Awareness of breast cancer

Cancer of the breast is a significant health concern, being one of the most prevalent cancers among women worldwide, affecting millions every year. This article aims to bring awareness of breast cancer, the risk factors, the role of lifestyle, and the importance of early detection!

Cancer of the breast remains one of the most common malignancies affecting women today. While the complexities of this disease are vast, recent research has illuminated the significant roles that hormones, diet, and lifestyle play in influencing breast cancer risk.

What is breast cancer?

Breast cancer, like other cancers, occurs when cells in the breast begin to grow uncontrollably. These abnormal cells can form a tumor, which may be detected through a lump in the breast or other symptoms. Breast cancer can occur in both men and women, though it is far more common in women.

Types of breast cancer

Breast cancer has multiple tumor subtypes that differ in risk factors, treatment, and prognosis.

Tumors that express hormone receptors for estrogen receptor (ER) or progesterone receptor (PR) are classified as Luminal A or Luminal B subtypes, also called hormone receptor-positive.
Tumors that express human epidermal growth factor receptor 2 (HER2) are called hormone receptor-negative.
Basal-like tumors that lack expression of ER, PR, and HER2 are referred to as triple-negative breast cancers.

These subtypes are defined based on whether the cancer cells carry hormone receptors for estrogen or progesterone, which can be targeted for treatment, and whether they carry HER2 (human epidermal growth receptor 2), a protein associated with cancer aggressiveness.

"Having a genetic predisposition increases a woman's lifetime risk of breast cancer, and there is evidence to suggest that this risk may be increased or decreased according to an individual's lifestyle." PMC

Understanding the risk factors of breast cancer

Several factors can influence the risk of developing breast cancer:

Age: Risk increases with age, particularly after 55 years.
Family History: A family history of breast cancer increases your risk, especially if close relatives were diagnosed.
Genetic factors: Certain gene mutations, such as BRCA1 and BRCA2, significantly raise the likelihood of breast cancer.
Hormonal influences: Extended exposure to estrogen and progesterone, whether from hormonal therapies or prolonged menstrual cycles, can contribute to risk.
Breast density: Dense breast can make it harder to spot cancer cells on a mammogram. The least dense breasts are almost all fatty tissue, while the most dense are mostly glandular and fibrous tissue. Dense breast tissue is at a slightly higher risk of developing breast cancer because cancers are more likely to arise in glandular and fibrous tissue.
Lifestyle factors: Diet, physical exercise, alcohol, smoking, excess weight (fat), and lack of sleep play a significant role in increasing breast cancer risk. 50% of breast cancer can be prevented through a healthy lifestyle.

Symptoms for breast cancer

Early detection is key to improving breast cancer outcomes. While some women may not experience any symptoms, it's crucial to be vigilant for several signs that could indicate the presence of breast cancer:

A lump or mass in the breast or underarm area.
Changes in the size or shape of the breast.
Discoloration or dimpling of the breast skin.
Any unusual discharge from the nipple.
Persistent pain in or near the breast.

If you notice any of these symptoms, it's crucial to consult a healthcare professional for a check-up.

Hormonal influences

Hormones, particularly estrogen and progesterone, have long been associated with the development and progression of breast cancer. Almost 70% of breast cancers are hormone receptor-positive, meaning they have receptors that respond to these hormones, promoting the growth and spread of cancer cells.

Here are factors the hormones may lead to breast cancer:

Estrogen plays a vital role in breast tissue development and function, but excessive levels or prolonged exposure can increase the risk of breast cancer.
The age of 1st menstruation can lead to breast cancer because of the long years of exposure to estrogen.
Late menopause is associated with a high risk of hormonal breast cancer due to prolonged periods of estrogen exposure.
Lack of pregnancy and breastfeeding are also factors that increase the risk of breast cancer due to estrogen exposure for an extended period.
Hormone replacement therapy (HRT), particularly combined estrogen and progesterone therapy, has been associated with a heightened risk of breast cancer, highlighting the importance of careful consideration when managing menopausal symptoms.
Greater exposure to progesterone increases breast cancer risk and leads to the development of hormone receptor-negative tumors, especially during perimenopause and menopause.

