Dense Breasts May be Leading Risk Factor For Breast Cancer

Women whose breasts are composed mainly of dense glandular tissue rather than fat may have higher odds of developing breast cancer, a recent study suggests.

Researchers examined data on more than 18,000 women with breast malignancies and 184,000 women the same age without breast cancer. They found breast density appeared to be the biggest indicator of cancer risk, even more than other common risk factors like family history or waiting until after age 30 to have babies.

“Women with dense breasts have a roughly 2-fold higher breast cancer risk relative to women with non-dense breasts,” said lead study author Dr. Natalie Engmann of the University of California, San Francisco.

This is a problem because 60 percent of younger women have dense breasts and so do 40 percent of older women who have gone through menopause – and because dense breasts make tumors harder to detect on mammograms, Engmann said.

“Our findings suggest that because breast density is a strong, common risk factor that can be modified, reducing the number of women with dense breasts may prevent a substantial proportion of breast cancer cases,” Engmann.

In the study, online February 2 in JAMA Oncology, researchers examined data on women with four categories of breast density: almost entirely fat, mostly fat with some dense tissue, moderately dense and predominantly dense. Then, they looked at several known breast cancer risk factors: women’s weight, family history of the disease, personal history of benign biopsy results, breast density and having a first baby after age 30.

About 39 percent of breast cancer cases before menopause and 26 percent of cases afterwards might be prevented if women in the two highest breast-density categories had less dense breast tissue, the study team calculated.

It’s unclear that women can do anything to reduce breast density, but it may make sense for them to consider screening alternatives to mammograms, said Dr. Christine Berg, a NCI researcher who wasn’t involved in the study.

“I think it makes more sense for a woman with dense breasts, particularly with other risk factors, to discuss with her doctor and the radiologist whether or not she would benefit from other types of screening such as MRI,” Berg said by email. “Breast tomosynthesis is an emerging technology which I think is better than standard mammography.”

Berg also recommended a calculator (here: http://bit.ly/2knIYuH) developed by the Breast Cancer Surveillance Consortium for women to assess their individual risk.

Bottom line: For women with dense breasts, the addition of alternate screening such as 3D bilateral whole breast ultrasound or MRI can improve the early detection of breast cancer.

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


Adding 3-D Mammography or Ultrasound to Regular Screening Finds More Cancers in Dense Breasts

Dense breasts have less fatty tissue and more non-fatty tissue compared to breasts that aren’t dense.

One way to measure breast density is the thickness of tissue on a mammogram. The BI-RADS (Breast Imaging Reporting and Database System), which reports the findings of mammograms, also includes information on breast density. Still, no one method of measuring breast density has been agreed upon by doctors. Breast density is not based on how your breasts feel during your self-exam or your doctor’s physical exam. Dense breasts have more gland tissue that makes and drains milk and supportive tissue (also called stroma) that surrounds the gland. Breast density can be inherited, so if your mother has dense breasts, it’s likely you will, too.

Research has shown that dense breasts:

  • can be 6 times more likely to develop cancer
  • can make it harder for mammograms to detect breast cancer; breast cancers (which look white like breast gland tissue) are easier to see on a mammogram when they’re surrounded by fatty tissue (which looks dark).

About 43% of women ages 40 to 74 years old in the United States are classified as having dense breasts.

As of September 2015, 24 states have passed legislation requiring that women be notified of their breast density with mammography results.

Because mammograms don’t always find cancers in dense breasts, researchers have been studying the effectiveness other screening methods for dense breasts.

A study has found that adding 3-D mammography (also called digital tomosynthesis) or breast ultrasound to regular screening mammograms can detect more cancers in dense breasts. Ultrasound was slightly better at detecting cancers in dense breasts than 3-D mammography and both screening methods had similar false-positive rates.

The study was published online on March 9, 2016 by the Journal of Clinical Oncology. Read the abstract of “Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial.”

The study also was presented on March 9, 2016 at the 2016 European Breast Cancer Conference. Read the abstract of “Interim results of the Adjunct Screening with Tomosynthesis or Ultrasound in Mammography-negative Dense Breasts (ASTOUND) trial.”

