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>.

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.

Breast Cancer & Circadian Rhythm Disruption from Electric Lighting

woman sleeping serenely

What You Need to Know: With industrialization comes electricity to light the night, both within the home and outside of it. A convergence of research in cells, rodents, and humans suggests that the health consequences of circadian disruption may be substantial. Evidence is accumulating to suggest that exposure to light at night may present a risk for breast cancer. It is not unwise to keep your night sleep time as dark as possible.

Background: Breast cancer is the leading cause of cancer death among women worldwide. Risk is highest in economically developed countries, and is rising rapidly in places that have historically had a low risk of the disease. Until the 1980s the researchers believed that this increase might be primarily related to diet. Yet, the evidence linking fat content in the adult diet to breast cancer (and showing decreases with fruit and vegetable consumption) is rather weak. In fact, other than alcohol, overall diet composition has not been strongly associated with breast cancer risk. Body mass has been linked, however. In fact, less than half of the risk in high-risk societies can be attributed to known risk factors. While recent evidence shows that physical activity can lower risk, a decrease in such activity is not likely accountable for the additional risk found in industrialized countries. So, besides obesity, less physical activity, and the use of hormones, could increased exposure to light during the dark hours (which can disrupt the “sleep hormone” melatonin be a culprit?

breast cancer tumor

The Evidence Linking Circadian Rhythm Disruption and Breast Cancer: The first suggestion that light at night might explain a portion of the breast cancer pandemic was made in 1987. The hypothesis was based on the idea that exposure to light at night would result in melatonin suppression, which in turn would increase breast cancer risk as described in the previous section. Since 1987, a series of predictions of this theory have been tested. Let’s turn to some of the evidence:

  • Shift work: Women who work nights (shift work) are at higher risk of breast cancer. The International Agency for Research on Cancer concluded that “shift work that includes circadian rhythm disruption is probably carcinogenic to humans.” The American Medical Association then broadened the topic in 2012 on the health habits of light at night in general. While subsequent studies have had mixed results, a meta-analysis (including a study of high-quality studies) linked night work to an increased risk (by a factor of 1.4).
  • Blind women: Four studies have suggested that blind women may be at a lower risk of breast cancer than sighted women.
  • Ecological analyses: Kloog analyzed cancers (lung, colon, larynx, and liver) in 164 countries. Breast cancer was significantly associated with nighttime illumination, and it was estimated that the risk was increased by a factor of 1.3 to 1.5, compared with the lowest lighted countries. The investigators controlled for fertility rate, per capita income, percent of urban population, and electricity consumption.
  • Genetics (circadian gene polymorphisms): Researchers first linked a circadian gene polymorphism to breast cancer risk in 2005.
  • Differences in methylation of circadian genes have been found when comparing day shift and night shift workers, offering a possible mechanism for an increased risk among night workers.

My Take: It is clear that electric lighting, including indoor evening light levels, has strong effects on our circadian rhythms. Recent studies show that the lighting used in at the typical home (in the industrialized world) is enough to delay melatonin onset and blunt its night peak. So here is what I would like you to do:

  • Limit your night exposure to light, whether from computer screens (the emitted light in the blue spectrum changes melatonin levels) or to night lights.
  • Sleep in a dark room, if possible (no light from the clock next to the bed, or seeping into your room from street lights, for example). Nocturnal light exposure and circadian disruption may be particularly important for children, and even exposure to light as a pregnant woman may affect fetal exposure to hormone levels in utero.

So many questions remain: Might circadian rhythm disruption affect your response to chemotherapy? Could it affect the natural history of breast cancer and affect the risk or pace of progression? Can we control our lighting in a more sophisticated fashion that might not be so disruptive? I’m Dr. Michael Hunter, and I thank you for reading this very long blog.

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: RG Stevens et al. Breast Cnacer and Cricadian Disruption from Electric Lighting in the Modern World. CA Cancer J Clin 2014;64: 207-218.

 

Sleep Patterns and Cancer: New Evidence

woman sleeping

I recently enjoyed a short essay by Cary Peasant, and want to share it with you.

Sleep disorders are common in both men and women. The body needs adequate sleep. Recent evidence shows the value of sleep to the body is to clean out waste molecules in the brain, allowing us to function better. This observation was even listed in Science as one of the most important scientific observations of 2013.

