Linking Obesity to Breast Cancer

Breast cancer is the second most common cancer in women worldwide, representing 16% of all cancers in women. Although early diagnosis and available treatments have improved survival rates, new prevention strategies are sought to reduce the incidence of this disease.

A new study published in the Journal of Cell Physiology describes how inflammation that characterizes fatty tissue is one of the main microenvironment actors responsible for promoting cancer. The authors also describe the involvement of steroid hormones and others factors produced by adipose tissue in breast cancer development. The study, “Multifaceted breast cancer: the molecular connection with obesity,” appeared in the July 1, 2016 edition of the international, per-reviewed journal focused on cancer-related issues.

Increasingly, obesity has been identified as a significant risk factor for many cancers and, after tobacco use, may be the single greatest modifiable cancer risk factor. Excess body weight may affect cancer risk through a number of mechanisms, some of which might be specific to certain cancer types. Excess body fat might affect:

  • Immune system function and inflammation
  • Levels of certain hormones, such as insulin and estrogen
  • Factors that regulate cell growth, such as insulin-like growth factor-1 (IGF-1)
  • Proteins that influence how the body uses certain hormones, such as sex hormone-binding globulin

Many studies have shown that being overweight and obese are associated with a modest increase in risk of postmenopausal breast cancer. This higher risk is seen mainly in women who have never used menopausal hormone therapy (MHT) and for tumors that express both estrogen and progesterone receptors. In contrast, being overweight and obese been found to be associated with a reduced risk of premenopausal breast cancer in some studies.

The relationship between obesity and breast cancer may be affected by the stage of life in which a woman gains weight and becomes obese. Epidemiologists are actively working to address this question. Weight gain during adult life, most often from about age 18 to between the ages of 50 and 60, has been consistently associated with risk of breast cancer after menopause.

The increased risk of postmenopausal breast cancer is thought to be due to increased levels of estrogen in obese women. After menopause, when the ovaries stop producing hormones, fat tissue becomes the most important source of estrogen. Because obese women have more fat tissue, their estrogen levels are higher, potentially leading to more rapid growth of estrogen-responsive breast tumors.

The relationship between obesity and breast cancer risk may also vary by race and ethnicity. There is limited evidence that the risk associated with overweight and obesity may be less among African American and Hispanic women than among white women.

While we still have much to learn about the link between weight loss and cancer risk, people who are overweight or obese should be encouraged and supported if they try to lose weight. Aside from possibly reducing cancer risk, losing weight can have many other health benefits, such as lowering the risk of heart disease and diabetes.

Bottom line: Obesity is associated with an increased risk of breast cancer and other cancers as well. Being overweight or obese also leads to a greater risk for many diseases, including diabetes, high blood pressure, cardiovascular diseases, and stroke. The best response is prevention with a proactive lifestyle focused on a healthy diet and regular exercise.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


Breast Cancer and Hormone Replacement Therapy (HRT)

Perhaps the most significant worry that most women have when considering whether or not to take Hormone Replacement Therapy (HRT) is the possible increased risk of breast cancer. Breast cancer is an estrogen dependent cancer and constitutes approximately 25% of all female cancers, therefore any woman who has an early menopause and does not take any estrogen supplementation will actually reduce her risk of developing breast cancer in later life.

There are two main types of HRT:

  • combination HRT contains the hormones estrogen and progesterone
  • estrogen-only HRT contains only estrogen

Combination HRT increases breast cancer risk by about 75%, even when used for only a short time. Combination HRT also increases the likelihood that the cancer may be found at a more advanced stage, as well as increasing the risk that a woman diagnosed with breast cancer will die from the disease. Breast cancer risk increases the most during the first 2 to 3 years of taking combination HRT. Higher-dose combination HRT increases breast cancer risk more than lower-dose combination HRT. Breast cancer risk goes back down to average about 2 years after you stop taking combination HRT.

Estrogen-only HRT increases the risk of breast cancer, but only when used for more than 10 years. Estrogen-only HRT also can increase the risk of ovarian cancer.

If you’ve been diagnosed with breast cancer or have tested positive for an abnormal breast cancer gene (BRCA1 or BRCA2) and so are at high risk, you shouldn’t use HRT. The hormones in HRT can cause hormone-receptor-positive breast cancers to develop and grow. While only a few small studies have looked at HRT use in women with a personal history of breast cancer, the fact that HRT use increases breast cancer risk among women in general makes almost all doctors advise women with a personal history of breast cancer to avoid HRT. The prescribing sheet included with HRT clearly states that it is “contraindicated in women with a diagnosis of breast cancer.”

Menopausal side effects can dramatically reduce quality of life for some women. These women have to weigh the benefits of HRT against the risks.  If you’re having severe hot flashes or other menopausal side effects and have a personal history of breast cancer, talk to your doctor about non-hormonal options, such as dietary changes, exercise, weight management, acupuncture, or meditation.

The small increase in the incidence of breast cancer in long-term users of HRT should be considered in the context of the benefits of HRT. Long-term use is indicated for the prevention of serious disorders as osteoporosis and cardiovascular disease (and perhaps also useful in the prevention of dementia). Only in women without any risk factor for these diseases and especially for cardiovascular disease, the excess of breast cancer is of real importance in terms of cost-benefit calculations. But for some women a small increase in the incidence of breast cancer is so terrifying, that they accept the probability of an earlier (premature) cardiovascular death.

Whether or not you take HRT, there are also lifestyle choices you can make to keep your breast cancer risk as low as it can be:

  • maintaining a healthy weight
  • exercising regularly
  • limiting alcohol
  • eating nutritious food
  • never smoking (or quitting if you do smoke)

These are just a few of the steps you can take to reduce your risk of breast cancer.

