Breast Cancer
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CANCERFORWARD | BY POLLY NIRAVATH, MD
Today, in the United States, there are over 2.5 million breast cancer survivors. In fact, breast cancer boasts an 89 percent relative survival rate! This is an especially remarkable statistic when one considers where we came from.
There was a steady increase in breast cancer death between 1975 and 1990, with an average increase in 0.4 percent per year in the death rate. However, the rates have markedly declined since then, with a 2.2 percent decrease in breast cancer death each year between 1990 and 2004, for a total decrease of more than 25 percent. So how have we made such rapid progress in such a relatively short period of time?
Roughly half of this reduction is due to the onset of routine screening mammography in the 1980’s, and the remaining half is due to improvements in our therapy. There have been relatively wild swings in our treatment practices, with essentially zero percent of women with localized breast cancer receiving chemotherapy in 1975, compared with 80 percent in 2000. Since then, with personalization of therapy, the number of women who receive chemotherapy has sharply dropped, with chemotherapy now tailored towards only women who truly need it. The end result of these drastic practice changes is a significant improvement in breast cancer survival for all women.
Through early detection, screening mammography has truly saved tens of thousands of women’s lives over the past three decades. Currently, there are conflicting recommendations regarding the use of screening mammography. The American Cancer Society (ACS) recommends annual mammograms for all women age 40 or older, continuing for as long as the woman is in good health. However, the U.S. Preventive Services Task Force (USPSTF) recommends mammograms every two years for women ages 50-74.
Most oncologists in the United States agree with the ACS recommendations. For breast cancer survivors; however, there is no ambiguity. Survivors should have annual mammograms and be followed regularly by their oncologist. Furthermore, another special group is comprised of those women who have a first degree relative (i.e. mother or sister) who was diagnosed with breast cancer under 50 years of age. These women should start having annual mammograms 10 years before the age of diagnosis of their relative. For example, if a woman’s mother was diagnosed with breast cancer at age 45, then that woman should begin her screening mammograms at age 35.
Aside from regular mammograms, there are many other things which breast cancer survivors can do which significantly reduce the risk of breast cancer recurrence and death from breast cancer.
First of all, regular exercise should be a key component of all survivors’ lifestyles. The Nurses’ Health Study followed nearly 3,000 breast cancer survivors and found that women who exercised regularly had half the chance of dying from breast cancer as women who did not exercise. Furthermore, the only exercise necessary was simply walking at an average pace for 3-5 hours each week. Aside from the numerous cardiovascular and psychological benefits of exercise, the benefits in terms of cancer survival are significant as well.
Secondly, maintaining a healthy weight has also proven to play an important role in breast cancer prevention. Particularly among never-smokers, women who gained more than 2 kg/m2 in their Body Mass Index (BMI) within 12 months after the time of diagnosis have a 1.6 times greater risk of dying from breast cancer than those women who maintain their weight. They also had a higher risk of breast cancer recurrence. For the average woman, gaining 2 kg/m2 in BMI equates to approximately a 12 pound weight gain. See how to calculate your own BMI and find out how to stay at that weight. Clearly, maintaining a healthy body weight provides enormous benefit for breast cancer survivors.
Finally, avoidance of alcohol is another measure which survivors can take to reduce their risk of breast cancer recurrence. A large study which followed nearly 1,900 breast cancer survivors found that women who drank 3-4 alcoholic drinks per week had a higher rate of breast cancer recurrence as well as breast cancer death. Regular drinkers were 1.35 times more likely to have their breast cancer come back, and 1.5 times more likely to die of breast cancer, than non-drinkers! The increased risk of recurrence was found to be even greater among post-menopausal and overweight survivors. These differences are clearly substantial, and most breast oncologists thus suggest that all their patients avoid alcohol, or at least limit themselves to less than three drinks per week.
Conversely, there are many interventions which are commonly believed to modulate the risk of breast cancer, but they have never been definitively proven to do so in high quality clinical trials.
For example, while diets which are rich in fresh fruits and vegetables may have many other positive health benefits, this is not known to reduce breast cancer risk. Similarly, anti-oxidant Vitamins A, C, and E, as well as carotenoids, are not known to significantly reduce a woman’s risk of breast cancer. “Statins” are drugs which lower cholesterol and also have an anti-inflammatory effect. They have been tested in clinical trials and have shown no benefit in breast cancer risk reduction. Lastly, the results regarding smoking and breast cancer risk have been inconsistent, with some trials showing a connection between smoking and the development of breast cancer, and others showing no such association. Thus, this area of research is too controversial to draw any clear conclusions at this point.
While we have made major strides in breast cancer screening and therapy in the recent past, much work still remains to be done. Nonetheless, there are many lifestyle choices which each breast cancer survivor can make on a daily basis to significantly reduce her own risk of breast cancer recurrence and death from breast cancer.
The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.
