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Lifestyle affects risk of second breast cancer

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Lifestyle affects risk of second breast cancer

Surviving breast cancer is no guarantee that a new cancer won’t appear in the other breast. However, research now suggests that women can build their own personal armor to at least partially protect themselves from this occurring.

All it takes, says Dr. Christopher I. Li, is to “stay at a normal weight, don’t smoke, and drink in moderation.”

The research, headed up by Li at the Fred Hutchinson Cancer Center in Seattle, Washington, suggests that obesity, smoking and drinking too much are all risk factors for breast cancer in the opposite breast — also called the “contralateral” breast — of women who’ve had an “estrogen receptor-positive invasive breast cancer.”

That’s because estrogen can fuel these tumors’ growth, and both fat tissue and excessive alcohol use directly increase estrogen levels in the body, Li and his team propose. They believe that smoking contributes to the risk because of all the cancer-causing substances one inhales when smoking.

Until now, there haven’t been many studies regarding ways that women could protect themselves from second breast cancers, according to the report in the September 8th online issue of the Journal of Clinical Oncology.

The new study included 365 women with a first estrogen receptor-positive breast cancer and a second contralateral cancer and 726 control subjects. By reviewing medical charts and interviewing the women directly, the researchers determined body mass index (BMI) and alcohol and tobacco use. BMI is an estimate of a person’s relative body fat calculated from her height and weight.

Compared with normal weight women, those who were obese were almost half again – by 40% — as likely to develop a contralateral breast cancer. Consumption of 7 or more alcoholic drinks per week nearly doubled the risk compared with no alcohol use. Findings were similar for current smoking.

Women who both smoke and drink following diagnosis of the first cancer had an even greater risk of a second cancer. The study showed that consuming 7 or more alcoholic drinks per week coupled with current smoking increased the odds of contralateral breast cancer more than 7-fold.

In a related editorial, Dr. Jennifer A. Ligibel, from the Dana-Farber Cancer Institute in Boston, points out that the study by Li and his team took place before use of hormonal therapy for estrogen receptor-positive breast cancer became routine. Therefore, a more modern study examining the effect of modifiable lifestyle factors should involve patients treated according to current guidelines.

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Breast defence

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Breast defence

Some women have specific genetic problems but those breast cancers number less than 10% of all. One expert recently told me that breast cancer causes are “multifactorial” and that the combination of lifestyle factors and genetic vulnerabilities that accounts for the abnormal growth of cells is still being figured out.

That means that most of the 22,700 Canadian women (and 180 men) expected to be diagnosed this year won’t even know what caused their illness. Neither will the 5,400 women who die from it. Sometimes we forget just how many different factors may contribute to breast cancer’s development. Here’s what’s known:

ESTROGEN

The more estrogen a woman makes over time or takes through post-menopausal combined hormone replacement therapy, the higher her risk for getting breast cancer. The more years a woman menstruates, the longer breast tissue is estrogen-exposed. Birth control pills only slightly increase risk.

AGE

The chance of getting breast cancer increases as a woman ages. According to Dr. Love, from 20 to 30 the risk is one in 2,000; from 40 to 49 the risk is one in 68; from 60 to 69 the risk is one in 26. After the age of 70, a woman has a one-in-eight chance of getting breast cancer.

ALCOHOL

The risk of breast cancer jumped by 30% in women who drank more than three drinks daily.

FAMILY HISTORY

Having a mother, sister or daughter with breast cancer almost doubles a woman’s risk, particularly if the relative was diagnosed before age 50. A family history of ovarian cancer also increases the risk of developing breast cancer.

RADIATION

Radiation therapy for a previous cancer heightens the risk of breast cancer. The risk is highest if there was chest radiation during puberty.

OBESITY

Post-menopausal women who are obese are more at risk; fat cells play a role in estrogen production so being overweight adds to risky estrogen exposure.

GENETIC MUTATIONS

Those who have inherited changes in the BRCA1 and BRCA2 genes have a higher risk (some up to 90%) of getting the disease, and possibly at a younger age. Many other genes are also associated with breast cancer, including the HER-2/neu oncogene.

ENVIRONMENT

We’re exposed to vast amounts of hormone-mimicking and cell-interrupting chemicals in products we use and through environmental pollutants, some of which increases the risk of breast cancer.

BREAST DENSITY

Dense breast tissue, as shown on a mammogram, increases your risk. One study published in the Journal of the National Cancer Institute found that the relative risk of developing breast cancer in post-menopausal women with dense breasts was 400% higher than in women with fatty non-dense breasts.

BREAST DISEASE

Some diseases, including hyperplasia, can increase breast cancer risk by up to four-fold.

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