The Tea about Breast Cancer
I’ll be spilling tea on the statistics of breast cancer, disparities in breast cancer as it relates to women of color, ways to identify breast cancer early, and ways to reduce your risk for breast cancer.
My goal for discussion is to always use inclusive language. However, much of the breast cancer data has not been updated in an inclusive manner so for this discussion when utilizing the term women, the research is referring to those biologically born with female genetic makeup and when utilizing the term men, the research is referring to those biologically born with male genetic makeup.
Now let’s start with some fast facts about breast cancer.
Fact #1: Breast Cancer mostly affects women but can affect some men also. However, it is a rare occurrence in men.
Fact #2: Breast Cancer mostly affects women over the age of 45. However, it can affect younger women also with about 9% of all new cases of breast cancer in the United States being found in women younger than 45 years of age.
Fact #3: There are some risk factors for Breast Cancer that you cannot change. But there are some other risk factors for Breast Cancer that you can change. We’ll discuss this topic further today so stay tuned.
Fact #4: You are not alone. A cancer diagnosis or even a pre-cancerous diagnosis for any form of cancer can be scary and life-altering. Know that there is help out there. I’ll list some resources for support in the show notes.
Here’s some sobering tea on Breast Cancer in black women. While black women have a lower percentage of new cases of breast cancer than white women, Black women have the highest death rate from breast cancer. Black women are 41% more likely to die from breast cancer than White women, despite being less likely to be diagnosed with it. Breast cancer is the leading cause of cancer death in black women and has recently surpassed lung cancer for this ranking with decreased rates of smoking.
Studies have found several factors that may be contributing to this phenomenon amongst black women including decreased rates of those who breastfeed their children and the increased rates of black women who carry excess weight in their abdominal area. Also, about 1 in 5 Black women with breast cancer have triple-negative breast cancer, a more aggressive form of breast cancer and this rate is more than any other racial/ethnic group making Black women twice as likely to be diagnosed with triple-negative breast cancer than white women.
Information from the American Cancer Society states that Triple Negative Breast Cancer accounts for about 10-15% of all breast cancers. The term triple-negative breast cancer refers to the fact that the cancer cells don’t have the female hormones, estrogen, or progesterone receptors and also don’t make any or too much of the protein called HER2. These three receptors are typically found in breast cancer, and many of the medication therapies for breast cancer target these receptors.
This is a wonderful explanation of triple-negative breast cancer brought to us by the Centers for Disease Control and Prevention or CDC. Think of cancer cells as a house. The front door may have three kinds of locks, called receptors; one lock is for the female hormone estrogen; one lock is for the female hormone progesterone; and One lock is for a protein called human epidermal growth factor or HER2.
If your form of breast cancer has any of these three locks, there are a variety of keys, like hormone therapy or other drugs, that can be used to help destroy the cancer cells.
But if one has triple-negative breast cancer, it means that those three locks aren’t there. The breast cancer cells test "negative" on all 3 tests; leaving fewer keys for treatment. However, chemotherapy is still an effective option. And other treatments are used like removing the breast lump or lumpectomy, removing the breast itself or mastectomy, and radiation therapy.
These cancers tend to be more common in women younger than age 40, who are Black, or who have a BRCA1 mutation.
Triple Negative Breast Cancer differs from other types of invasive breast cancer in that it tends to grow and spread faster, and it tends to have a worse potential outcome due to fewer treatment options available for this form of cancer.
Also, research from the American Cancer Society found that due to other socioeconomic factors, systemic racism, and barriers to access to quality healthcare, black women have been found to be more likely to be diagnosed with advanced-stage disease, which is usually more costly and difficult to treat; More likely to experience delays in treatment; and Less likely to receive recommended treatment leading to higher rates of death from breast cancer.
So now that we know the statistics let’s sip some tea as we discuss ways to identify breast cancer early. As the research has shown, your chance for survival is increased when cancer is found early enough for interventions to be provided.
Breast Cancer Screening recommendations have changed some over the past several years and some recommendations will vary depending on the academic group you are following. However, here is some consensus on the screening recommendations.