The ASTOUND study was started in December 2012 and included 3,231 women with breasts classified by BI-RADS as either consistently dense or extremely dense. The women were 44 to 78 years old, and screening mammograms had found no cancer in their breasts.

After their last regular screening mammogram, the women also had a 3-D mammogram and breast ultrasound. The 3-D mammograms and ultrasounds were read by different radiologists who knew that the standard screening mammogram had found no cancer, but didn’t know the result of the other additional screening test.

The additional screening tests found 24 breast cancers:

  • 12 were detected by both 3-D mammogram and ultrasound
  • one was detected only by 3-D mammogram
  • 11 were detected only by ultrasound

“These results mean that tomosynthesis detected an additional four breast cancers per 1,000 women screened and ultrasound detected an additional seven breast cancers per 1,000,” said Dr. Nehmat Houssami, professor of public health at the University of Sydney, who presented the study at the European Breast Cancer Conference.

There were 107 false-positive results:

  • 53 for 3-D mammograms
  • 65 for ultrasound

This difference wasn’t statistically significant, which means that it was likely due to chance and not because of the difference in screening methods.

In an editorial in the Journal of Clinical Oncology that ran with the paper, Wendie Berg, M.D., of the Magee Women’s Hospital at the University of Pittsburgh Medical Center, wrote that a high false-positive rate is why many doctors have been reluctant to use ultrasound for breast cancer screening. The ASTOUND study may start to change that.

“Importantly, in preliminary results from the ASTOUND trial, false-positive recalls (2.0%) and biopsies (0.7%) were acceptably low,” Dr. Berg wrote.

“…Our study does not provide all the answers on this issue but provides the first critical piece of information on how these two tests compare,” Dr. Houssami added. “If a woman is concerned that her breasts are very dense on the mammogram (or has been told her breasts are very dense and would like more testing), I can use the data from ASTOUND to discuss with her the option of having the ultrasound or the tomosynthesis screen; I would discuss with her the pros and cons of adding another test to improve sensitivity for detecting cancer, but would also point out this could have additional harms such as more false alarms.”

Bottom line: For women with dense breasts, the addition of 3D mammography or bilateral whole breast ultrasound improves the early detection of breast cancer.

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


Adding 3-D Whole Breast Ultrasound to Mammography Improves Detection of Breast Cancer!

Women with dense (less fatty) breast tissue represent 40 percent of all U.S. women, and they are four to six times more likely to develop breast cancer than women with non-dense breast tissue. Cancers in these women are also more likely to go undetected after having a mammogram.

A recent study published in the American Journal of Roentgenology, conclude that for women with dense breast tissue, combining mammography with a 3-D automated breast ultrasound system can improve the detection of breast cancer by 29 percent.

The study analyzed the performance of 17 radiologists in their detection of breast cancer using full-field digital mammography only versus full-field digital mammography followed by 3-D automated breast ultrasound.

The radiologists looked at 185 cases collected from prior clinical studies in which both imaging methodologies had been used. Out of the 52 cases in which cancer was identified, 31 had been interpreted in the prior clinical studies as negative for cancer on the mammogram.

When comparing the mammogram and 3-D ultrasound results to results from the mammogram only, the radiologists enhanced their ability to detect cancer by what the study’s researchers termed a “statistically significant relative improvement.”

“The improved detection in nearly a third of women with dense breasts is significant because it means those are cancers that might not have been found until it became more apparent on a mammogram,” Giger said. “And by the time they were discovered, the cancer might have been at a more advanced stage.

“The takeaway here is women with dense breasts should augment traditional mammographic screening with another type of imaging modality, such as 3-D ultrasound (or MRI), in order to avoid missing cancerous lesions,” Giger added.

