Poor adolescent diet associated with premenopausal breast cancer

“During adolescence and early adulthood, when the mammary gland is rapidly developing and is therefore particularly susceptible to lifestyle factors, it is important to consume a diet rich in vegetables, fruit, whole grains, nuts, seeds, and legumes and to avoid soda consumption and a high intake of sugar, refined carbohydrates, and red and processed meats.”

– lead author Karin B. Michels, ScD, PhD, professor and chair of the Department of Epidemiology at the UCLA Fielding School of Public Health, Los Angeles

Key points: Women who consumed a diet associated with chronic inflammation  as adolescents or young adults appear to have a higher risk of developing premenopausal breast cancer, as compared with those who had a diet not linked to inflammation.

Background: Researchers used data from 45,204 women in the Nurses’ Health Study II who had completed a food frequency questionnaire in 1998, when they were ages 33 to 52, about their diet during high School. The investigators then assed adult diet by first using a food frequency questionnaire in 1991, when participants were ages 27 to 44, and then every 4 years thereafter. They gave each woman’s diet an inflammatory score using a previously method that links diet with inflammatory markers in the blood.

During 22 years of follow-up, 870 of the women who completed the high school food frequency questionnaire were diagnosed with premenopausal breast cancer and 490 were diagnosed with postmenopausal breast cancer. When women were divided into five groups based on the inflammatory score of their adolescent diet, those in the highest score group had a 35 percent higher risk for premenopausal breast cancer relative to those in the lowest score group. When the same analysis was done based on early adulthood diet, those in the highest inflammatory score group had a 41 percent higher risk for premenopausal breast cancer relative to those in the lowest score group.

I’m Michael Hunter, the Breast Cancer Doctor.

Prostate Cancer Family History Linked to Breast Cancer Risk

What You Need to Know: Family history is a significant risk factor for breast cancer, especially in women who have first-degree relatives with the disease. That risk might be even higher if there is a first-degree relative with prostate cancer, a new study suggests.

  • In women with a family history of prostate cancer, there was a 14% increase in the relative risk of developing breast cancer. However, in women with a family history of both breast and prostate cancer, the relative risk increased to 78%.
  • In addition, the risks associated with a family history of both breast and prostate cancer was higher in black women than in white women.

“While this study is limited to largely postmenopausal women, one might expect to see a similar or stronger risk in younger women,” said first author Jennifer Beebe-Dimmer, MPH, PhD, from the Karmanos Cancer Institute and Wayne State University School of Medicine in Detroit. “We tend to see a stronger family history of breast cancer among women diagnosed at younger ages, and the same may be true for a family history of prostate cancer,” Dr Beebe-Dimmer told Medscape Medical News. We believe that physicians may want to consider family history of prostate cancer in addition to breast cancer before making recommendations about screening,” she added.

Dr Beebe-Dimmer pointed out that there is some evidence that men might have a higher risk for prostate cancer if they have first-degree relatives with breast cancer.

“We and others have shown the opposite association, particularly when female relatives are diagnosed with early-onset disease,” she said. “It has been suggested that a relatively small proportion of the prostate cancer cases diagnosed in families with breast and/or ovarian cancer are related to BRCA1/2, suggesting that there may be other genes and/or shared environmental exposures that explain the clustering.”

Multiple Relatives Increases Risk

  • The study included  78,171 women who participated in the Women’s Health Initiative Observational Study from 1993 to 1998. The women were followed for a median of 132 months from the date of enrollment, and there was a median of 60 months between enrollment and the diagnosis of breast cancer. There were 3506 cases of incident breast cancer diagnosed in the cohort up to August 31, 2009.
  • Participants with breast cancer were more likely than those without to be white non-Hispanic and college educated, and to have a history of hormone use and benign breast disease. They were also more likely to have undergone mammography screening within 2 years of the baseline examination.
  • Median age at the time of breast cancer diagnosis was 69 years (range, 50 – 90 years).
  • A positive family history of breast cancer was reported by 11,608 women in the cohort, and women with breast cancer were more likely than those without to report a family history of the disease (20.5% vs 14.6%).
  • Having a single family member with breast cancer was associated with an increase in risk of approximately 40%, after adjustment for cofounders (hazard ratio [HR], 1.42; 95% CI, 1.30 – 1.55). Having multiple family members with breast cancer increased that risk (adjusted HR [aHR], 1.66; 95% confidence interval [CI], 1.32 – 1.88).
  • Women with breast cancer were also more likely than those without to report that at least one first-degree relative had been diagnosed with prostate cancer (11.6% vs 10.1%). This family history was associated with a significant, albeit modest, increase in breast cancer risk after adjustment for confounders such as a family history of breast cancer (aHR, 1.14; 95% CI, 1.02 – 1.26).
  • The risk was highest for those with a family history of both breast and prostate cancer (aHR, 1.78; 95% CI, 1.45 – 2.19).
  • When the data were stratified by race, the risk was highest in black women who had “multiple affected first-degree family members” (aHR, 2.85; 95% CI, 1.33 – 2.08). A family history of prostate cancer was modestly predictive in both white and black women, but only reached statistical significance in white women. Although black women with a family history of both diseases appeared to be at greater risk of developing breast cancer (aHR, 2.34; 95% CI, 1.09 – 5.02), “the risk estimates were not significantly different as evidenced by the overlapping CIs,” note Dr Beebe-Dimmer and colleagues.