I found recent basic science and referenced clinical studies very important. Hakim and coworkers (Cancer Research 2014, volume 74, page 1329) studied mice which had experimental tumors TC-1 or 3LLC. If the mice were subjected to sleep disruption (using a mechanical sweeper during daylight hours to fragment the sleep patterns of the mice), the cancers grew faster and became larger. Also, these tumors in sleep deprived mice were more invasive into normal muscle and subcutaneous tissues of the mice. The reason for the accelerated cancer growth and invasiveness was increased tumor macrophages. The authors identified the TLR4, MYD88 and TRIG pathways to be controlling the macrophages, which may prompt new cancer treatments if pathway modulating drugs can be developed.

But are sleep disorders associated with cancers in people? Yes , and more than you might think. Short sleep duration increased the incidence of breast cancer (S. Pinheiro, Cancer Res 2006; 66: 5521). Since colon polyps are more frequent in patients with sleep disorders (C. Thompson, Cancer 2011; 117: 841), it is not surprising that colon cancer is also more frequent (L Jiao and coworkers, Br J Cancer 2013; 108: 213). Even liver cancer is increased in sleep deprived J. Liang, Sleep Med 2012; 13; 869).

I suggest that this basic and clinical data should prompt us to review sleep patterns in our patients and if they are deficient, to refer those patients to sleep specialists for evaluation and treatment. This should be associated with reduction of fatigue and sleepiness, as well as possible improving tumor control.

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: http://boards.medscape.com/forums/?128@@.2a5c927d!comment=1

Breast Cancer Risk: BMI Matters (Shape, Not So Much)

obese white woman

Summary: A study of predominantly white women finds a larger waist circumference is associated with higher risk of postmenopausal breast cancer, but not beyond its contribution to Body Mass Index (BMI). The study, by American Cancer Society researchers, fails to confirm previous findings that body shape itself is an independent risk factor for breast cancer. The current study appears in the April 2014 issue of Cancer Causes, and Control.

Background: Abdominal obesity is linked to a number of conditions, including heart disease, type II diabetes, and breast and other cancers. Those studies have led to the theory that having an “apple shaped” body, with weight concentrated in the chest and torso, is riskier than having a “pear-shaped” body, with fat concentrated in the hips, thighs and buttocks.

The Evidence: To explore the theory, researchers led by Mia Gadet, PhD, analyzed data from 28,965 women participating in the Cancer Prevention Study II. Among those women there were 1,088 invasive breast cancer cases diagnosed during a median 11.58 years of follow-up. They found a statistically significant positive association between waist circumference and postmenopausal breast cancer risk; however, when they adjusted for BMI, the association disappeared.

“Iif you have a high BMI, regardless if you are pear or apple shaped, you are at higher risk of breast cancer,” said Dr. Gaudet. “Most prior studies on this issue looked at BMI or at waist circumference, but had not looked at them together. This study brings some clarity to the association between obesity and risk of breast cancer.”

Dr. Gaudet says the data could help women focus on what’s important in what has been a confusing array of potential risk factors for breast cancer. “We know being overweight, particularly when the weight gain happened during adulthood, is one of the important modifiable risk factors for breast cancer in post-menopausal women. This new data indicates it’s not what shape you are, it’s what kind of shape you are in that probably ought to be their focus.” 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: Mia M. Gaudet, Brian D. Carter, Alpa V. Patel, Lauren R. Teras, Eric J. Jacobs, Susan M. Gapstur. Waist circumference, body mass index, and postmenopausal breast cancer incidence in the Cancer Prevention Study-II Nutrition Cohort. Cancer Causes & Control, 2014; DOI: 10.1007/s10552-014-0376-4


Father’s Age at Daughter’s Birth May Affect Her Cancer Risk

teenage boy and girl
 
What You Need to Know: A parent’s age at birth, particularly a father’s age, may affect the adult-onset cancer risk for daughters — especially for breast cancer. Women born to a father under the age of 20 had a 35 percent greater risk of breast cancer and more than two times greater risk of ovarian cancer, when compared to those born to a father whose age at his daughter’s birth was 25 to 29 years old.
 
