Living Well This year, nearly 300,000 women in the U.S. will receive a breast cancer diagnosis. And more than 43,000 will die from breast cancer...
Think of eight women in your life... At least one of them is likely to get breast cancer in her lifetime. Maybe you've already experienced it yourself.
Those are terrible odds.
Since October is Breast Cancer Awareness Month, we're taking today to cover some of the facts you need to know... like how to understand your risk, what you should do after a diagnosis, and the best ways to prevent breast cancer...
Are there different types of breast cancer?
Doctors describe breast cancer by where it is or how it appears. The most common is invasive ductal carcinoma. That's a cancer that starts in the milk ducts and then grows outward into the tissue. Some types respond better to treatment than others. For example, inflammatory breast cancer grows rapidly and avoids early detection, meaning it's much harder to treat.
Breast cancer also falls into categories based on the types of receptors found in the tumor. These receptors attract estrogen, progesterone, and the HER2/neu gene. For example, ER (estrogen receptor) positive means the tumor grows from estrogen production. If you are ER or PR (progesterone receptor) positive, hormone therapy after your traditional cancer treatment can prevent recurrence. About 80% of all tumors are ER-positive.
If you have triple-negative breast cancer, none of these receptors are present. Unfortunately, that makes it more difficult to treat, though not impossible.
Breast cancer is also further categorized as invasive or noninvasive. Noninvasive means the cancer stays in the same place in the breast, either the milk ducts or the lobules. It's sometimes called pre-cancer because it doesn't spread to other tissue. When it does spread, it's called invasive – meaning the cancer is growing and invading healthy tissue throughout the breast.
How do I check for breast cancer?
Start with self-exams every month. Check for things like unusual shapes, swelling, redness, or dimpling. Check for lumps both lying down and standing up. Using light, then medium, then firm pressure, work in small circles to check for any unusual lumps. If you're still menstruating, it's best to do it about a week after the end of your period, to avoid any swelling.
If you find a lump, report it to your doctor. But don't panic... While you might have breast cancer, there's a chance you have something called fibrocystic breast disease. More than 3 million women struggle with this each year. In fact, some estimates put the lifetime prevalence at 70% to 90%. With this disease, the breast feels like it has lumps that are actually fluid-filled cysts or fibrous scars. Typically, they enlarge with changes in hormone levels and may cause pain or tenderness.
When should I get a mammogram?
The American Cancer Society recommends annual mammograms for women aged 45 to 54. After 54, it recommends switching to a mammogram every two years, unless you're in a high-risk group. It's also important to remember that mammograms have about an 87% detection rate, making them an important tool to find breast cancer early. However, each test increases the odds of a false positive. After 10 years of exams, you're about 50% to 60% likely to get a false positive. That requires additional testing.
If you're under 40, the false-positive rate is higher as well. In addition, many providers may save it as a later measure if you're of child-bearing age, as the radiation can cause some damage.
When it's time for your first mammogram, you may want to take an aspirin for the pain and be sure to go at a time when you aren't close to your period so your breasts aren't as tender. Also be sure to wear a shirt instead of a dress and avoid any deodorant, powders, or lotions. These may contain metallic traces that give false readings.
What if it is cancer?
Breast cancer, like many other cancers, uses the traditional triad of treatments: surgery, radiation, and chemotherapy. You may only need one of these, or you may need a combination. Much of this will depend on the type of cancer and whether or not it's invasive.
Although it's the most commonly diagnosed cancer in women, survival rates improve every year. In 2017, about 41,000 people died from breast cancer. But that's still much lower than it was. Between 1989 and 2015, breast cancer deaths in women dropped 39%, largely due to early detection. That's why we recommend educating yourself about the risks and using regular self-exams to keep in tune with your health.
Is it just genetic?
It might surprise you, but only about 10% of all breast cancer cases are inherited. The most common genes responsible are BRCA1 and BRCA2... However, just because you have a mutation on one of these genes doesn't necessarily mean you'll get cancer. There are other genes responsible as well.
Your risk does increase based on family history. Risk factors include having any blood relatives who had breast cancer before age 50, relatives with triple-negative breast cancer, Ashkenazi Jewish heritage, or a family history of other cancers.
How can I reduce my risk?
While you can't control your genetics, a new study shows you do have the power to take control of one major factor... exercise.
An international group of researchers examined the effects of exercising and being sedentary on breast cancer risk. The team utilized other studies linking genetic variations with different activity levels from U.K. BioBank to examine the "exercise genes" of nearly 131,000 women. Roughly 70,000 of the participants had invasive breast cancer.
They found the women genetically predisposed to exercise had a 41% lower risk of developing invasive breast cancer than those who were likely sedentary – regardless of factors like the tumor type or how far the cancer had spread. Similarly, the participants predicted to be the most sedentary had a 104% higher risk of developing one of the most aggressive forms of breast cancer.
For this study, researchers used this genetic predisposition to predict activity levels. But you can take control of your own life, even if your genes make it harder to do so. Any movement counts – like walking, jogging, or swimming – but researchers did see more of a risk reduction in women predisposed to more vigorous exercise.
My favorite type of this exercise is called high-intensity interval training ("HIIT")...
HIIT mixes moderate movement with short bursts of intense exercise. And research shows HIIT gives you the same benefits as a longer, less-intense cardio workout would.
I do 20- to 45-second bursts of intense movement followed by 20- to 90-second periods of rest or slow movements for one cycle (or rep). So if you're a beginner, you could walk moderately for a minute, then jog quickly for 20 seconds, then repeat. I try to do four to eight of these cycles almost daily. (With an easy warm-up and cooldown, that's about 20 to 30 minutes a day.) And during cold or rainy days, I love doing this on a stationary bicycle indoors, too.
Are there any new treatment options?
Longtime readers know I closely follow the developments in immunotherapy – essentially, a way to train your body's own immune system to fight cancer.
In 2018, a few immunotherapy drugs for first-line treatment won federal approval for some cancers. That means patients don't have to endure rounds of radiation and chemotherapy first and only start immunotherapy as a last resort.
One of those first-line options focuses on advanced triple-negative breast cancer. This is one of the most difficult types of breast cancer to treat, so hitting it right away with immunotherapy shows a lot of promise.
I've written a book called The Living Cure where I share the recent developments in immunotherapy, 10 questions you must ask your doctor immediately after cancer diagnosis, and where to find the most cutting-edge treatments (sometimes for free).
If you're a subscriber to Retirement Millionaire, click here to read it. If you aren't a subscriber, you can buy a copy here.
What We're Reading...
- The five steps of a breast cancer self-exam.
- Something different: How eye color changes throughout our lives.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
October 6, 2022