Neolife medical management

Breast cancer is the most common form of cancer among women, accounting for almost a quarter of all tumors occurring in women with an incidence of 93.6 cases per 100,000 women/year.

The incidence of breast cancer in women is rising between 2-3% each year; among the possible causes of this increase are the changes in reproductive patterns, poor lifestyle habits and hormone replacement therapy with non-bioidentical estrogen and progesterone.

Fortunately, the mortality rate of breast cancer has dropped concurrently with the increase in incidence, thanks to early diagnosis and improved treatments whereby Multidisciplinary Care of breast cancer has played a vital role. In Spain, the overall survival rate from breast cancer currently stands at 83%, which is between 90% in the United States and 79% in Europe.

MAIN RISK FACTORS OF BREAST CANCER

Hormonal and reproductive factors. This includes all situations that involve the breasts being subject to high levels of estrogen throughout one’s life.

• Early menarche (1st menstruation before 11 years old) or late menopause (after 55 years old).
• Nulliparity (never having given birth).
• Late age having 1st child, above 30 years old; can result in a delay in the maturity of the mammary gland.
• Oral contraceptives in young women; excess risk disappears once the treatment is stopped, so the overall effect is scarce.
• Combined hormone replacement therapy.

 Family history.

• Only 15% of cases of breast cancer are associated with family history; and only 5% are associated with a known genetic mutation (BRCA 1 and 2).

 Prenatal risk factors, due to the effect of hormonal exposure in the womb.

• Baby birth weight.
• Advanced maternal age.

Obesity

• It is more significant during post-menopause as the source of hormones comes from adipose tissue.

Diet

• Fundamentally owing to the consumption of alcohol, sugar and fast absorption carbohydrates, as well as polyunsaturated fatty acids and trans fats from hydrogenated oils.

Environmental and occupational factors:

• Ionizing radiation, if exposure has occurred during the first years of life, adolescence or pregnancy. For example, due to thoracic radiotherapy, for diseases such as lymphoma during childhood and youth.
• Women with career changes or night shifts. Changes to the circadian rhythm can involve a decrease or suppression in the secretion of melatonin; this theory is still limited with regards to humans, although it is supported by studies with laboratory animals.

High mammographic density.

Previous breast pathology

• Proliferative lesions with atypia, ductal carcinoma in situ and lobular carcinoma in situ.

BREAST CANCER PREVENTION

Primary prevention 

This involves all of the interventions we can carry out in order to reduce the personal risk of developing breast cancer before it appears.

There is a group of risk factors that can’t be changed and that we can do little to influence:

• Age of menarche and menopause.
• Ionizing radiation treatment for disease before the age of 25.
• The risk of benign breast lesions.
• Family history.

However, other risk factors can be clearly influenced in order to reduce the risks of developing breast cancer:

• Physical exercise. Moderate physical exercise equivalent to walking at a brisk pace 30 minutes a day OR 1 hour a day 3 days a week is enough; it has also been seen to improve the prognosis and favor an improved treatment tolerance in women who have already had breast cancer.
• Diet
  • Decrease maximum alcohol intake to 1 drink a day, especially distilled alcoholic drinks.
  • Reduce the intake of animal fats (from red meat) and polyunsaturated fatty acids and trans fats (margarine, commercial bakery products).
  • A diet rich in fiber, such as vegetables, legumes, fruit, fish and olive oil (the Mediterranean Diet).
  • The consumption of soybean derivatives has not been shown to be of any benefit (except in those of East Asian heritage who may have consumed larger quantities of soybean derivatives from childhood).

• Nutritional supplementation. Sufficient intake of Vitamin D, as this has been shown to inhibit the growth of tumor cells in experimental studies.
• It is difficult to modify the advancement of childbearing age and number of children per woman, as government policies on family protection are influencing factors.

Secondary prevention

Here, the objective is the early diagnosis of the disease in order to be able to perform less aggressive treatments and improve the overall prognosis.

With breast cancer, the only diagnostic test that has proven to reduce mortality rates, by performing it on the public, is screening with mammograms.

When screening campaigns are carried out on the public, they are aimed at women between 50-70 years old, with a screening every 2 years.

They can also be performed as a form of early diagnosis, as part of a gynecological check-up of healthy women starting at the age of 40, although these must take into account the limitations due to the higher radiation density of the breast and the different behavior of tumors in younger women.

In women under 40, an increased risk is only present on a case by case basis owing to both family and personal medical history.

BIBLIOGRAPHY

(1) Epidemiological situation of breast cancer in Spain. Pollán M et al. Psycho-Oncology. Vol 4, num. 2-3, 2007, pp 231-248.

(2) Breast cancer today. Advances in the epidemiology of female breast cancer. Pollán M. Method 77 (2013) 71-75.