Giger is the A.N. Pritzker Professor of Radiology for the Committee on Medical Physics and the College at the University of Chicago, as well as the vice-chair for Basic Science Research in the Department of Radiology. She is a member of the National Academy of Engineering and is considered one of the pioneers in the development of computer-aided diagnosis, authoring or co-authoring more than 300 scientific manuscripts. She also is the inventor/co-inventor of 25 patents, and serves as a reviewer for various national and international granting agencies, including the National Institutes of Health and the U.S. Army. In the breast cancer study, she served as an independent evaluator for the Food and Drug Administration’s approval of the Automated Breast Ultrasound System from GE Healthcare.

Bottom line: For women with dense breasts, the addition of 3D bilateral whole breast ultrasound improves the early detection of breast cancer.

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


Half of Women Can Benefit from Mammography at Age 40.

A new study shows that women at the age of 40 should undergo a mammogram, as nearly half of them would benefit from the breast cancer screening. For the review, the researchers found that half of the women aged 40 to 44 had above average risk for breast cancer, which made them eligible for yearly screenings.

The findings presented at the American Society of Breast Surgeons annual meeting in Dallas is important because the latest guidelines on mammograms advise that most women can wait until the age of 45 or 50 to start having annual screenings.

But the review of female patients between the ages of 40 and 44 found that 50 percent had an above-average risk for breast cancer, and therefore would be eligible to begin screening mammography at age 40, said lead researcher Dr. Jennifer Plichta. The study also found a significant percentage of women would qualify for other breast screening methods, including breast MRI and genetic testing, Plichta said. “We believe formal risk assessment is essential for women ages 40 to 44 in order to identify those who require screening mammography to start at the age of 40, and those who would qualify for screening MRIs and genetic testing,” Plichta said.

The cancer society updated its guidelines in 2015, recommending that women could wait until age 45 to start receiving annual mammograms. Previously, the cancer society had recommended yearly screenings starting at age 40. The American Society of Breast Surgeons (ASBS) subsequently changed its guidelines to mirror the new cancer society recommendation, Plichta said. The American Society of Breast Surgeons (ASBS) also updated their guidelines with a few more details, which included:

  • Women should have mammograms prior to 45 years of age if their risk of developing breast cancer exceeds 15 percent.
  • Women with 20 percent or higher should also undergo MRI.
  • Women with at least a five-percent risk of a breast cancer-related genetic mutation should undergo genetic testing.

 

“Critical to the development and interpretation of both of these new guidelines is formal risk assessment,” Plichta said. “Furthermore, risk assessment is needed not only to determine who qualifies for mammography, but also who may require screening MRIs and/or genetic testing.”

Breast cancer risk assessments are typically not a part of standard care for this age group, the researchers noted. Since the new guidelines lean heavily on knowing breast cancer risk, doctors need to redouble their efforts to make sure risk assessments are done for women in their early 40s, they concluded.

Bottom line: Given that more than half of women between the ages of 40-45 had risk factors for breast cancer, mammogram screenings should begin at age 40, rather than age 45 or 50. Risk assessment is the best way to determine who would benefit from mammography screening at age 40.

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


Never Too Old for a Mammogram?

You are never too old to get a mammogram. According to a new study presented at RSNA 2016 in Chicago, researchers from the University of California, San Francisco (UCSF) found that women between the ages of 75 and 90 continue to benefit from screening.

Lee’s group used data from the National Mammography Database, evaluating more than 5.6 million screening mammograms performed between January 2008 and December 2014. The exams were done at 150 facilities across 31 U.S. states. Lee and her colleagues looked at patient age, mammogram results, recall rates for more testing, biopsy referrals and biopsy results. The investigators also looked at the percentage of breast cancers found when a biopsy was recommended or performed. Ideally, Lee explained, screening should result in a higher cancer detection rate and a low recall rate.

Based on an analysis of nearly 7 million mammograms over a seven-year period, “the benefit continues with increasing age up until 90,” said study author Dr. Cindy Lee. She is an assistant professor in residence at the University of California, San Francisco.

The question of when to stop having mammograms has been widely debated. In 2009, the U.S. Preventive Services Task Force issued new guidelines, saying there wasn’t enough evidence to assess the balance of benefits and harms of screening mammography in women aged 75 and older.

