Archive for risk factors
Breast Cancer is a very frightening illness for a woman to contemplate. Our breasts are one of the symbolic parts of our anatomy which define us as women. The diagnosis of cancer is hard enough to hear, but when it is breast cancer, it strikes to the heart and soul of a woman.
There are many types of breast cancer and each of them carries a different prognosis and cure potential. There is much research into causes, treatments and prevention currently ongoing. Now more than ever there are better treatments for breast cancer, and many women who have received this diagnosis live for decades following diagnosis and treatment.
To understand the different types of breast cancer, it is important to know the anatomy and different parts of the breast. The breast is made up of glandular, fatty and fibrous tissue.
The glandular tissue includes lobules which lie deep in the breast and are the milk producing glands; and the ducts which are responsible for carrying milk to the nipple.
The fibrous tissue surrounds the glandular tissue and adds some support to breast tissue.
The fatty tissue surrounds the glandular and fibrous tissue and gives the breast the soft consistency.
Within all of this are the lymph system and the blood vessel system. When a woman goes through menopause, the glandular tissue shrinks, the fibrous tissue looses some of its support and the breast increases the amount of fatty tissue. This decreases the density of the breast and aids in mammogram detection of abnormalities.
What types of cancer can affect the breast?
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DCIS: this stands for Ductal Carcinoma in Situ. This is the most common type of noninvasive breast cancer; it is confined to the ducts of the breast and has not spread into surrounding tissue or distant organs. It is detected on mammogram, 1:5 cases (20%) of breast cancer will be DCIS and it is felt to be almost completely curable. If necrosis is present on biopsy however, this signals the cancer is more aggressive and may be capable of spreading. A sub type of DCIS is Papillary Cancer.
LCIS: this is Lobular Carcinoma in situ. This cancer begins in the lobules which are the milk producing glands of the breast. It does not extend beyond the wall of the lobule, hence the term “in situ”. It is felt to have a low likelihood of becoming a metastatic (spreading) cancer however statistically its’ presence raises the risk of invasive cancer in the same or opposite breast. Researchers are not sure why this is the case.
Both of the above types of breast cancer are felt to have a low malignant potential. This means that they are unlikely to spread or invade surrounding healthy breast tissue, or spread by the lymph system and blood stream to other organs and cause a cancer in those organs.
The types of breast cancer discussed below are all types with a malignant aspect to them, meaning they will grow into surrounding breast tissue and interfere with normal functioning, and can spread to other organs and cause the same diseased activity. Women die from breast cancer when the organs the cancer has invaded can no longer work normally to sustain life. Treatments are aimed at both preventing spread to other organs, as well as trying to destroy the cancerous breast tissue and any metastatic cancer tissue.
Invasive/Infiltrating Ductal Carcinoma: this is the most common invasive breast cancer. It accounts for 8 out of 10 invasive breast cancers diagnosed. It begins in the ducts and spreads through the walls into the fatty tissue. It is able to metastasize through the lymph system to other organs. A few additional subtypes are Tubular and Paget’s disease.
Invasive Lobular Carcinoma: as the name suggests, this begins in the lobules or milk glands and can spread locally as well as metastasize to other organs. It is more rare and only accounts for 1:10 diagnosis of invasive breast cancer. It is difficult to find on mammogram
Inflammatory Breast Cancer: This type is more uncommon than the above types and the cancer’s DNA behaves differently than other types of cancers. Its’ presentation is different in that there is no specific lump or cluster of calcifications as seen with the above types of breast cancer. Rather, it causes blockage of lymph vessels in the skin which in turn causes a redness and warmth to the skin of an area of the breast. Along with this redness and warmth is a thickening and pitted appearance likened to the peel of an orange. It accounts for 1-3% of breast cancers and usually occurs in younger women and there is a slightly higher incidence in African American women. The breast becomes larger and this is what is seen on mammogram, it is often mistaken for mastitis. MRI is the more sensitive imaging technique for evaluating this cancer. This is a very aggressive cancer and it is difficult to treat successfully as it is usually advanced when discovered. The 5-year survival rate is 40% as compared to 87% for other types of breast cancer.
Triple Negative Breast Cancer: this will be further explained below, but these cancers are usually very invasive ductal cancers with no protein receptors which make them amenable to treatment. They are usually present in younger women and slightly higher incidence in African American women. They are rapidly growing cancers.
