure your tissue type. If you have dense breasts, take other steps to lower your odds for breast cancer. You may need to get screened more often or use more advanced screening tests.

Get Your Workouts In

Get Your Workouts In

5/13

Regular physical activity can lower your breast cancer risk. Experts say you should get either 150 minutes of moderate exercise or 75 minutes of harder, vigorous workouts over the course of a week. You can also do a bit of both.

Watch the Scale

Watch the Scale

6/13

When you eat a balanced diet and exercise, that can help you stay at a healthy weight, which also lowers your chance of breast cancer. Extra pounds, particularly if you put them on as an adult, are linked to a higher risk of the disease. That’s especially true for women who have been through menopause.

Consider Your Birth Control

Consider Your Birth Control

7/13

Hormonal forms of contraception — such as pills and some IUDs — are linked to a slightly higher chance of breast cancer. But they can also protect you against other types of tumors. Your doctor can help you think about how the things that raise your odds of having breast cancer compare with the reliability and health benefits of different types of birth control and decide what’s best for you.

What About HRT?

What About HRT?

8/13

Some women take hormone replacement therapy to ease menopause symptoms or prevent bone fractures. But your risk of breast cancer rises when you take the combination type (estrogen and progesterone) or if you take the estrogen-only type for many years. If menopause seriously affects you, talk to your doctor about your options. If you decide to take this medication, you’ll want the lowest effective dose for the shortest amount of time.

Make Sure You Get Fiber

Make Sure You Get Fiber

9/13

You can find this nutrient in whole grains, vegetables, fruits, and beans. Women who eat plenty of these foods had a lower risk of breast cancer, according to several studies. Scientists aren’t exactly sure how it works to prevent tumors, but they’re doing more research to understand why. A fiber-rich diet can also help your health in other ways, like lowering your odds of diabetes and heart disease.

Keep It Dark

Keep It Dark

10/13

Women exposed to a lot of light at night — whether because they do shift work or they live in well-lit areas — may have a higher risk of breast cancer. Researchers think the link is a hormone called melatonin, which your body makes when darkness falls so that you’ll feel sleepy. If you can, try to control how much light you’re around at night. Tools like blackout shades, a sleeping mask, and low-watt bulbs in your bathroom can help.

Do You Get Vitamin D?

Do You Get Vitamin D?

11/13

Your body makes its own vitamin D when sunlight hits your skin. But a more reliable way to get enough is through foods like salmon, oysters, sardines, and fortified foods like milk and orange juice. When you don’t get enough of this nutrient, your risk of breast cancer may go up. You can also get it in supplement form, but talk to your doctor before you take it.

Check Your Toiletries

Check Your Toiletries

12/13

Many cosmetics, lotions, and hair products have parabens, which can act like a weak estrogen in your body. Some scientists think these chemicals might be able to trigger hormone-positive breast cancer, but the research is far from clear. If you’re worried about the risk, you can buy items made without this substance.

Be Informed

Be Informed

13/13

There’s a lot of misinformation about breast cancer out there. To address some common myths: A mammogram is an important screening tool, and it will not cause a tumor to spread. You will not raise your risk if you shave your underarms or use antiperspirant. Wearing a bra — underwire or other types — does not affect your odds.

No Breast Cancer Risk for Testosterone Use in Menopausal Women

Posted by

0


The use of transdermal testosterone in the treatment of hypoactive sexual desire disorder (HSDD) in postmenopausal women is effective and existing studies show no apparent association with breast cancer.

However, reliable studies are lacking and caution is urged, particularly for women with hormone-sensitive breast cancer, say the authors of a new systematic review, led by Ritika Gera of the London Breast Institute, Princess Grace Hospital, UK.

Transdermal testosterone, used as a gel or patch, is commonly prescribed for HSDD in postmenopausal women. Testosterone is also frequently used in women, off-label, for general menopausal symptoms.

“A consensus is yet to be reached on the safety of transdermal testosterone use for postmenopausal women and the nature of its relationship with breast cancer,” say Gera and colleagues.

“Our systematic review aims to tackle this uncertainty.”

Only Three Studies Could Be Reviewed but Provide Important Insights

The researchers initially identified more than 200 studies by searching PubMed and Ovid, but only three randomized controlled trials sufficiently met their criteria, and even those could not be compared because of substantial differences in age groups and the number of women who were also taking estrogen.