Reference: Cancer. Published online March 9, 2015. Abstract    

A Benign Breast Biopsy That Is Not So Benign

What You Need to Know: Women with atypical hyperplasia of the breast have a higher risk of developing breast cancer than previously thought, a study has found. Atypical hyperplasia of the breast is a precancerous condition found in about one-tenth of the over 1 million breast biopsies with benign findings performed annually in the United States.

Background: Atypical hyperplasia of the breast is a precancerous condition found in about one-tenth of the over 1 million breast biopsies with benign findings performed annually in the United States. Viewed under a microscope, atypia contains breast cells that are beginning to grow out of control (hyperplasia) and cluster into abnormal patterns (atypical). Atypia lesions are considered benign, but by its risk and appearance and genetic changes, they exhibit some of the early features of cancer.

The Mayo Clinic (USA) team had previously showed that two common statistical risk prediction models (the BCRAT and the IBIS models) performed poorly in women with atypical hyperplasia, underscoring the need to provide alternative approaches for predicting risk in this population.

The Study: To clearly define this risk, the Mayo Clinic team followed 698 women with atypia who had been biopsied at Mayo Clinic between 1967 and 2001. They reviewed pathology and medical records, and used patient follow-up questionnaires to determine which women developed breast cancer and when. The researchers found that after an average follow-up of 12.5 years, 143 women had developed the disease.

  • Importantly, the Mayo findings were validated by researchers at Vanderbilt University using biopsies from a separate cohort of women with atypia. Both data sets revealed that at 25 years following biopsy, 25 to 30 percent of these women had developed breast cancer.
  • Data from hundreds of women with these benign lesions indicate that their absolute risk of developing breast cancer grows by over 1 percent a year. The study found that after five years, 7 percent of these women had developed the disease; after 10 years, that number had increased to 13 percent; and after 25 years, 30 percent had breast cancer.
  • Researchers gave an even more accurate estimate of risk by incorporating information from a patient’s pathology specimen. They found that as the extent of atypia in a biopsy increased, as measured by the number of separate atypia lesions or foci, so did the woman’s risk of developing breast cancer. For example, at 25 years post-biopsy, 47 percent women with three or more foci of atypia in the biopsy had developed breast cancer, compared to only 24 percent of women with one focus.

My Take: Consideration should be given to additional risk-reducing measures for this population of women. Perhaps the option of MRI screenings (in addition to mammograms) and consideration of anti-estrogen therapies such as tamoxifen can reduce cancer risk. While previous research demonstrated that women with atypic have a 4 to 5x increased risk of developing breast cancer, this is a measure known as relative risk. Few studies have had adequate patient numbers and follow-up length to better understand absolute risk – the chance that a woman will develop breast cancer over a certain period of time.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References: 

  • Lynn C. Hartmann, Amy C. Degnim, Richard J. Santen, William D. Dupont, Karthik Ghosh. Atypical Hyperplasia of the Breast — Risk Assessment and Management Options. New England Journal of Medicine, 2015; 372 (1): 78 DOI: 10.1056/NEJMsr1407164
  • Mayo Clinic. “Women with atypical hyperplasia are at higher risk of breast cancer.” ScienceDaily. ScienceDaily, 31 December 2014. <www.sciencedaily.com/releases/2014/12/141231190106.htm>.

Exercise Lowers Chances of Getting Breast Cancer

What You Need to Know: Postmenopausal women who in the past 4 years who have undertaken regular physical activity (equivalent to at least 4 hours walking per week) had a lower risk for invasive breast cancer.