When a breast cancer is diagnosed, biopsied and/or removed, several tests are done on the tissue to determine how the specific cancer will respond to therapies. This helps to determine a treatment course and to some extend predict the response and potential survival rate for the patient. These tests are also used to additionally categorize the type of cancer. There are receptors on the walls of the cancer cells which are proteins which can turn on growth when triggered.
The common receptors tested are for estrogen and progesterone. These proteins (receptors) allow these hormones which are naturally occurring in a woman’s body to attach to the cancer cell and fuel its growth. A breast cancer which has these receptors will be called ER + or PR+, or both ER/PR+, and likewise ER-, PR- or ER/PR-. ER or PR positive breast cancers actually have a better prognosis because they can respond to treatment. 2/3’s of breast cancers will contain at least one of these proteins.
HER2: this is a growth promoting protein. There are genes within the breast cell that when “turned on” will instruct the cell to make this protein. HER2 cancers have increased amounts of HER2 genes which leads to increased amounts of this protein. This type of cancer can spread and be more aggressive, however certain chemotherapy agents have been developed which can effectively treat this type of breast cancer. Any of the above cancers discussed with the exception of the IN-SITU cancers can be determined to be ER or PR + or -; and they may or may not have HER2 protein.
BRCA1 AND BRCA2: many of you have heard about this type of genetic testing. These terms do not relate to a specific cancer but rather a genetic tendency or risk factor for developing breast cancer.
This would be a gene that is passed down within families. BRCA 1 and 2 genes are the most common causes of hereditary breast cancer. Normally, the BRCA1 and BRCA2 genes help prevent cancer by making proteins that prevent abnormal cell growth. When there is an inherited mutation on these genes, they are unable to prevent this abnormal growth. The risk of developing breast cancer with these gene mutations is as high as 80%. These cancers usually occur earlier in life of the women with these genetic mutations. The cancer often occurs bilaterally or in both breasts but not necessarily at the same time. There is an increased risk of ovarian cancer with these gene mutations. In the US, there is an increased risk of BRCA1 and BRCA2 in women of Ashkenazi Jewish descent.
There are other gene mutations that are not as common.
ATM is a gene which helps repair DNA when functioning normally. It controls cell division. Researchers have yet to discover why a mutation of this gene causes cancer.
P53 is a tumor suppressor gene which plays a role in cell growth when functioning normally. When damaged, it looses the ability to block cell growth. 50% of all cancers of all types will have a p53 mutation. This mutation carries increased risk of brain cancer, leukemia, sarcoma as well as breast cancer when a mutation exists.
PTEN is a gene which regulates cell growth. It is felt by researchers to be the most important tumor suppressor gene yet discovered. When functioning normally, it protects a cell from progressing to a cancer. It may cause cell death if such a precancerous change in the cell occurs. Mutations of this gene are associated with large numbers of cancer types, including breast.
CHEK2 is an inherited genetic marker for breast cancer similar to BRCA1 and BRCA2. The CHEK2 gene normally produces a protein which prevents cells from growing uncontrollably. When mutated, it cannot regulate cell growth and carries a 3 fold increased risk of breast cancer .
The good news about breast cancer is that we know more about it.
Diagnosis and tissue typing have become more sophisticated resulting in improved therapy and improved survival.
Now more than ever women are surviving breast cancer and living long and productive lives.
It is a very frightening diagnosis to consider, and women often delay getting screening tests and exams to aid in early diagnosis because of this fear.
It is vitally important for a woman to identify her risk factors for breast cancer and improve her lifestyle to reduce risk factors which can be controlled.(risk factor is anything, genetic or lifestyle, that increases the risk for a particular disease)
These risk factors have been discussed in a prior posting on our website. I encourage readers to familiarize themselves with those risk factors and begin a program which helps you to reduce them.
I also encourage readers talk with their medical providers about their concerns regarding mammograms and screening tests.
Remember-most breast cancers caught in early stages carry an excellent prognosis for long survival.
ANOTHER REASON TO TAKE CARE OF YOURSELF- BREAST CANCER
There are many risk factors that can potentiate breast cancer in women; the life time incidence of breast cancer in women is 1 in8. This means for every 8 women you know, one of them will develop breast cancer in their lifetime. So what causes breast cancer and what are women doing to help cause this to happen?
Breast cancer occurs when certain cells within breast tissue divide in a manner which allows uncontrolled growth and destruction of surrounding tissue. The cancer cell can then spread to lymph glands and other organs where they grow in the same destructive way. This growth is not the normal growth that is necessary to the function of the body part it is growing in, in this case, breast tissue. Researchers continue to look for the different factors which can influence the occurrence of breast cancer. They feel that something happens to the DNA, or genes of the cells, which cause the factors which normally control growth, to be compromised. This could be a genetic mutation a woman is born with, it can be age, exposure to radiation at a younger age, or a host of other lifestyle issues.