The trials were “too heterogeneous for a meta-analysis. A systematic review was deemed the most appropriate analysis of the data available,” they note in their review, published in the December issue of Anticancer Research.

However, the studies “did offer some important insights,” they add.

The first study (Gynecol Endocrinol. 2011;27:39-48), of 641 women who became menopausal as a result of surgery and received transdermal testosterone therapy and estrogen, found no significant increase in the occurrence of major adverse effects over an approximately 4-year follow-up; however, the study did not include women who were naturally post-menopausal. There were three cases of invasive breast cancer, which is consistent with age-appropriate expected rates.

The second study (Climacteric. 2010;13:121-131), of the randomized, placebo-controlled ADORE trial, included 272 naturally menopausal women who received transdermal testosterone (300 µg) or placebo for HSDD twice a week for 6 months, and most participants were not taking other hormone therapy. No occurrences of breast cancer, myocardial infarction, or death were reported during the trial; however, there was no post-termination follow-up.

There were significant improvements in various measures of satisfying sexual episodes in the testosterone-treated group.

The third study (N Engl J Med. 2008;359:2005-2017) was a double-blind, placebo-controlled 52-week trial of 464 postmenopausal women with low libido who were not taking estrogen and received transdermal testosterone (150 or 300 µg/day) or placebo.

In that study, four cases of breast cancer occurred in the testosterone group; however, one case developed within the first 4 months of the study and one case had symptoms prior to randomization. One of the patients reported having a sister who was also at risk of breast cancer, and one patient took 300 µg/day of testosterone for 104 weeks as part of a treatment extension. There were no occurrences of breast cancer in the placebo group.

Compared with placebo, there was a significantly greater increase in satisfying sexual episodes in the testosterone 300 µg/day group (P < .001) but not the testosterone 150 µg/day group (P = .11).

“The findings from the New England Journal of Medicine study were slightly alarming since four cases of breast cancer were seen in the transdermal testosterone group and none in the control group,” senior author Kefah Mokbel, MBBS MS, also of the London Breast Institute, told Medscape Medical News.

Overall, he said, “We were surprised by the paucity of studies in this field. By contrast, there are numerous studies looking at testosterone and prostate cancer risk.”

Mokbel also noted that the review focused on the medical indication of HSDD with transdermal testosterone because evidence is conflicting or lacking of the benefits of testosterone for other postmenopausal symptoms, including fatigue, insomnia, and mood swings.

Randomized, Placebo-Controlled Trials Needed

The review underscores the fact that more research is needed to determine the safety of the widespread use of transdermal testosterone in postmenopausal women, the authors assert.

“There is clearly a need to further investigate any potential safety risks related with the use of transdermal testosterone, particularly by using randomized prospective trials,” the authors write.

“A double-blind prospective trial with a large cohort of postmenopausal women who do not have any previous history of cancer should be conducted.”

They offer key recommendations for the design of clinical trials that will more effectively assess the relationship between use of transdermal testosterone and breast cancer in postmenopausal women, as follows.

  • Participants who have previously taken systemic estrogen/estrogen-progestin in the previous 3 months or have testosterone implants should be excluded.
  • Adjust for confounding risk factors for breast cancer such as body mass index and ethnicity. Participants should subsequently be randomized to placebo or varying concentrations of transdermal testosterone.
  • Follow-up should be for at least a year and participants should be checked for the development of breast cancer in the years following study termination.
  • The development of breast cancer throughout the trial should be assessed using a standard method.
  • Mammography should be conducted prior to study initiation and upon study termination. The presence of symptoms of breast cancer prior to study initiation should be an exclusion factor.
  • A Pap smear must also be conducted prior to study initiation to determine the risk of cervical cancer, and those with suspicious results should be excluded.
  • Randomization should include varying concentrations of transdermal testosterone or placebo.
  • Participants should be asked to keep a sexual desire and activity journal to document any increase in their arousal levels because of the transdermal testosterone treatment.

Treatment in Women Who Have Already Had Breast Cancer

Finally, the authors add that more research is needed into the use of transdermal testosterone among different groups of women who have already had breast cancer.

“Further experimentation is required to determine the long-term effects of transdermal testosterone therapy on women with estrogen receptor-positive breast cancer.”

And caution should be also exercised when considering use of transdermal testosterone in patients with triple-negative breast cancer that is positive for androgen receptor expression, they conclude.