A mammogram, which is like an x-ray of the Breast, is our main screening resource. An individual may choose to undergo mammogram screening as early as age 40 to 49. However, the academic groups differ on if this is necessary or not for this age group, and definitely recommend you have this discussion with your personal doctor to determine the risks and benefits of screening within this age group.
For women ages 50 to 74, the academic groups agree that routine breast screening should occur. However, the timeframe for repeat screening is debatable with some groups recommending yearly screening and some recommending screening every 2 years.
Beyond age 75, the recommendation to screen or not screen for breast cancer is variable. The thought behind this is since most breast cancers will be found and diagnosed when a woman is in her 60s, there should be a balance of if there is a further risk of harm to continue screening beyond age 75 and the thought that at that age a woman is more likely to be at higher risk from heart disease than breast cancer.
For those women who are considered to be at high risk, these guidelines won’t likely apply to you so you will definitely want to discuss this with your doctor.
Another way to screen for breast cancer is with an MRI or Magnetic Resonance Imaging which uses magnets and radio waves to take pictures of the breast.
Breast MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk and are reserved for those who are at higher risk.
Other forms of screening include Clinical Breast Exams, which are manual exams that may be performed by your doctor, and self breast exams which are manual and visual exams that you perform on your own body to look for any new or different changes in your breast that may be concerning. Check out the show notes for a detailed guide on performing your self breast evaluation.
There are times when one of these screening modalities may not find your breast cancer early enough. This is called a false negative result.
So it’s important to know your risk and to discuss with your doctor the recommended screening routine for you.
As we discussed at the top, there are some risks for breast cancer that you cannot change. For example, age. Most breast cancers are diagnosed after age 50.
We also cannot alter our genes and studies have shown that about 5 to 10 percent of breast cancers are hereditary. BRCA 1 and 2 are two specific gene mutations that have been identified that may contribute to hereditary breast cancer. BRCA is an abbreviation for Breast Cancer Gene. BRCA1 and BRCA2 are two different genes that have been found to impact a person’s chances of developing breast cancer. All women have BRCA1 and BRCA2 genes, and normally these genes play a role in the prevention of breast cancer. But there are some women who have mutations or alterations in those genes causing them to not work properly to carry out their role of breast cancer prevention.
According to the CDC, about 1 in every 500 women in the United States has a mutation in either her BRCA1 or BRCA2 gene. People with a BRCA gene mutation are more likely to develop breast cancer and more likely to develop cancer at a younger age.
However, not every woman who has a BRCA1 or BRCA2 gene mutation will get breast cancer, but having a gene mutation puts you at an increased risk for this cancer.
I’ll share with you some additional information from the CDC. About 50 out of 100 women with a BRCA1 or BRCA2 gene mutation will get breast cancer by the time they turn 70 years old, compared to only 7 out of 100 women in the general United States population.
Another risk factor we cannot change is our family history and inherited risks. Sometimes I encounter individuals who aren’t well informed regarding the health of their close family members and who don’t know much about what conditions their parents, siblings or grandparents have or may have had. If you are one of these individuals, I encourage you to take a moment with your family members to become aware of what health conditions others may have or have had as this will be helpful for you to know what conditions you may be at risk for developing. When you know your risk, it's helpful to look for these conditions earlier to prevent the condition altogether or the worsening of the condition.
Here are some findings that may help you to determine if you may be at risk for BRCA gene mutations and these are based on your family history.
You may be at increased risk if your family history includes:
Several relatives with breast cancer.
Any relatives with ovarian cancer.
Relatives who got breast cancer before age 50.
A relative with cancer in both breasts.
A relative who had both breast and ovarian cancers.
A male relative with breast cancer.
Ashkenazi Jewish ancestry (Central or Eastern European) and any relative with breast or ovarian cancer.
A relative with a known BRCA gene mutation.
Additional breast cancer risk factors that we cannot change include our reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
We cannot change the risk factor of having dense breast tissue. The breast has 3 kinds of tissue: fibrous tissue; glandular tissue; and fatty tissue. When a mammogram report states that someone has dense breast tissue, this means that their breast contains MORE fibrous and glandular tissue and LESS fatty tissue. Dense breast tissue can hide breast cancer lesions on a mammogram because they become more challenging to see in the imaging study. This is actually an instance where having an area of the body with more fatty tissue is protective.
