Prevention and Risk Assessment

In order to prevent breast cancer from occurring we must understand what causes it to begin and what causes it to grow. Ultimately all breast cancer has a "genetic" origin. It does not mean that everyone who is diagnosed with breast cancer has had a relative affected by breast cancer as only 25% of all women or men diagnosed have a positive family history. It means in the other 75% of breast cancers diagnosed, there is a change in the genes that control the cells growth and division. Once altered, the cells begin to divide in a "chaotic" or disorganized manner forming a mass or a cancerous growth.

Not all cancers grow at the same rate. Some are very rapidly dividing tumors and others may take years to become evident on mammography or on clinical exam. There are many factors that play a role in the growth and development of breast cancer.

Although genetics plays a role in all cancers, one single genetic alteration is not enough for a cancer to form. Even women with BRCA-1 and BRCA-2 gene alterations (the genes that have been found to be associated with breast and ovarian cancer) are not guaranteed to develop cancer. They are clearly at a much greater risk for the development of breast and ovarian cancer but other factors still come into play. Women who test positive for the BRCA-1 and BRCA-2 genes have an 80 to 90% chance of developing cancer. But this gene alteration accounts for only five to nine percent of all breast cancers diagnosed. Other internal and external factors are involved in the formation of a cancer.

Your physician can determine your individual risk for the development of cancer in the future. The most widely used formula is called the GAIL risk model and takes into consideration many factors. This is only an estimate and can be used to assess your risk profile.

The most prominent factor in the risk assessment is having been born a woman. Only one percent of breast cancers are diagnosed in men, therefore, being female is the most obvious risk factor. The next factor that comes into play is age. The preponderance of breast cancers are diagnosed in women over 60 but cancer can occur at any age. (80% of all breast cancers occur in women over 50 with no family history) The next factor we look at is how many first-degree family members (mother, sister or daughter) have been diagnosed with this disease.

A history of multiple breast biopsies, particularly those with atypical changes is a significant factor. Estrogen exposure is the next factor that has many components. Estrogen does not cause a cancer to form, but it can promote the growth and progression of the disease. Menarche, the age of your first menstrual period, is a factor that you cannot control. The earlier your period begins the higher the risk. Being nulliparus, never having given birth, and having your first child after the age of thirty, also increases your risk profile.

The GAIL risk assessment allows your physician to determine your five-year and lifetime risk and can become an important factor in your decision-making process when it comes to breast cancer prevention.

There are risk factors that are under your control. The foods you eat and the toxins that you choose to put in your body is an area within your control. The obvious toxins tobacco and excessive alcohol consumption can be eliminated, as they are associated with so many cancers and disease processes in our bodies.

Obesity, a diet high in saturated fats, lack of exercise, and environmental pollutants are also linked to the development of breast cancer. Radiation exposure (in levels much higher than mammography requires for screening) has deleterious effects on normal cellular function. Free radical formation is thought to be at the root of the aforementioned factors and, therefore, vitamins, antioxidants, and a healthy lifestyle are certainly an option for those who choose to be proactive.

All women may want to adopt these strategies since we are all, by virtue of being female, at risk. The incidence of breast cancer has increased over the past 25 years from 1 in 15 to 1 in 8. Certainly our lifestyles have been altered during that time period and we have the power to alter them in a positive manner.

In addition to lifestyle and dietary modifications, there are several options for women at high risk. If you are at a significant risk, your physician may recommend you take a drug called tamoxifen. In a recent study, the National Cancer Institute and National Surgical Breast and Bowel Project were able to show a 44% reduction in the development of breast cancer in women at high risk. It works by blocking estrogen receptors in the breast and, therefore, prevents the cells with the potential for cancer from dividing. The decision to go on tamoxifen should be discussed at length with your team of physicians, as there are potential side effects along with its benefits.

There are clinical trials currently available looking at grape seed extract in post-menopausal women. Grape seed extract is being studied to see how effectively chemicals in grape seed extract lower estrogen levels in healthy but breast cancer-prone post-menopausal women. A high level of estrogen in these women is a known risk factor for breast cancer.

Additionally there is a Phase 2 clinical trial looking at a drug called deslorelin intrnasally. This hormone shuts down ovarian activity and then the patients on the trial receive low-dose replacement therapy.

Lastly, we are partnering with City of Hope to look at the newest class of aromatase inhibitors in the prevention of breast cancer. This study will involve the use of exemestane in post-menopausal women to decrease breast cancer risk.

To learn more about inherited cancers visit.  Myriad tests.
Don't hesitate to ask Dr. Curio and the breast cancer specialists how they can help.
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Contact Dr. Lisa Curcio to discuss your risk for breast cancer . Dr. Curcio is a breast cancer heredity risk specialist and she can advise you on your breast cancer risk.

Speaker's Information: As a breast cancer survivor and breast cancer surgeon, Dr. Lisa Curcio is available to share her story. Dr. Curcio is a strong advocate for breast cancer research, treatment and education. If you would like Dr. Lisa Curcio to speak with your group, organization or association, please call our office at 949.770.0797 and we would be happy to discuss your request.Visit "Advanced Breast Care Specialists of Orange County"  in Mission Viejo, California.