The role of diet

Diet is a critical factor that can influence breast cancer risk. Research suggests that diets high in saturated fats and low in fruits and vegetables may contribute to increased risk. On the other hand, a diet rich in phytonutrients, such as fruits, vegetables, nuts, and whole grains, can help promote overall health and may lower cancer risk.

A diet rich in phytonutrients, such as fruits, vegetables, nuts, and whole grains, can help promote overall health and may lower cancer risk.

Some specific dietary components have shown promise in studies; for instance, omega-3 fatty acids, found in fatty fish, possess anti-inflammatory properties that could be protective against cancer. Similarly, the Mediterranean diet, characterized by high consumption of vegetables, whole grains, and healthy fats, has been correlated with a reduced risk of various cancers, including breast cancer.

Women with metabolic syndrome, obesity, high blood pressure, elevated blood sugar, and abnormal cholesterol can benefit from a low-fat diet and reduce the risk of breast cancer.

Vitamin D

In a follow-up study for 9 years, women with sufficient vitamin D had a 21% lower risk of breast cancer compared to women with vitamin D deficiency. But there's a lot of conflicting data regarding vitamin D and low risk of cancer!

Excess weight

Lifestyle choices play a pivotal role in reducing breast cancer risk. Regular physical activity has been shown to help maintain a healthy weight and reduce estrogen levels, two factors that can lower the risk of developing breast cancer. This underscores the importance of being aware of our choices and taking necessary precautions.

Conversely, excess weight, particularly postmenopausal obesity, has been linked to an increased risk due to the higher levels of estrogen produced by fat tissue. It's important to be aware of this risk factor and take necessary precautions.

Study suggests around 40% of postmenopausal hormone-positive breast cancers are linked to excess body fat.

A study found that women who areBlack, Hispanic, Latin, and overweight or obese have higher chances to be diagnosed with advanced breast cancer. (I don't understand why white caucus women and Asians are exempt here!)

However, in young women, increased body fat (not obesity) reduces the risk of breast cancer, while in post-menopause women, weight gain and excess body fat increase the risk.

Excess body weight increases estrogen and insulin, which can increase cell division, increasing the risk for cancer. Also, excess body weight is associated with inflammation, and inflammation is a known risk factor for the development of cancer.

Alcohol

Alcohol consumption is associated with an elevated risk of breast cancer. Studies indicate that even moderate alcohol intake can slightly increase the risk, likely due to alcohol's effect on estrogen levels. Women who drink alcohol, even in moderate doses, increase their risk of breast cancer.

Alcohol weakens the immune system and can damage DNA, which can lead to cancer.

Lack of restorative sleep

A Californian study concluded that sleep deficiency may be a risk factor for breast cancer. The disruption in the circadian rhythm is recognized as a potential carcinogen by the International Agency for Research on Cancer (IARC).

Sleep helps regulate critical processes in our body that can prevent cancer, such as cell growth, inflammation, and immune function.

In the case of breast cancer, lack of sleep can reduce the production of melatonin, a hormone that regulates estrogen levels, which may lead to cancer.

Sleep affects how our body produces and uses hormones like growth hormone, melatonin, cortisol, leptin, and ghrelin, which are essential for many bodily functions.

Lack of sleep may lead to high levels of cortisol, which can weaken the immune system, making it harder for the body to fight off cancer cells. It can also lead to inflammation, which can damage cells and DNA.

Additionally, high cortisol can affect the body's metabolism, leading to conditions like obesity and insulin resistance, which are linked to certain types of cancer.

Breast cancer in black women

A meta-analysis published recently states that in the US, "black women have a risk of dying from all types of breast cancer. Black women with breast cancer are more likely 40% to die of the disease."

African American women have a lower incidence of breast cancer but higher mortality compared to White women. Additionally, both Sub-Saharian women and African American women have a higher incidence of premenopausal breast cancer compared to European women and White women in the US.