Previous treatment with radiation therapy to the chest or breast area for another condition before the age of 30 can increase one’s risk for breast cancer. We cannot change this risk factor.
And exposure to a medication called DES is a risk factor for breast cancer that we cannot change. DES was given to some pregnant women in the United States between the 1940s and 1970s to prevent miscarriage. Women who took DES, or whose mothers took DES while pregnant with them, have a higher risk of getting breast cancer.
According to data from the American Cancer Society; Overall, a woman in the United States has a 1 in 8 chance that she will develop breast cancer. This equates to about a 13% chance of developing breast cancer at some point in your life. However, the bright side to this is that this also means that there is a 7 in 8 chance that you will never develop breast cancer. So let's talk about ways to reduce your risk.
#1: Get moving! Studies have shown that exercise can reduce one’s risk for breast cancer. Aim to get at least 150 to 300 minutes or 2 and a half to 5 hours of moderate to vigorous physical activity each week. Choose activities like brisk walking, mowing the lawn with a push lawnmower, cycling, playing tennis, hiking, jogging or running, playing basketball, or dancing in a high-intensity dance class like Zumba.
#2: Maintain a healthy weight! Older women who have an overweight or obese weight have a higher risk of developing breast cancer. Increased Weight gain with increasing age has also been associated with an increased risk of breast cancer.
#3: Beware of hormones! Hormone replacement therapy after menopause can increase one’s risk for the development of breast cancer especially when taken for a prolonged period of time, typically greater than 5 years. So talk to your doctor and consider some non-hormonal options for treating your menopausal symptoms.
#4: For those who are able and have the desire, to reproduce! Having your first pregnancy before age 30, and breastfeeding for at least several months after childbirth can be beneficial in reducing some of your risk for the development of breast cancer.
#5: Limit Alcohol consumption! Studies have shown that alcohol intake can increase one’s risk for the development of breast cancer. If you opt to drink alcohol, try not to exceed one alcoholic drink per day.
This leads us to our Ask The Expert Segment of the podcast. In today’s Ask The Expert segment our question is “Is it true that processed meats cause cancer?”. This question was submitted anonymously but a special thank you for submitting this question.
Now let me get you some crackling hot tea regarding processed meat.
In 2015 the World Health Organization WHO classified processed meat as carcinogenic to humans meaning that it was proven to be linked to increasing one’s risk for cancer, specifically colorectal cancer. Their studies found that just 50 grams of processed meat eaten daily increases the risk of colorectal cancer by 18%. Meaning that about 4 slices of bacon or 1 hot dog can increase your risk of colorectal cancer to almost a 1 in 5 chance.
Another 2015 study and a 2017 study showed that nitrite intake from processed meat increased a woman’s risk of breast cancer by over 20%. Eating just 15 grams of processed meat daily was shown to increase one’s risk of breast cancer. Keep in mind that this amount was much less than the amount mentioned in the colorectal cancer findings.
So when you’re deciding what to put on your plate, steer clear of ham, sausage, hot dogs, bacon, pepperoni, beef jerky, and deli meats including roast beef and turkey. Be a label reader and avoid foods that contain nitrites or nitrates. Nitrates are nitrogen based compounds that are added to meats during their processing to preserve the meat. Nitrites are derived from nitrates so you may see these terms used interchangeably but steer clear of both nitrates and nitrites.
The components of processed meats that are responsible for their cancer risk include nitrates added; heme iron which is a pigment that makes the meat red; and chemicals called Heterocyclic amines and polycyclic amines which are produced when meat is cooked at high temperatures like frying your bacon or grilling your hotdog. All of these components cause damage to the healthy cells within our body increasing your risk for the development of cancerous cells.
So think outside of the deli box for your health!
Instead of a deli sandwich, choose a plant based sandwich made with fresh vegetables, hummus, and or tofu.
Add vegetables to your plate for a vegetable hash instead of the traditional bacon and egg breakfast.
At your next cookout, try a plant based burger or a carrot hotdog instead.
Use food to promote health, not disease.
The Essence of Health is in You!