In the analysis, which included data from 39 states from 2008 through 2014, nearly four breast cancers were found for every 1,000 patients screened. The recall rate was 10 percent.

“We are finding more cancers with increasing age,” Lee said, which makes sense because the risk rises with age. “We are doing better at catching them,” she said. And, “we have decreased the recall rate. We are calling back fewer women for additional testing, but are finding more cancers.”

The study authors concluded that “there is no clear age cut-off point” to determine when to stop screening. The study suggests the decision to screen may depend on a woman’s personal choice and health status. Older women with 10 years of life expectancy, for instance, might choose to continue screening, Lee said.

Robert Smith, vice president of screening for the American Cancer Society, said the study findings show that mammograms are still worthwhile after the age of 70.

“Breast cancer incidence and mortality increase as women age, and roughly 30 percent of breast cancer deaths each year occur in women who were diagnosed after the age of 70,” he said.

“Many of these deaths are avoidable, as Lee and colleagues demonstrate in this new report, since mammography screening performs increasingly well as women get older. While incidence is high, the disease is slower growing and density is lower, providing improved opportunity for early detection,” Smith explained.

Bottom line: Older women can benefit from continued mammography screening and no age should be defined as the cut-off for screening. As always, the choice to continue screening should be a shared decision between the patient and her physician.

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


Breast Cancer Deaths Increasing for Black Women

While breast cancer deaths are on the decline, black women still have worse outcomes than white women, according to data released by the CDC. The report noted disparate trends in breast cancer incidence among different races and age groups. The new study also finds that the rates vary from city to city and the disparity is getting worse, not better.

The study, which looked at breast cancer deaths between 2010 and 2014 in the 43 most populous U.S. cities, found that African-American women are 43% more likely to die from breast cancer than white women. That is an increase from 2009, when the difference in death rates was 39.7%.

“This disparity results in 3,854 excess deaths of black women every year. That is a shocking and alarming number,” says study researcher Marc S. Hurlbert, PhD, of the Breast Cancer Research Foundation in New York.

In 42 of the 43 cities examined in the study, African-American women die from breast cancer at higher rates than white women. In Boston, women of both races die at about the same rate. The difference in death rates is “startlingly high” in Atlanta, where African-American women are dying of breast cancer at a rate more than double that of white women, according to the Avon Foundation, which funded the study.

Cities topping the list with the largest breast cancer death disparities are:

  1. Atlanta
  2. Austin, TX
  3. Wichita, KS
  4. San Antonio, TX
  5. Kansas City, MO
  6. Dallas
  7. Memphis, TN
  8. Los Angeles
  9. Oklahoma City
  10. Chicago

 

Interestingly, mortality rates fell at the same pace for women younger than 50, regardless of race. This data could provide some hope for the future, according to the CDC.  The study did find some cities, such as Boston, Philadelphia, and Memphis, had significantly improved the disparity. Researchers say these cities are taking steps like setting up task forces aimed at improving mammography quality and expanding screening, diagnosis, and treatment programs to cover uninsured women.

The declining mortality rate among younger women supports prior studies that showed screening efforts like mammography have been successful in catching more cancers at an early stage. The report also recommended initiatives to combat obesity, which is increasing in prevalence among black women and is associated with a higher risk of breast cancer.

Bottom line: Breast cancer deaths in black women are increasing. We need a greater targeted effort on early detection among black women and increasing awareness of the known risks, such as obesity, associated with a higher risk of breast cancer.

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


New Genomic Test REDUCES Need for Chemotherapy in Breast Cancer Patients

For some women, surviving breast cancer may no longer need to involve chemotherapy. Doctors have long known that many early-stage breast cancer patients who undergo chemotherapy don’t actually need it to prevent recurrence of the disease after surgery. But they haven’t known exactly which patients might safely skip the toxic treatment.

A new study published in the New England Journal of Medicine says based on the gene activity of tumor.  The so-called genomic test measures the activity of genes that control the growth and spread of cancer, and can identify women with a low risk of recurrence and therefore little to gain from chemotherapy.