At the recent European Breast Cancer Conference in Barcelona Spain, the head of epidemiology at the University of Milan Dr Carlo La Vecchia spoke of one such risk factor which has been somewhat controversial; that of obesity. He sited figures from the International Agency for Research on Cancer that 25-30% of breast cancer may be prevented by maintaining a lean body mass. Epidemiologists note that the incidence of breast cancer is rising, however they speculate that our genes have been essentially the same over the past many decades. (Maybe the Epigenetic expression has changed though.)
So what does fat have to do with breast cancer? The fat cells developed later in life tend to store estrogen, so the more fat there is, the more estrogen the breast tissue will be exposed to. Since estrogen fuels many breast cancers, this could lead to an increased risk that some researchers feel is as high as 60 %. It is recommended by the American Cancer Society to engage in 30 minutes of exercise 5 days a week to lower your risk of breast cancer. It is also recommended that even lean women continue to work at maintaining increased muscle mass to lessen the creation of new fat cells. As mentioned above, this risk factor is felt to be controversial and not easy to prove. It has been noted however, that the risk of breast cancer seems to occur when weight is gained later in life and not at a younger age. This may in part be due to the fact that weight gain in menopausal years is often visceral fat which is hormonally more active than subcutaneous fat.
What are the other risk factors for Breast Cancer?
- Gender- being female means increased amounts of estrogen acting on cell growth in breast tissue
- Age- 2/3 s of breast cancer occurs after age 55; 1/8 of breast cancers occur under age 45. Age effects the genes which regulate our bodies function and the older a person is, the more likelihood a mistake in the genetic code will occur
- Genetic factors- many women believe that if no one in their family has had breast cancer, they are not likely to get it. Inherited genetic mutations such as BRCA1 and BRCA2 only account for 5-10% of cancers
- Family history- having a first degree relative (mother, sister, daughter) with breast cancer doubles a woman’s risk of developing breast cancer. It is thought that 20-30% of women with breast cancer have a positive family history.
- Prior history of breast cancer- this increases the risk of a second cancer not considered a recurrence, by 3-4 times.
- Race and ethnicity- there is a slightly higher rate of breast cancer in White women over African American women, however African American women are more likely to die from their cancer as they tend to get more aggressive types of breast cancer. Asian, Hispanic and Native American women have a lower incidence and risk of dying from breast cancer.
- Dense breast tissue- make screening harder, there is more glandular tissue and less fatty tissue
- Menses- beginning before age 12 and menopause after 55 increases risk due to increased exposure of breast tissue to more hormonal cycles. For this same reason, no children or children after 30 and less years of breast feeding can also mean more estrogen and progesterone exposure to breast tissue which in turn raises risk.
- Previous chest radiation for other conditions such as lymphoma and certain cancers which can occur at young age
- DES- Women who were given DES during pregnancy and their daughters in-utero at that time, are at higher risk for breast cancer due to mutations of genes.
There are some life style issues that are felt to affect the risk of getting breast cancer. There is some slight increase in risk to women who have been on Oral Contraceptives for several years although this risk declines when the OCP is stopped and continues to decline there after.
Combined HRT has been shown in studies to increase the risk of breast cancer in as little as 2 years of use. This risk is somewhat attenuated when estrogen is used alone, without progesterone. (HRT = hormone replacement therapy)
Use of more than 7 alcoholic drinks a week can also increase risk of breast cancer, this risk can be as much as 1 ½ times normal if 2-5 drinks per day are consumed on a regular basis.
It is important to discuss with your provider your risk of getting breast cancer in order to decide on screening and proper health maintenance. Having one or more of the above risk factors does not mean you will get breast cancer, it merely reflects your risk may be higher and there are things you can do t0 reduce those risks. Many risks are out of our control, but several of these risks are within our control. In many cases, the diagnosis of breast cancer can be made early, treatments have come a long way and are very effective. There continues to be exciting research discovering new factors influencing the occurrence and growth of breast cancer, which can and will open up new therapies. An MP3 recording of this post precedes the YouTube.com videos.
Below are some YouTube.com videos about Epigenetics. This is new and important information.
Cardiovascular disease (heart and blood vessel disease) is the number one cause of death in women. One in three women will have
cardiovascular disease. The signs and symptoms will be different than in men and will usually present later (up to 10 years) than in men. This all depends on genetics and life style.
