Breast cancer. Those two little words can strike fear in the heart of even the strongest women among us. In fact, statistics show that one in eight women will be diagnosed with breast cancer at one point in their lifetime. Most women know of at least one other woman who has been diagnosed with breast cancer. And some families seem to have more breast cancer than others do. For many women, breast cancer seems inevitable. This is not the case! With the right information, women can make rational choices that can decrease their chances of getting breast cancer.
In the Ashkenazi Jewish population, one in every 40 individual carries a harmful mutation in the genes BRCA1 or BRCA2. This mutation rate is much higher than that in the general U.S. population (1 in 400), and can be passed on by men and women alike. A mutation changes a woman’s lifetime risk of breast cancer from 12% (1 in 8) to nearly 80% (see table). Any Ashkenazi woman with a personal history of breast or ovarian cancer should be tested. Women with mothers, grandmothers, aunts, sisters or daughters with breast or ovarian cancer should also consider testing. For women who come from small families or male-predominant families – which might hide a mutation – it’s important to talk to a genetics expert about possible risk.
If a woman is found to have a BRCA mutation, steps can be taken to detect cancer earlier, when there is a better chance for cure, or to prevent cancer altogether. Adding an annual MRI (a non-radiation-based screening tool) to the annual mammogram can increase the sensitivity of screening and the ability to detect early stage cancers. The data supporting MRI’s ability to detect cancer are so good that insurance plans are obligated to cover this test for BRCA mutation carriers. Some women opt for preventive surgery. Removing the ovaries by age 35 or when childbearing is complete can not only reduce the risk of ovarian cancer by nearly 95%, but can also reduce the risk of breast cancer by about 50%; preventive mastectomies (removing both breasts) can reduce the risk of breast cancer by almost 100%.
Of course, preventive surgeries may seem dramatic, but women like Angelina Jolie are making this choice every day to take control of their life and eliminate their risk. For those who are at high risk for breast cancer but are not ready to make this choice, there are two medications that are now FDA-approved to reduce the risk of breast cancer. Tamoxifen, when taken daily for five years, can reduce the lifetime risk of cancer by 40-50%.
A newer study published in 2011 shows that for postmenopausal women with an increased risk of breast cancer, the drug exemestane, also called Aromasin, can be even more effective than tamoxifen. These and other options should be discussed in detail with a clinician specializing in the management of breast cancer risk.
For women who do not have a strong family history and may not carry the BRCA gene mutations, there are still things that can be done to reduce the likelihood of breast cancer. Screening for the average-risk woman should start at age 40.
Women should not live in fear of breast cancer. Ashkenazi women in particular have the opportunity to take control of their personal risk and take steps to turn that knowledge into the power to prevent cancer.
BREAST CANCER DATA-SUPPORTED, RISK-REDUCING STRATEGIES
Active lifestyle
At least 270 minutes per week of cardio exercise
Healthy body weight, with a target BMI of 24
Reducing alcohol to no more than 3-4 alcoholic beverages per week, without binge drinking
Increasing vegetable consumption and reducing processed foods
Supplementation of vitamin D
No smoking
Consider daily aspirin