The Evidence: Lu and her colleagues examined a cohort of 133,479 female teachers and administrators from the California Teachers Study. Between 1995 and 2010, 5,359 women were diagnosed with breast cancer, 515 women were diagnosed with ovarian cancer and 1,110 women were diagnosed with endometrial cancer.
  • While the team of researchers did not find an association for maternal age at birth for any type of cancer, they found that paternal age is linked to an increased adult-onset cancer risk for daughters .
  • Women born to a father under the age of 20 had a 35 percent greater risk of breast cancer and more than two times greater risk of ovarian cancer, when compared to those born to a father whose age at his daughter’s birth was 25 to 29 years old.
  • Women born to a father whose age at childbirth was 30 to 34 years had a 25 percent greater risk of endometrial cancer than those born to a father age 25 to 29.

Lu and her team were not surprised to find a relationship between older fathers and an increased risk of hormone-related cancers, especially since there has been increasing evidence suggesting that daughters born to older fathers have increased risk of breast cancer, noted Lu. However, there have been no previous studies that examine the effects that young paternal age has on a daughter’s breast cancer risk or the effects of parental age on the risk of ovarian cancer and endometrial cancer.

“We observed that young paternal age, as well as advanced paternal age, increase the risk of breast cancer,” said Lu. “We also found that young paternal age increases the risk of ovarian cancer.”

My Take: We have an increasing understand of factors associated with the development of cancers, including breast cancer.   While we don’t get to choose how old our dads are when they conceive us, we are also learning about modifiable risk factors (including weight, physical activity, and others). 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: City of Hope. “Father’s age at birth may affect daughter’s cancer risk.” ScienceDaily. ScienceDaily, 7 April 2014. <www.sciencedaily.com/releases/2014/04/140407153810.htm>.

Sports Reduces Breast Cancer Risk

Seniors jogging exercise on forest woods road

Practising sport for more than an hour day reduces the risk of contracting breast cancer, and this applies to women of any age and any weight, and also unaffected by geographical location, according to research presented to the 9th European Breast Cancer Conference (EBCC-9). Compared with the least active women, those with the highest level of physical activity reduced their risk of breast cancer by 12%, researchers say.

The Study: Professor Mathieu Boniol, Research Director at the International Prevention Research Institute, Lyon, France, recently reported the results of a meta-analysis (study of a group of studies) of 37 studies published between 1987 and 2013, representing over four million women. “These are all the studies looking at the relationship between physical exercise and breast cancer risk that have been published to date, so we are confident that the results of our analysis are robust,” he said.

The Evidence: Although the results varied according to tumour type, the overall message was encouraging, the researchers say. However, in women taking hormone replacement therapy (HRT), the protective effect of exercise seemed to be cancelled out. But increased awareness of the side effects of HRT means that its use is decreasing in a number of countries, and this means that the beneficial effects of activity will most likely grow in the years to come. “Whether or not this will be the case is an interesting question and deserves to be followed up at a later date,” Prof Boniol said.

Physical activity is known to have a protective role in other cancers, as well as in disorders such as cardiovascular disease. Although the mechanisms for its effect are unclear, the results are largely independent of body mass index (BMI), so the effect must be due to more than weight control. And the age at which sporting activity starts also appears to be immaterial; the researchers found no indication that breast cancer risk would decrease only when physical activity started at a young age.

“Adding breast cancer, including its aggressive types, to the list of diseases that can be prevented by physical activity should encourage the development of cities that foster sport by becoming bike and walk-friendly, the creation of new sports facilities, and the promotion of exercise through education campaigns,” said Prof Boniol. “This is a low cost, simple strategy to reduce the risk of a disease that currently has a very high cost, both to healthcare systems and to patients and their families. It is good news both for individuals and for policy makers.”

My Take: Women have a real impetus to increase their physical activity by even modest increments. This review comfirms that improvements in breast health can now be added to the other established health benefits of physical activity. So keep moving! I love for my patients to get a minimum of the equivalent of a brisk walk, 5 times per week. If you can do more, great. But even that small amount of additional activity can add years to your life, while potentially lowering your risk of heart attack, stroke, dementia, and cancer. 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: The European CanCer Organisation (ECCO). “Regular physical activity reduces breast cancer risk irrespective of age.” ScienceDaily. ScienceDaily, 20 March 2014. <www.sciencedaily.com/releases/2014/03/140320100816.htm>.