Genetics is what you inherit from your family. A clue to your genetics is present in the lives of older living and deceased relatives. When you might become menopausal, the problems like hypertension, diabetes, heart attack and brain attack (also called stroke) you might be susceptible to all represent possible risk (risk factors) you do not completely control. You do have some influence on gene expression (how the gene is used by your body) through your diet, your response to stress, whether or not you smoke or are exposed to smoke, and the amount and regularity of exercise through out your life.
In the following mp3, Anne Vaillancourt – the Menopause Mentor, and I discuss the variables affecting heart disease in women.
We welcome your questions and comments. Leave them in the comment section or contact us through our contact page.
Skin cancer is the most prevalent of all diagnosed cancers in the US with over 1 million new cases diagnosed yearly.
The cause of skin cancer is primarily felt to be the result of too much radiation, usually from the sun, coupled with inadequate DNA repair within the various types of skin cells. Damage to the cellular DNA can cause genetic mutations that then lead to skin cancer.
There are primarily 3 types of skin cancer which are the most common.
In order of prevalence
- Basal Cell (BCC)
- Squamous Cell (SCC)
The skin has several layers. Radiation has different intensities and penetration abilities which can cause damage to the different layers.
The outer layer of skin forms the epidermis, underneath this is the dermis. Within the epidermis is the most superficial layer of squamous cells, underneath this layer are the basal cells and within them are the melanocytes (that make pigment).
The dermis houses blood vessels, lymph tissue, nerves, hair follicles all held in place by collagen.
The harmful sun radiation causing damage consists of UVA and UVB. Tanning beds involve UVA radiation only.
UVB is present in different intensities depending on time of day, season and location. It is responsible for burning of skin, can accelerate aging, and facilitate skin cancer.
UVA is capable of penetrating deeper in the skin layers, is present year round during all daylight hours and is equally as harmful to the skin.
So what are the 5 risk factors for skin cancer?
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- Excessive time in the sun or the occurrence of severe sunburns (especially before age 20).
- Having light colored skin, hair, and eyes
- Having a family member with skin cancer
- Being over the age of 50 years
- use of tanning beds
- repeated medical or occupational exposure to radiation
- being immune-compromised (cancer chemotherapy, HIV+, on drugs like Methotrexate for arthritis or other inflammatory disease)
- occupational exposure to coal tar or arsenic.
How do I tell if a mole or spot might be skin cancer?
Dermatologist suggest using a system called ABCDE to evaluate for possible signs of skin cancer.
A- asymmetry. A skin lesion that is or has become irregular in shape
B- border irregularity. A mole or spot has developed a fuzzy or irregular shaped border
C-color irregularity. A mole is not uniform in color, it has irregular spots within it of different shades of brown or has black, red areas.
D-diameter of more than 6 mm or larger than a pencil eraser.
E-evolving. Any mole or lesion which is changing or looks different that other moles or spots.
Basal Cell cancer or BCC (cells within outer layer or epidermis) is the most common type of skin cancer.
It is often described as a fleshy bump occurring in sun exposed areas and more commonly in fair skinned individuals.
50% of people with a BCC will have a second cancer within their lifetime. BCC tend not to grow quickly and do not metastasize (spread) to other organs, but they can grow very deep and affect nerves and underlying bone. Cure rate if treated early is 95%.
Squamous Cell canceror SCC (superficial layer of cells within the epidermis) is a more aggressive cancer and can grow quickly.
It can become large and cause local tissue destruction. SCC has the potential for metastasis. It also occurs primarily over sun exposed areas and also has a cure rate of up to 95% if treated early. SCC is more of a red, scaly lesion but can also have a bumpy appearance.
Melanoma is the most deadly of the skin cancers, accounting for 8,000 deaths a year. It is estimated that 100,000 new diagnoses per year are made. It begins in the melanocytes (with basal cell in epidermis) or pigment cells and can occur within an existing mole or a new mole. It can easily metastasize and early detection and treatment is key to survival! It is most commonly dark in color, sometimes blue/black, however ANY change in an existing mole can be a warning sign.
Skin cancer is not to be taken lightly, it is a serious cancer which is in most cases easily treatable if caught early. Sunscreen is a must to avoid the harmful radiation. Choose a sunscreen with ability to block and absorb both UVA and UVB. Use a sunscreen all day, every day regardless of geographic location or time of year. (Maybe not for 20 minutes so you can make a little vitamin D in your skin but always all day after that)
Melanoma and other Skin Cancers – Do You Have it?