It is important to note that most breast cancers are believed to be sporadic, meaning they arise from a complex interplay of genetics and environmental conditions.
I will review some of the guidelines below, but only about 5-10% of breast cancers can be attributable to specific gene mutations (including BRCA2, CHEK2, TP53, PALB2 ). Even if you have inherited these mutations – it still doesn’t guarantee cancer, it simply raises your lifetime risk.
Early Detection of Breast Cancer
Breast cancer incidence is quite low under the age of 40 years old, and begins to rise with age. We strongly advise you to talk to your doctor about risks and when to begin screening. For those at average risk (lifetime risk of 15% or less), screening should often be considered between 40 to 45 years old.
On the opposite spectrum, after 75 years old, screening is offered when life expectancy is at least 10 years. There is no clear upper limit to age or ideal frequency, but usually recommended every 1 to 2 years.
Here are some means, including breast exams and mammographies, to detect breast cancer.
Breast Self-Exams (BSE): This is controversial. Some believe this leads to more biopsies and worry. Others believe it makes women become more familiar with how their breasts normally look and feel, so they can quickly detect any changes like lumps, dimpling, or skin changes.
Clinical Breast Exams (CBE): We recommend regular clinical breast exams by a healthcare provider. These exams are typically done during routine check-ups.
Mammography: Mammograms are crucial for early detection, especially for women over 40. Regular screening mammograms can detect tumors that are too small to be felt. We encourage women to follow recommended mammography guidelines. Mammograms usually detect tumors around 1cm – anything much smaller than this, can be missed by this technology. Mammograms can also detect microcalcifications which can be another early sign of a pending tumor.
Breast MRI: this technology can detect tumors down to a few millimeters (subcentimeter) and can also pick up DCIS – another version of a more noninvasive breast cancer. Breast MRIs are often recommended to supplement screening for those at high risk – BRCA1/2, strong family history or prior chest radiation. The other notable benefit is that Breast MRIs are not affected by breast density (which can sometimes limit mammography).
Galleri, Liquid Biopsy: this is very new technology. While the current standards are mammogram, directed ultrasound, and breast MRI, this test detects small 100 base pair Free DNA segments of cancer from multiple sources (breast being one source). For its application to breast cancer it has a sensitivity of about 30% which is relatively low.
Environmental & Genetic Risk Factors
Here are some of the more common environmental and genetic risks and exposures.
Environmental Risk Factors
Hormone Replacement Therapy (HRT): Long-term use of combined estrogen and progestin hormone therapy can increase risks of certain types of breast cancer. Estrogen can stimulate the growth of breast tissue and heightened cell activity thus raising risk of a genetic mutation or mutations arising. Certain breast cancers can be sensitive or responsive to estrogens and progestins and other breast cancers are NOT hormone sensitive – it really depends upon the type of breast cancer. The most important factor here is duration of usage.
Exposure to Radiation: Previous exposure to radiation, particularly in the chest area, can increase the risk of breast cancer.
Alcohol Consumption: Moderate and high alcohol intake is associated with an increased risk of breast cancer. For females, moderate usage is 7 or more per week (males more than 14 per week). As Dr Huberman has said – alcohol is a toxin/carcinogen and no amount of alcohol is safe. But, like most things in life, we’d advise moderation and the less alcohol the better.
Obesity: Maintaining a healthy weight is important, as obesity is linked to an increased risk of breast cancer, particularly in postmenopausal women.
Lifestyle Choices: Making healthier choices - such as a good diet (low saturated fats, lots of veggies and fruit), physical activity, avoidance of smoking can reduce risks. Try adding these five cancer fighting foods to your plate.
Genetic Risk Factors
BRCA1/BRCA 2: If you know someone in the family that has the BRCA1 or BRCA2 gene – bring this to our attention.
Strong Family History: even if you don’t have BRCA1/2, there are many other genetic issues here and may want to consider looking for more rare genes that put you at risk for breast cancer.
Artificial Intelligence & Breast Cancer Diagnosis
AI can play a significant role in breast cancer detection and diagnosis. We are in AI’s infancy in its regular application to medicine, but here is how it could potentially help and aid in diagnosis and come up with better treatment options.
Image Analysis: AI algorithms can analyze mammograms and breast MRI images to detect abnormalities, including suspicious masses or microcalcifications. This can assist radiologists in making more accurate diagnoses.
Pathology: AI can aid pathologists in analyzing tissue samples from biopsies, improving the accuracy and speed of diagnosis.
Genomic Analysis: AI can analyze genomic data to identify specific genetic mutations associated with an increased risk of breast cancer. This can guide personalized prevention and direct more targeted treatment strategies.
Schedule your annual check-up and talk with your doctor about breast cancer prevention today. Looking to transform your health? Partner with the incredible providers at LifeScape. Request a Meet & Greet today.