- See more at: http://www.cancerforward.org/survivor-resources/cancer-experts/Polly-Niravath-MD/breast-cancer-risk-and-recurrence-in-women-then-and-now#sthash.BgZYxbLb.dpufThere was a steady increase in breast cancer death between 1975 and 1990, with an average increase in 0.4 percent per year in the death rate. However, the rates have markedly declined since then, with a 2.2 percent decrease in breast cancer death each year between 1990 and 2004, for a total decrease of more than 25 percent. So how have we made such rapid progress in such a relatively short period of time?
Roughly half of this reduction is due to the onset of routine screening mammography in the 1980’s, and the remaining half is due to improvements in our therapy. There have been relatively wild swings in our treatment practices, with essentially zero percent of women with localized breast cancer receiving chemotherapy in 1975, compared with 80 percent in 2000. Since then, with personalization of therapy, the number of women who receive chemotherapy has sharply dropped, with chemotherapy now tailored towards only women who truly need it. The end result of these drastic practice changes is a significant improvement in breast cancer survival for all women.
Through early detection, screening mammography has truly saved tens of thousands of women’s lives over the past three decades. Currently, there are conflicting recommendations regarding the use of screening mammography. The American Cancer Society (ACS) recommends annual mammograms for all women age 40 or older, continuing for as long as the woman is in good health. However, the U.S. Preventive Services Task Force (USPSTF) recommends mammograms every two years for women ages 50-74.
Most oncologists in the United States agree with the ACS recommendations. For breast cancer survivors; however, there is no ambiguity. Survivors should have annual mammograms and be followed regularly by their oncologist. Furthermore, another special group is comprised of those women who have a first degree relative (i.e. mother or sister) who was diagnosed with breast cancer under 50 years of age. These women should start having annual mammograms 10 years before the age of diagnosis of their relative. For example, if a woman’s mother was diagnosed with breast cancer at age 45, then that woman should begin her screening mammograms at age 35.
Aside from regular mammograms, there are many other things which breast cancer survivors can do which significantly reduce the risk of breast cancer recurrence and death from breast cancer.
First of all, regular exercise should be a key component of all survivors’ lifestyles. The Nurses’ Health Study followed nearly 3,000 breast cancer survivors and found that women who exercised regularly had half the chance of dying from breast cancer as women who did not exercise. Furthermore, the only exercise necessary was simply walking at an average pace for 3-5 hours each week. Aside from the numerous cardiovascular and psychological benefits of exercise, the benefits in terms of cancer survival are significant as well.
Secondly, maintaining a healthy weight has also proven to play an important role in breast cancer prevention. Particularly among never-smokers, women who gained more than 2 kg/m2 in their Body Mass Index (BMI) within 12 months after the time of diagnosis have a 1.6 times greater risk of dying from breast cancer than those women who maintain their weight. They also had a higher risk of breast cancer recurrence. For the average woman, gaining 2 kg/m2 in BMI equates to approximately a 12 pound weight gain. See how to calculate your own BMI and find out how to stay at that weight. Clearly, maintaining a healthy body weight provides enormous benefit for breast cancer survivors.
Finally, avoidance of alcohol is another measure which survivors can take to reduce their risk of breast cancer recurrence. A large study which followed nearly 1,900 breast cancer survivors found that women who drank 3-4 alcoholic drinks per week had a higher rate of breast cancer recurrence as well as breast cancer death. Regular drinkers were 1.35 times more likely to have their breast cancer come back, and 1.5 times more likely to die of breast cancer, than non-drinkers! The increased risk of recurrence was found to be even greater among post-menopausal and overweight survivors. These differences are clearly substantial, and most breast oncologists thus suggest that all their patients avoid alcohol, or at least limit themselves to less than three drinks per week.
Conversely, there are many interventions which are commonly believed to modulate the risk of breast cancer, but they have never been definitively proven to do so in high quality clinical trials.
For example, while diets which are rich in fresh fruits and vegetables may have many other positive health benefits, this is not known to reduce breast cancer risk. Similarly, anti-oxidant Vitamins A, C, and E, as well as carotenoids, are not known to significantly reduce a woman’s risk of breast cancer. “Statins” are drugs which lower cholesterol and also have an anti-inflammatory effect. They have been tested in clinical trials and have shown no benefit in breast cancer risk reduction. Lastly, the results regarding smoking and breast cancer risk have been inconsistent, with some trials showing a connection between smoking and the development of breast cancer, and others showing no such association. Thus, this area of research is too controversial to draw any clear conclusions at this point.
While we have made major strides in breast cancer screening and therapy in the recent past, much work still remains to be done. Nonetheless, there are many lifestyle choices which each breast cancer survivor can make on a daily basis to significantly reduce her own risk of breast cancer recurrence and death from breast cancer.
The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.
http://www.cancerforward.org/survivor-resources/cancer-experts/Polly-Niravath-MD/breast-cancer-risk-and-recurrence-in-women-then-and-now
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