Home > Dr. Ward's Newspaper Column Home > 2010
Breast Cancer Potpourri
October 04, 2010
• Established risk factors for breast cancer that you can’t do much about include age, family history, breast density, early onset of periods, late onset of menopause, and delaying having children until later in a woman’s reproductive years. However, obesity, particularly postmenopausal obesity, post menopausal hormones, alcohol consumption and physical inactivity are all risk factors that can be modified to decrease one’s individual risk of breast cancer.
• After steadily increasing for 25 years, the age-adjusted incidence of breast cancer has been decreasing each year since 2002. This is largely attributed to a dramatic decrease in the use of post menopausal estrogen/progesterone replacement therapy after the Women’s Health Initiative trial demonstrated multiple ill effects of hormone replacement.
• The incidence of breast cancer could be further impacted if more women considered at high risk of developing breast cancer were offered tamoxifen or raloxifene therapy, a treatment that can decrease their risk by nearly 50 percent. Unfortunately only a fraction of the 2 million women eligible for the therapy receive it.
• The death rate for breast cancer has been steadily decreasing since 1990, particularly in younger women. The decline has been attributed to both screening mammography, which detects cancer earlier when it is easier to treat, and better treatments.
• The incidence of breast cancer in Washington is the third highest in the nation. The mortality rate, however, is only the 22nd highest. It is unclear why we are so high in incidence. It is a credit to all of us that the mortality rate doesn’t mirror the incidence.
• White women get more breast cancer than African American women, yet mortality rates in African American women are higher. This is likely not due to biology, but to socioeconomic and cultural disparities in accessing screening mammography and more advanced treatments.
• Traditionally we have used the size of a cancer and the number of lymph nodes involved to determine who was at the greatest risk for recurrence and death from early breast cancers. Those at substantial risk received chemotherapy in an attempt to prevent recurrence. More recently, the import of a growth receptor called Her2 and Her2-directed therapies have dramatically improved cure rates and survival for the 20 percent subset of patients whose cancers have higher than normal amounts of Her2 on the cell surface. But that is child’s play compared to the potential of gene mutation analysis to more clearly define who needs chemotherapy, and just as importantly, who does not.
• We used to say that pre-menopausal women with breast cancer did not do as well as post-menopausal women, and we treated them thusly. However, for a given stage of cancer, the assumption is not true. We also used to believe that post-menopausal women were less responsive and tolerant to chemotherapy. Once again, that is not true.
• Somewhere between 5 and 10 percent of breast cancers result from inherited mutations in the genes BRCA1 or BRCA2. The mutations are present in less than 1 percent of the general population, but confer a greater than 50 percent risk of developing breast cancer by age 70. This risk can be reduced by half with the use of preventative tamoxifen or raloxifene and by 90 percent with prophylactic bilateral mastectomies.
• More dollars are spent on breast cancer research than for any other cancer. More patient advocacy is done on behalf of breast cancer than for any other cancer. Breast cancer gets more press than any other cancer. The public is better educated about breast cancer than any other cancer. Lots of people know that October is breast cancer awareness month. Do you know the month for colon, lung or prostate cancer awareness? I suspect that there is a connection here to the remarkable advances being seen in this disease.
Dr. Ward is a medical oncologist at Puget Sound Cancer Centers. He can be reached at (425) 775-1677.