The MINDACT trial analyzed whether a different genomic test – the 70-gene MammaPrint test — could also determine which women needed chemotherapy with early stage breast cancer. The researchers estimated that their findings would apply to 35,000 to 40,000 women a year in the United States, and 60,000 to 70,000 in Europe. They are patients with early disease who because of tumor size, cancerous lymph nodes and other factors would normally be prescribed chemotherapy. The biggest benefit to patients, using this genomic test, is the ability to avoid the toxicities of chemotherapy (potentially including permanent nerve damage, heart failure and leukemia).

The results of the study will be of most use for cases that have fallen into a gray zone, when the disease is in an early stage but has some anatomical features that suggest it may be aggressive. But the genomic test says it is low risk.

Dr. Fatima Cardoso, an author of the study and a breast oncologist at Champalimaud Clinical Center in Lisbon, said that traditionally, women with early cancer, but a high clinical risk were usually given chemotherapy. She said that doctors knew that not all would benefit from it, but gave it to all anyway to err on the side of caution, because they could not identify which women did not really need it.

The main goal of the study was to find out whether women with a high clinical risk but a low genomic risk could safely forgo chemotherapy. The researchers said that it was safe for women with early disease and high clinical risk, but low genomic risk, to skip chemotherapy. The findings mean that 46 percent of women with early-stage disease who are thought to be at high clinical risk may be able to skip chemotherapy.

The genomic test is expensive, but the price pales in comparison to the cost of chemotherapy. By allowing patients to avoid toxic and costly unnecessary chemotherapy treatments, this particular test demonstrates the value of advanced diagnostic testing which leads to better decision-making for women with breast cancer.

Bottom line: Genomic testing and other advanced diagnostic tools are re-shaping the way we treat breast cancer and improving decision making. The end result is better for patient care and improves clinical outcomes.

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


Molecular Breast Imaging for Detecting Breast Cancer? The What and How.

Molecular breast imaging (MBI) is a method for detecting breast cancer. The technique is also known as a Miraluma test, sestamibi, scintimammography, or breast specific gamma imaging.

MBI uses a radioactive tracer that “lights up” any areas of cancer inside the breast. This tracer is injected into the body through a vein in the arm. Breast cancer cells tend to take up the radioactive substance much more than normal cells do. A special camera called a nuclear medicine scanner then scans the breast, looking for any areas where the radioactive substance is concentrated. The process takes about half an hour, and unlike mammography, it yields images of cancerous tissue regardless of the tissue’s density.

MBI continues to be tested, but it appears to hold promise for detecting breast cancer in women who are at higher-than-average risk for the disease and have dense breasts. When women have a lot of dense breast tissue, tumors become hard to spot on mammograms. On mammograms, fatty breast tissue looks dark, but dense tissue is light, like tumors, so it can hide any cancerous areas that may be present.

In a recent study published in the August 2016 issue of the American Journal of Roentgenology, Molecular breast imaging was shown to be effective as a supplementary screening tool to mammography for women with dense breasts. Researchers from Ohio, California, and New Hampshire performed a retrospective study to assess the utility of MBI as a supplementary screening tool for 1,696 women with dense breast tissue. The results showed that 13 mammographically occult malignancies were detected among the study group. Eleven were invasive, one was node positive, and one had unknown node positivity. Other findings showed:

  • Lesion size ranged from 0.6 to 2.4 cm, mean 1.1 cm
  • Incremental cancer detection rate was 7.7%
  • Recall rate was 8.4%
  • Biopsy rate was 3.7%

When incorporated into a community-based clinical practice environment, molecular breast imaging yielded a high incremental cancer detection rate of 7.7 cases of breast cancer for every 1,000 women at an acceptable radiation dose. However, one drawback of MBI is that it involves a much greater dose of radiation than mammograms.

MRI (magnetic resonance imaging), is often the preferred tool for evaluating women who are considered high-risk and have dense breasts. However, MRI has no radiation, but is more expensive than MBI and can return false positive results, leading to unnecessary biopsies. If a mammogram shows that you have dense breast tissue, MBI may be an alternative to ask about.