The Study: Fournier and colleagues analyzed data from biennial questionnaires completed by 59,308 postmenopausal women who were enrolled in E3N, the French component of the European Prospective Investigation Into Cancer and Nutrition (EPIC) study. The mean duration of follow-up was 8.5 years, during which time 2,155 women were found to have a first primary invasive breast cancer.

Results: Postmenopausal women who in the previous 4 years had undertaken 12 or more MET-h (metabolic equivalent task-hours; roughly equivalent to at least 4 hours walking per week) had a 10% decreased risk of invasive breast cancer compared with women who were less active. 

My Take: It is not necessary to engage in vigorous or very frequent exercise; even walking 30 minutes per day seems beneficial. Keep moving, as you may reduce your own risk of cancer, diabetes, high blood pressure, heart attack, stroke, or even dementia! I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Cancer Epidemiology, Biomarkers & Prevention 2014; doi:10.1158/1055-9965.EPI-14-0150.

 

The Pill Linked to Breast Cancer Risk

What You Need to Know

  • Recent use of some oral contraceptives is associated with an increased risk of breast cancer.
  • Risk varies with formulation of the contraceptives, and those with low-dose estrogen were not associated with cancer.

The Study:  In a nested case-control study, women (ages 20-49) who had used birth control pills within the previous year had a 1.5x increase in the risk of disease, compared with those who had never or formerly used the drugs, according to Elisabeth Beaber, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues.

But the risk varied with formulation of the contraceptives; some types — notably those with low-dose estrogen — were not associated with cancer, Beaber and colleagues reported in the Aug. 1 issue of Cancer Research.

Many women ask about oral contraceptives and breast cancer,” and the benefits and risks need to be clearly understood, commented Holly Pederson, MD, of the Cleveland Clinic.

In women under 50, she told MedPage Today, “their absolute risk of breast cancer is less than 2%.”

But while that risk “raises red flags,” the main concern is not oral contraceptives, she said, but familial and genetic predispositions, such as mutations in the BRCA genes. Those factors, she noted, were not analyzed in the study.

Pederson added that it’s “important to reinforce to our patients that the most commonly used birth control pill — low-dose [estrogen] monophasic — was even in this study not associated with an increased risk.”

The issue is not a new one, Beaber and colleagues noted: a 1996 pooled analysis of more than 150,000 women, a third of them with breast cancer, showed a slight increase in risk associated with oral contraceptives.

Since then, two major studies have reached differing conclusions. The Nurses’ Health Study II found an excess breast cancer risk associated with current oral contraceptive use and with one specific formulation, while the Women’s Contraceptive and Reproductive Experiences Study found no such risks.

But most such studies have relied on participant recall, lacked data on current contraceptive formulations, and didn’t stratify breast cancer risk by estrogen receptor status, they noted.

To help fill the gap, Beaber and colleagues turned to the records of the Group Health Cooperative, an integrated health care delivery system in the Seattle-Puget Sound area.

They obtained information on estrogen receptor status from the Surveillance, Epidemiology, and End Results (SEER) database.

Other findings related to recent use of oral contraceptives included:

  • High-dose estrogen was associated with an odds ratio for cancer of 2.7
  • Ethynodiol diacetate was associated with an odds ratio of 2.
  • Triphasic dosing with an average of 0.75 milligrams of norethindrone was associated with an odds ratio of 3.1
  • Other types, including low-dose estrogen oral contraceptives, were not linked to an increased risk, they reported.

The odds ratio for estrogen receptor–positive disease was 1.7 (with a 95% confidence interval from 1.3 to 2.1), while for estrogen receptor-negative disease it was 1.2, with a 95% confidence interval from 0.8 to 1.8. The difference between the two was not significantly different, Beaber and colleagues reported.

“Our results suggest that use of contemporary oral contraceptives in the past year is associated with an increased breast cancer risk relative to never or former oral contraceptive use,” Beaber said in a statement, adding the risk “may vary by oral contraceptive formulation.”

Beaber cautioned that the results need confirmation and “should be interpreted cautiously.” She noted that breast cancer remains rare in young women and that oral contraceptives have “numerous established health benefits” that need to be considered as well by doctors and patients.

Those benefits include reproductive planning, menses regulation, decreased dysmenorrhea, and decreased risk of benign breast conditions, she and colleagues concluded.

My Take: Fortunately, the overall risk of breast cancer is quite low in this age group, so even though a 1.5x increase seems extraordinarily large (and I would note that the study numbers are remarkably low (at least for women on the pill for over 6 months), it represents only a small increase in absolute risk. And remember, low-dose estrogen pills were not associated with increased risk. I do think that those with a strong family history of breast cancer may wish to proceed with more caution. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Primary reference: Beaber E, et al “Recent oral contraceptive use by formulation and Breast cancer risk among women 20 to 49 years of age” Cancer Res 2014; 74; 4078–89.