Schizophrenia Tied to Elevated Breast Cancer Risk

Posted by

0


Rates of breast cancer are higher in women with schizophrenia than in women in the general population, new research shows.

Investigators in China and Maryland conducted a meta-analysis of studies that included more than 120,000 women and found that schizophrenia was associated with a significantly higher risk for breast cancer, although there was also significant heterogeneity found between the studies.

I think the association with breast cancer in female patients with schizophrenia is an important focus for clinicians, first author Chuanjun Zhuo, MD, PhD, Department of Psychiatric Laboratory, Tianjin Medical University, China, told Medscape Medical News.

I think clinicians should screen women with schizophrenia and monitor cancer markers frequently, he said.

The study was published online March 7 in JAMA Psychiatry.

Cancer Risk “Uncertain”

The risk of cancer in patients with schizophrenia remains uncertain, the authors write.

This population suffers from numerous chronic health conditions that typically are risk factors for the development of cancer (eg, smoking, alcohol and substance abuse, obesity, and lack of exercise), but results of epidemiologic studies have been inconsistent regarding the cancer risk, the investigators note.

Several analyses have shown that increased risk may be associated not only with factors related to an unhealthy lifestyle but also with genetic mechanisms and other potential factors that may be involved in the interaction between schizophrenia and cancer pathogenesis.

Because schizophrenia has been associated with a lower risk for certain types of cancer (eg, colorectal cancer, malignant melanoma, and prostate cancer), it is possible that genetic factors involved in schizophrenia pathogenesis may be protective against cancer, the authors write.

However, some studies have suggested an increased risk for breast cancer in schizophrenia patients, compared with the general population, and other studies have had mixed results or have used flawed statistical methods that did not adequately account for heterogeneity.

In the current study, the investigators set out to perform an updated meta-analysis to lead to better prevention and early treatment of breast cancer in women with schizophrenia.

In the meta-analysis, only cohort studies were included. In addition, studies had to be published as a full-length article in English, include adult women (age ≥18 years), have schizophrenia exposure identified at baseline, have a control group consisting of women from the general population without schizophrenia, have a documented incidence of breast cancer on follow-up, and report the standardized incidence ratios (SIRs), at least adjusted for age and corresponding 95% confidence intervals (CIs) for breast cancer incidence in women with schizophrenia, compared with control persons.

The researchers used several statistical approaches to the data. They extracted data of SIRs and established the lower and upper limits of 95% CIs to calculate log SIRs and their corresponding standard errors (SEs).

These logarithmically transformed SIRs and their corresponding SEs were used to stabilize the variance and normalize the distribution.

To evaluate the heterogeneity among the included cohort studies, the researchers used the Cochran Q test and the I 2 statistic, as well as a random-effects model, for meta-analyzing the SIR, because this model is considered to produce a more generalized result by considering heterogeneity between studies.

Shared Mechanisms?

The researchers identified 11 studies published between 1992 and 2016 that met the inclusion criteria. Participants (n = 125,760) were drawn from Europe, the United States, and Asia.

Of the 12 cohorts, five included hospitalized patients with schizophrenia; the remaining studies did not specify the source of the patients.

Study sizes ranged from 1388 to 446,447 patients with schizophrenia; the number of breast cancer cases ranged from 42 to 1042.

Six of the studies excluded breast cancer cases that were present prior to the diagnosis of schizophrenia. The remaining studies did not specify whether those cases were excluded.

Schizophrenia was found to be associated with a significantly increased risk for breast cancer in women (SIR, 1.31; 95% CI, 1.14 – 1.50; P < .001), with significant heterogeneity (P < 0.001; I 2 = 89%).

Because of the substantial between-study variance, which was reflected by the wide prediction interval (PI; 0.81 – 2.10), it is possible that a future study will show a decreased breast cancer risk in women with schizophrenia, compared with the general population, the authors comment.

The researchers investigated sensitivity of the findings by omitting one study at a time, but this did not significantly alter the results. The SIR varied between 1.29 and 1.38 (all Ps < .01).

The subgroup analyses found that the association between schizophrenia and increased breast cancer incidence was significant in studies in which breast cancer occurred before the diagnosis of schizophrenia was excluded (SIR, 1.34; 95% CI, 1.20 – 1.51; P < .001; I 2 = 84%) as well as studies with >100 breast cancer cases (SIR, 1.31; 95% CI, 1.18 – 1.46; P < 0.001; I 2 = 84%).