Bottom line: If you are at average risk for breast cancer and do not have dense breasts, mammography remains the screening tool of choice for you. Many doctors believe that, for most women, mammography is better than MBI at detecting breast tumors when they are small and generally easier to treat.

 

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 area


Heart Disease in Women: Breast Cancer Takes a Back Seat

When it comes to women’s health, breast cancer tends to get more attention than heart disease. Many women believe that cancer is more of a threat, but they’re wrong. Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer.  New research shows at least five times as many women die from heart disease as breast cancer and misconceptions about cardiovascular risks among women — and doctors who treat them — is partly to blame.

In a new study published in Global Heart, the journal of the World Heart Federation, researchers from Ohio State University found that awareness of women’s risks of developing coronary artery disease (CAD) has increased over the past decade, but men are still more aggressively treated at the first signs of the heart-related condition.

The research indicates CAD kills at least as many women as men each year, but doctors are less likely to recommend preventive measures for women, compared to men at risk for the condition — such as lowering cholesterol, taking aspirin, or making lifestyle changes in their dietary and exercise habits.

Heart disease is still largely considered a “man’s disease” by many women and doctors who should know better, according to lead researchers Martha Gulati, M.D., and Kavita Sharma, M.D. “One in three women get heart disease; one in two get heart disease or stroke, and one in eight get breast cancer,” states Dr. Gulati. “One in four women die from heart disease and one in 30 women die from breast cancer. Heart disease is the No. 1 killer of women. Lack of awareness is a [factor].”

According to the study, cardiovascular diseases are the leading cause of death for men and women worldwide, killing 8.6 million women alone each year. That’s one-third of all deaths in women.

According to the American Heart Association, cardiovascular disease — including heart disease, high blood pressure, and stroke — kills nearly a half-million women in the U.S. each year. That figure exceeds the next seven causes of death combined. More women die from CAD than of all cancers (including breast cancer, which kills about 40,000 women annually), respiratory conditions, Alzheimer’s disease, and accidents combined. Women are also 15 percent more likely than men to die of a heart attack and twice as likely to have a second heart attack in the six years following the first.

The researchers added that while most American women can identify breast cancer as a risk to their health, few can do the same for heart disease.

The new research highlights other differences between men’s and women’s heart risks:

  • Obesity (tied to lack of exercise and unhealthy diets) increases the risk of CAD by 64 percent in women but only 46 percent in men.
  • CT scans and other imaging techniques show that women have narrower coronary arteries than do men, which may account for the greater risks women face.
  • Women with an immediate family member who has had CAD face greater risks than men.
  • Diabetes raises a woman’s CAD risk by three to seven times, while for men it is two to three times.

The researchers said awareness of the impact of CAD on women is growing. In 1997, only 30 percent of American women surveyed were aware that the leading cause of death in women is heart disease. By 2009, that level of awareness had grown to 54 percent. But that figure still indicates many women mistakenly believe breast cancer is a bigger threat to their lives than heart disease. In addition, fewer than one in five physicians recognize that more women than men die each year from CAD.

Health experts recommend the following heart-healthy tips:

  • Diet: Consume at least five daily servings of fruit and vegetables; limit consumption of fried and fatty foods; buy lean, low-fat protein; and choose lower-fat and whole grain foods.

 

  • Exercise: Get at least 20-30 minutes of moderate-intensity exercise five days a week (150 minutes weekly). That activity should be strenuous enough to increase your heart rate and make you break a sweat, but light enough that you can carry on a conversation.

 

  • Stress: Look for ways to lower your stress level through exercise, relaxation techniques, Yoga, swimming, or other activities.

Bottom line: Cardiovascular disease is the number one killer of men and women and far more dangerous to women than breast cancer. Greater awareness is needed among patients and physicians about the prevalence of CVD in women. Following a “heart healthy” lifestyle can significantly reduce your risk of cardiovascular death.

 

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 area.


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.