Secondary reference: http://www.medpagetoday.com/HematologyOncology/BreastCancer/47024

Too Few Breast Cancer Survivors Get Enough Exercise

women walking exercise

What You Need to Know: Exercise has been linked to better survival, less morbidity, and improved quality of life after a diagnosis of breast cancer, according to the researchers. Many women diagnosed with breast cancer do not meet the national guidelines for weekly exercise, especially black women, according to a new study.

“Our results suggest that physical activity education should be incorporated into breast cancer care,” said researcher Brionna Hair, MPH, a PhD candidate in the Department of Epidemiology at the University of North Carolina at Chapel Hill. The hope is that our study will encourage medical care providers to talk with their patients about the benefits of physical activity, not only for prolonging survival, but also for improving quality of life,” Hair told Medscape Medical News.

The study was published online June 9 in Cancer. National guidelines recommend 150 minutes of moderate-intensity exercise each week, or 75 minutes of vigorous exercise.

The Evidence:

  • The 1735 study participants were part of the prospective Carolina Breast Cancer Study.
  • All were diagnosed with invasive breast cancer from 2008 to 2011, and 48% of the cohort was black.
  • Hair and her colleagues assessed self-reported physical activity levels in women 20 to 74 years of age before and after diagnosis.

Just 35% of the women met suggested guidelines for physical activity after diagnosis, and 59% reported a decrease in physical activity. Black women were less likely than white women to meet exercise guidelines after diagnosis (odds ratio,1.38), according to a multivariate analysis adjusted for age, race, income, education, marital status, body mass index, alcohol consumption, smoking status, comorbidities, cancer stage, type of treatment, lymph node removal, and prediagnosis exercise.

In black women, there was an association between treatment and physical activity after diagnosis (P < .01). Exercise levels were lowest in black women who received chemotherapy only or who received neither chemotherapy nor radiotherapy. For black women in particular, who experience higher rates of breast cancer morbidity and mortality, “these results suggest that strategies to increase physical activity among breast cancer patients should be tailored to each patient’s individual needs,” Hair stated.

Results from the Black Women’s Health Study highlight the benefits of exercise, linking it to lower risk for aggressive breast cancer. The researchers acknowledge that an overestimation of activity levels could have resulted because participants might have been more motivated to exercise than women in the general population. In addition, the fact that the study used self-reported recall of activity could have led to an over- or underestimation of levels.

“This study provides evidence that although physical activity after a breast cancer diagnosis is important, the majority of breast cancer survivors do not meet recommended guidelines,” said Vanessa Sheppard, PhD, associate professor of oncology and assistant director of health disparities research at Georgetown University Lombardi Comprehensive Cancer Center in Washington, DC. In fact, for many women, levels of physical activity are lower than they were before their diagnosis,” she added.

Reasons for this might be related to insufficient knowledge about the benefits of exercise, physical limitations resulting from treatment, or problems with access to safe and affordable places to exercise, she told Medscape Medical News. She noted that the results for black women are concerning. Increased awareness is needed about the importance of exercise for breast cancer survivors in general and for some at-risk groups in particular, such as black and low-income women.

“From a clinical perspective, providers can encourage and facilitate exercise among breast cancer survivors by becoming aware of and providing referrals to local resources, like survivorship programs or exercise physiologists with a background in cancer rehabilitation,” Dr. Sheppard said. “In many instances, simply encouraging people to walk is important. Trying to get to 10,000 steps per day is a goal that is low cost and could be encouraged.”

My Take: Check in with a valued health professional regarding exercise. Then: Aim for a minimum of 150 minutes per week of the equivalent of a brisk walk (for example, walk 30 minutes, 5 times per week). I’m Dr. Michael hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Cancer. Published online June 9, 2014. Abstract; http://www.medscape.com/viewarticle/826642

Video: Red Meat Consumption and Breast Cancer Risk

grilled meat steak diet french fries dinner

Here is a link to a CNN video examining the relationship between red meat consumption and breast cancer. While no definitive link has been established, this study suggests that earlier consumption (say, in your 30s) may increase risk.

CLICK HERE: http://www.cnn.com/video/data/2.0/video/health/2014/06/14/pkg-red-meat-increases-breast-cancer-risk.cnn.html

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.