Bottom line: If you’ve been diagnosed with breast cancer or have tested positive for an abnormal breast cancer gene (BRCA1 or BRCA2) and so are at high risk, you shouldn’t use HRT.  Patients with menopausal symptoms should speak to their doctor about treatment options.

(*information for this article was obtained from breastcancer.org)

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


Osteoporosis Affects Women AND Men

Osteoporosis is disease of the bones that occurs when a person loses too much bone, produces too little bone or both and can affect both men and women. Osteoporosis is often called the ‘silent thief’ because bone loss occurs without symptoms unless one has fractured. The disease can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence.

But while millions of men suffer from osteoporosis, the vast majority of people with this potentially painful condition are women. The International Osteoporosis Foundation estimates that osteoporosis affects about 200 million women worldwide.

Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined. At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime. Why the gender gap? Women start with lower bone density than their male peers and they lose bone mass more quickly as they age, which leads to osteoporosis in some women. Between the ages of 20 and 80, the average white woman loses one-third of her hip bone density, compared to a bone density loss of only one-fourth in men.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, osteoporosis statistics show a greater burden for women in the following ways:

  • 68 percent of the 44 million people at risk for osteoporosis are women.
  • One of every two women over age 50 will likely have an osteoporosis-related fracture in their lifetime. That’s twice the rate of fractures in men — one in four.
  • 75 percent of all cases of hip osteoporosis affect women.

Osteoporosis and Estrogen

Estrogen is a hormone that helps regulate a woman’s reproductive cycle. At the same time, it plays a role in keeping bones strong and healthy, in both men and women. While premenopausal women have more estrogen than men, they will experience dramatic drops in estrogen production due to menopause, and are more likely to experience bone loss and osteoporosis at that time.

Women are at increased osteoporosis risk related to estrogen levels if they:

  • Experience irregular or infrequent periods, or began having their periods at a later than normal age.
  • Have had their ovaries removed (at any age).
  • Are going through menopause, with those undergoing menopause at an early age having an even higher risk.

 

Women lose bone mass much more quickly in the years immediately after menopause than they do at any other time in their lives.

In contrast, data suggests that women who have more estrogen than their peers, such as women who began their menstrual cycles earlier than normal or who have used estrogen containing contraceptives, are likely to have higher bone density.

Osteoporosis: Underdiagnosed in Men

Because osteoporosis occurs more frequently in women than men, less attention is paid to bone health in men, and those who have osteoporosis may go undiagnosed and untreated. A study of 895 nursing home residents over age 50 revealed that doctors were less likely to consider osteoporosis diagnosis and treatment for men than women, even when the men had recently experienced a fracture, a widely recognized red flag for osteoporosis. The reality is that 80,000 men experience osteoporosis-related fractures every year, and close to 23,000 die as a result of fracture-related complications.

Bone loss is a normal part of aging in both men and women; by about age 75, men and women lose bone at the same rate and both genders are less able to absorb calcium. However, when men get osteoporosis, it is usually related to another health condition, a lifestyle choice (smoking or alcohol abuse), or medication that has bone loss as a side effect.

Bottom line: Osteoporosis risk is different for men and women, but the disease is dangerous for anyone who gets it. Talk to your doctor about getting an osteoporosis screening if you know you have risk factors.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


Men Can Get Breast Cancer

Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2016, about 2,600 men are expected to be diagnosed with the disease. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,000.

Wait, men don’t have breasts like women, so how do they get breast cancer? The “breasts” of an adult man are similar to the breasts of a girl before puberty. In girls, this tissue grows and develops, but in men, it doesn’t. But because it is still breast tissue, men can get breast cancer. Men get the same types of breast cancers that women do, but cancers involving the parts that make and store milk are rare.

Who Is at Risk?

Most breast cancers happen to men between ages 60 and 70. Other risk factors of male breast cancer include:

  • Breast cancer in a close female relative.
  • Previous radiation treatment to the chest increases your risk.
  • History of radiation exposure of the chest.
  • Enlargement of breasts (called gynecomastia) from drug or hormone treatments, or even some infections and poisons.
  • Taking estrogen.
  • A rare genetic condition called Klinefelter’s syndrome.
  • Severe liver disease (called cirrhosis).
  • Diseases of the testicles such as mumpsorchitis, a testicular injury, or an undescended testicle.

What Are The Symptoms of Breast Cancer in Men?

The symptoms of breast cancer in men are similar to those in women. These include:

  • A breast lump that you can see or feel
  • An enlargement of one breast
  • Nipple pain
  • Discharge from the nipple
  • Sores on the nipple or areola
  • An inverted nipple
  • Enlarged underarm lymph nodes

 

The good news is that treatment and survival rates are largely the same for men as for women. The five-year relative survival rate for male breast cancer is 84 percent. The 10-year relative survival rate is 72 percent. These are only averages, though. Breast cancer also tends to be diagnosed later in men than in women.

Where the difference lies is in diagnosis and screening. As Marleen Meyers, an assistant professor of medical oncology with NYU Langone Medical Center told U.S. News and World Report last year, men don’t undergo routine breast cancer screenings.  “They only seek medical attention when they feel a lump, whereas women have routine screenings and get it identified earlier,” Meyers said. “By the time men come in, the tumor is usually at least 1 centimeter in size, and the cancer has often spread.”

Because male breast cancer is so rare, experts don’t see much benefit in general-population screenings, such as mammograms, according to the American Cancer Society.

As always, if you experience any of the symptoms associated with breast cancer, see your doctor right away and get evaluated. Regardless whether you are a man or woman, the best way to fight breast cancer is through awareness and early detection.

Bottom line: Less than 1% of breast cancer occurs in men, but men can and do get breast cancer. Although men do not require yearly screening mammograms, awareness of the signs and symptoms can lead to early detection and improved survival.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.