African women are less likely to get breast cancer than European women. While European women get breast cancer after menopause, for African women, it's more common to get breast cancer before menopause.

According to the Breast Cancer Association, "black women are statistically more likely to have diabetes, high insulin, heart disease, and obesity, and are less likely to breastfeed after childbirth, all of which are risk factors for breast cancer."

Black women in the US have lower rates of breastfeeding and nearly twice the rates of triple-negative breast cancer (an aggressive subtype) compared with white women. This subtype is prevalent in Black women in premenopause.

In comparison to Caucasians, African-American women had 18% higher levels of estradiol, and high levels of estradiol can contribute to breast cancer by stimulating cell growth.

Black women are also exposed to cancer through environmental factors; hair products and cosmetics used by black women contain high endocrine-disrupting chemicals. Research shows that Black women have high rates of uterine fibroids, infertility, early puberty, and endometrial and breast cancers.

Despite a lower incidence of the disease, breast cancer-specific mortality in low-income countries throughout Africa is significantly higher compared to high-income countries.

Fear, stigma, and misinformation play significant roles in the experience of breast cancer for Black Women worldwide. To add to this burden is both the fear of discrimination and lack of medical care because of systemic racism.

The systemic problems of racism, colonialism, and poor governance leave too many patients trapped, and they're at higher risk of financial burden.

Results in several studies suggest that a combination of tumor biology and differences in access to care are influential for breast cancer outcomes in Black women.

"Black women with breast cancer are at least partially attributable to factors that are independent of tumor biology, for example, socioeconomic inequality, delays in diagnosis, and inadequate access to timely quality cancer treatment resulting from systemic racism." Medical Xpress

"Roughly one-third to one-half of cancer cases are preventable" World Health Organization.

Breastfeeding lowers breast cancer risk

Breastfeeding reduces the risk of both pre-and postmenopausal breast cancers. Breastfeeding reduces the time a woman is exposed to estrogen.

Additionally, during pregnancy and breastfeeding, the breast sheds off some tissue that could contain damaged DNA, thus reducing the risk of breast cancer.

Breastfeeding for 12 months or longer reduces the risk of breast cancer by up to 23%.

Breastfeeding not only reduces breast cancer risk but also confers other health benefits to the mother, including reduced risk for endometrial and ovarian cancers and reduced risk for chronic conditions that are also risk factors for cancer, such as hypertension and diabetes.

Reproductive risk factors associated with breast cancer risk include age of menarche, number of pregnancies, age at first birth, lifetime duration of breastfeeding, age at menopause, and use of menopausal hormone therapy; however, research has found that these factors are differentially associated with each cancer subtype.

The importance of early detection

The earlier breast cancer is detected, the higher the chances of effective treatment and survival. Regular screening methods include:

Mammograms: Recommended yearly for women starting at age 40 or earlier based on risk factors.
Clinical breast exams: These are conducted by healthcare professionals and can help detect abnormalities.
Self-exams: Being familiar with your breast tissue can help you notice any changes; however, self-exams should supplement, not replace, professional screenings.

Overcoming stigma and building support

Despite the prevalence of breast cancer, stigma and misinformation still exist. It's essential to foster open conversations about breast health, encouraging women to prioritize their screenings and health.

Support from friends, family, and community organizations can be critical for those affected by breast cancer, providing emotional and practical assistance.

Conclusion

Breast cancer is a serious health concern that affects many lives. By understanding its symptoms, risk factors, and the importance of early detection, we can empower ourselves and those around us.

A healthy lifestyle can help reduce the risk of breast cancer, even for people with genetic predisposition. A healthy diet and lifestyle changes should be the 1st steps.

Together, we can break this disease's stigma, inspire healthy lifestyle choices, and advocate for regular screenings. Early detection saves lives, and awareness is the first step towards effective prevention and treatment.

Let's continue to support each other in the fight against breast cancer and promote a future where everyone has access to critical resources and information about their health.