However, the association between schizophrenia and breast cancer incidence was not significant in studies that did not specify the exclusion of breast cancer cases that occurred prior to the diagnosis of schizophrenia (SIR, 1.38; 95% CI, 0.89 – 2.14; P = 0.15; I 2 = 91%) or in studies with <100 breast cancer cases (SIR, 1.50; 95% CI, 0.78 – 2.87; P = 0.23; I 2 = 93%)

The differences between subgroups were not statistically significant.

The researchers determined on the basis of the Egger regression test that there was no potential publication bias (P = .64).

The authors speculate that several potential mechanisms may be involved in the association between schizophrenia and increased breast cancer risk, including obesity and nulliparity, and possible shared pathophysiologic factors, including pathways involved in angiogenesis and cell-cycle regulation.

Increased prolactin levels, which have been observed in women with schizophrenia, may raise the risk for breast cancer, particularly in women receiving certain antipsychotics, they suggest.

Most psychiatrists focus only on treatment of positive and negative symptoms in patients with schizophrenia and tend to neglect the physical status, especially in female patients, said Dr Zhuo.

But psychiatrists should not ignore cancer markers and should remain aware of them, he added.

Be on the Lookout

Commenting on the study for Medscape Medical News, Gail Daumit, MD, MHS, professor of medicine, psychiatry, and behavioral sciences, epidemiology, health policy and management, and mental health, Johns Hopkins Medical Institutions, Baltimore, Maryland, who was not involved with the study, called it a nicely done meta-analysis.

One limitation was that the analysis incorporated studies that measured cancer incidence in different ways, such as the use of cancer registries and the use of billing data, she noted.

Nevertheless, the analysis shows a signal of increased risk of cancer in this population that should prompt clinicians to be on the lookout and make sure that women with schizophrenia get the recommended breast cancer screening appropriate for their age and risk factors, since this population is often ignored in their physical needs.

Additionally, the potential role of prolactin in increasing breast cancer risk warrants further research.

Antipsychotic medications are widely used not only for schizophrenia but also for other conditions, and more work regarding a possible prolactin connection needs to be done, she said.

Zhuo noted that his future research will focus on cancers for which the incidence is lower in patients with schizophrenia than in the general population.

There is a high rate of smoking in people with schizophrenia, compared to the general population, but no higher rate of lung cancer, suggesting a possible protective factor, which I am interested in exploring, he said.

Do Neighborhood Environmental Factors Impact Breast Cancer Risk?

Posted by

0


Obesity is well established as a risk factor for breast cancer. A recent study found that for every 5 kilograms gained in body weight since early adulthood, the risk of postmenopausal breast cancer increased by 11% (among women not on hormone replacement therapy).

1,2

Another study showed a differential impact of excess adiposity on breast cancer risk across racial and ethnic categories.

1,3

Yet another study found that both body mass index (BMI) and adult weight gain significantly increased the risk of breast cancer in the overall study population, but the increase was greater among Native Hawaiians and Japanese Americans than among White, African American, and Latino women who had the same BMI.

1,4

We know that the neighborhood environment has an impact on adiposity and obesity; and we know that obesity is a major modifiable risk factor for postmenopausal breast cancer. What has received less attention is the impact of obesogenic environmental factors on breast cancer risk. By obesogenic factors, we mean those social and manufactured attributes of a residential area that promote weight gain and obesity. Knowledge about the impact of obesogenic environmental factors on breast cancer risk could translate into new prevention measures. For example, we know that factors such as poverty, poor nutrition, and lack of recreational facilities promote weight gain. But there has been minimal data on any direct association between obesogenic environmental factors and breast cancer risk; no studies have determined whether obesogenic factors in the residential environment can account for the documented associations between body weight parameters and breast cancer risk.

1

Moreover, studies examining these types of factors are difficult to conduct and to evaluate accurately, given underlying biases and the challenge of identifying a truly causal relationship.

To address these knowledge gaps, Conroy and colleagues assessed the association between breast cancer incidence and specific obesogenic factors in residential areas. The researchers sought to test the hypothesis that neighborhoods with lower socioeconomic status, more urban characteristics, more unhealthy foods, fewer recreational facilities, and fewer parks would be associated with an increased breast cancer risk.

1

The study included 48,247 postmenopausal women enrolled in the Multiethnic Cohort Study (MEC), an observational cohort established in 1993 to study the role that diet and other lifestyle factors have on cancer risk.

1,5-7

Participants included women from four racial or ethnic groups living in California: African Americans, Japanese Americans, Latinos, and Whites.

1

The study analyzed 5 “neighborhood obesogenic factors”—composite factors known to drive weight gain and obesity—and their impact on breast cancer risk. These factors included neighborhood socioeconomic status, urban environment, mixed-land development, unhealthy food options, and parks. Neighborhood socioeconomic status was a composite of data for education, housing, employment, occupation, income, and poverty. The urban environmental factors included characteristics such as high population density and high traffic density; mixed-land development referred to as more recreational facilities and businesses per capita; unhealthy food outlets meant a high ratio of unhealthy to healthy restaurants; and parks denoted a high number of parks per capita.

1

During the nearly 17 years of follow-up, 2341 women in the cohort were diagnosed with invasive breast cancer. Using Cox proportional hazards regression, the study assessed the association between the 4 neighborhood obesogenic factors and breast cancer risk, adjusting for prediagnostic BMI, weight gain since age 21, and established risk factors.

The most significant associations had to do with neighborhood socioeconomic status, urbanicity, and mixed-land development; but although these factors were independently associated with breast cancer risk, they were also differentially associated by race and ethnicity. In particular, lower neighborhood socioeconomic status was associated with lower breast cancer risk (Quintile 1 vs 5: hazard ratio (HR), 0.79; 95% confidence interval (CI), 0.66-0.95), an association that was more pronounced among Latinos (Quintile 1 vs 5: HR, 0.60; 95% CI, 0.43-0.85). In addition, more urban environments were associated with decreased breast cancer risk in Japanese Americans (Quintile 5 vs 1: HR, 0.49; 95% CI, 0.26-0.90). Moreover, a lower level of mixed-land development was associated with higher breast cancer risk in Latinos (Quintile 1 vs 5: HR, 1.46; 95% CI, 1.10-1.93).

1

While Conroy and colleagues found a reduced breast cancer risk in women with lower neighborhood socioeconomic status, these women also had higher rates of morbidity and mortality.

1

“It is important to note that women of lower socioeconomic status have lower survival after breast cancer diagnosis, and we believe that this is due to their being more likely to be diagnosed at [a] later stage, and less likely to receive guideline treatments,” said Scarlett Lin Gomez, PhD, MPH, Research Scientist at the Cancer Prevention Institute of California and a coauthor of the Conroy study.

Published: March 29, 2017

References

Contraceptive pill could increase breast cancer risk more than experts first thought, study finds

Posted by

0


Nonetheless, experts say birth control has a positive effect on the lives of women

 Taking the contraceptive pill could increase your risk of breast cancer more than previously feared, new research suggests.

A study from the University of Michigan has revealed that some commonly prescribed birth control pills may quadruple levels of synthetic oestrogen and progesterone hormones.

Both of which are thought to play a part in stimulating breast cancers to grow, which is why some breast cancer patients are prescribed hormone therapy to block their effects on cancer cells.

Superdrug to sell reduced price morning after pill

The research showed that blood taken from women who use birth control pills contained much higher levels of hormones compared to women who don’t.

And, that four out of seven formulations tested were found to quadruple the levels of progestin, a synthetic version of the hormone progesterone.

Another formulation also resulted in 40 per cent higher exposure to ethinyl estradiol,  synthetic version of oestrogen.

Despite the findings, the study’s lead author, human evolutionary biologist Beverly Strassmann, stressed that the contraceptive pill has had such a positive effect on the lives of so many women.

But, that it’s also important for companies to design birth control pills in a way that doesn’t contribute to a greater risk of breast cancer.

“Not enough has changed over the generations of these drugs and given how many people take hormonal birth control worldwide — millions — the pharmaceutical industry shouldn’t rest on its laurels,” she said.

Previously commenting on the links between breast cancer and birth control, the NHS states that, “the baseline risk of women of a fertile age developing breast cancer is small,” and that “Unfortunately, there are often no easy answers when weighing up the benefits and risk.”

Cancer Research UK currently advises that as little as one per cent of breast cancers in women are a result of oral contraceptives.

“The protective effects of the pill against womb and ovarian cancers last longer than the increased risks of breast and cervical cancers,” it says.

“Overall, this means that the protective effects outweigh the increased risk of cancer if you look at all women who have taken the pill.”