Breast Cancer- What’s Your Risk?
In honor of the end of Breast Cancer Awareness Month let’s talk about risks and screenings. When should you get a screening mammogram? At what age should you start? How often should you get one? Do you need an ultrasound or an MRI for further evaluation and how often?
These questions have different answers depending on whose advice you are looking for. All the groups that make official recommendations have their own particular guidelines for routine screening mammograms. They all agree on the risk factors though.
- Family history/ genetics
- Younger age for first period
- Older age for first childbirth
- Older age for menopause
- Breast density
- Use of birth control and/or hormone replacement
- Lack of exercise
- Alcohol use
- Radiation exposure
The most aggressive guidelines for screening are from the National Comprehensive Cancer Network. They recommend annual mammograms starting at age 40, and clinical breast exams. The most relaxed guidelines are from the US Preventive Services Task Force which does not even give recommendations for women with higher risk but only recommends screening mammograms every 2 years, beginning at age 50, and recommends against breast self-exam. The American Cancer Society recommends screening mammograms annually at 45 and decreasing to every other year at 55. The American Congress of Obstetricians & Gynecologists recommends annual screening mammos at age 40. All but the USPSTF recommend being aware of the feeling of your own normal breast tissue and having an annual MRI if the lifetime risk of breast cancer is calculated to be more than 20% based on family history.
How do you determine a woman’s lifetime risk of getting breast cancer? There are computer programs available that allow us to calculate that based on family history and the personal risk factors listed above. At your next physical exam we can determine if we need to calculate this risk, and at a followup appointment we can take the time to enter your personal and family data into a program that will give us a percentage chance that you could have breast cancer in the next 10 years and also the chances of developing breast cancer in your lifetime. These are sobering statistics (I have entered my own data and even with no family history of breast cancer my lifetime chances of developing it are 12%!). If your lifetime risk is 20% or higher you are entitled to see a genetic counselor and your insurance is obligated to pay for it, as well as an MRI (thank you Affordable Care Act).
Come in and let’s talk about your personal and family risk factors for developing breast cancer and make sure you are getting the appropriate screening to ensure your longest healthiest life.
Can exercise counteract alcohol?
If you exercise all week can you drink all weekend? Maybe. The quote in British outlet the Mail Online is “Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotalers.” That’s a simplification of course. There’s a large 10 year study published in the peer-reviewed British Journal of Sports Medicine that shows physical activity can counteract some of the ills of alcohol consumption. It’s a strong study looking at data that was collected from adults aged 40+ from national surveys in the United Kingdom. The study shows that while alcohol intake increases death from cancer especially but also from all causes, people who followed the recommended level of physical activity were no more at risk than the non-drinkers. Alcohol has been shown to increase one’s likelihood of cancer, in particular mouth and throat, esophagus, liver, colon and rectum, and breast cancers, according to the journal Addiction. And it is imperative to note that the study was looking at death from cancer and other causes, not diagnosis rates.
The researchers, who hail from the UK, Canada, Australia and also Norway, used data from England and Scotland from 1994-2006. There were 36,370 people, both men and women, who answered questions about a multitude of health behaviors, and categorized their level of exercise and alcohol. These participants were followed over time to see how their health changed. The researchers controlled for the most obvious factors like body size, smoking status, and sex/gender. They used MET (metabolic equivalent of task) hours to categorize exercise, where 1 MET is sitting at rest, and the more intense the exercise, the higher the MET. For example jogging for 1 hour is equal to 7 MET hours while calisthenics at home for an hour would be 3.5 MET hours.
It’s important to understand what the categories were for both exercise and alcohol. Bottom line, you can’t drink too heavily no matter how much you exercise. In this study they defined hazardous levels as 14-15 drinks per week for women and 19-21 for men. At this level the exercise still seemed to counter the alcohol. But above that level the benefits of exercise did not outweigh the impacts of alcohol. What about exercise levels? They considered inactive as less than 7 MET hours per week, lower active as between 7.5-15 MET hours and higher active as >15 MET hours per week. In practical terms that’s jogging for 30 min 4 times per week. This level of exercise also offered a protective effect against cardiovascular disease, confirming results we already know from a multitude of other studies.
While we can’t be certain that exercise alone reduced the risks associated with alcohol consumption- it could be other lifestyle factors that were not measured- it seems like a good assumption for now. We know we should exercise for our heart health, to reduce cancer risks, and to maintain strong bones and muscles. But if you are someone who drinks alcohol consider this a very strong push to make physical activity a priority. Get moving!
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Are walnuts the new superfood?
These days it’s hard to glance at a health magazine, flip past the cooking channel, or chat with your one vegan friend without hearing the word “superfood”. It seems like they just keep coming up with new ones. One week its kale, the next its acai, then before you know it you’re on amazon wondering if you should order some Maca powder from the Andes because apparently it’s a natural energy booster and you can sprinkle it in your smoothie. It’s hard to keep up without getting swept up. So, many people (rightfully so) regard superfoods with a healthy amount of skepticism. A superfood is “a nutrient-rich food considered to be especially beneficial for health and well-being.” That’s a pretty broad definition– it’s no wonder they keep announcing new ones! But please read on about walnuts.
This week I read two interesting articles about walnuts and their correlation to reduced cancer deaths. The British Journal of Cancer recently published an article written by a Harvard researcher reporting that his research had shown that tree nuts in general were found to reduce a man’s chances of dying from prostate cancer. Tree nuts include walnuts, almonds, cashews, macadamias and pine nuts. Now, prostate cancer is typically a slow-growing cancer that occurs later in men’s lives. Interestingly, most men who have it will not die from it, but will die from a completely unrelated cause as the disease is very often asymptomatic. However, after lung cancer, prostate is still the second leading cancer killer among men. It’s an extremely hit-or-miss cancer, to say the least, and so we have to ask: how can men reduce their chances of suffering prostate cancer’s fatal effects? The study looked back at 47,000+ men and found that those who ate tree nuts five times per week had a 34% lower chance of dying from prostate cancer than men who ate nuts less often. Let me be clear: both groups had the same rate of diagnosis of prostate cancer regardless of how many nuts they ate. The tree nuts don’t appear to keep men from developing prostate cancer, but they do seem to make them less likely to die from it.
If you think that sounds bizarre, researchers were pretty puzzled too. The research remains largely inconclusive as to exactly why tree nuts correlate to lower prostate cancer deaths, but several other studies have noticed and documented this relationship as well. The next study I read was published in Cancer Prevention Research and was actually performed on mice not humans, but it still offered some new insights on the topic. Some mice had walnuts added to their standard diet- either a diet of typical mouse kibbles or a Western diet. The mice who consumed walnuts were found to have fewer colon cancer tumors (2.3 fold fewer in the western diet group). The researchers then analyzed the stool of all the mice in the study and found that the mice that had eaten walnuts, especially the males, had more diverse gut biomes than the mice that had not been fed walnuts. More definitive research is needed to determine whether the change in the gut flora is behind the decrease in tumor development or whether it is just yet another benefit of the walnuts. Regardless, the walnuts seem to have had a surprisingly beneficial impact.
So what is it in the nuts that contribute to our health? Is it the B vitamins? The magnesium? Or a plant-specific type of chemical that offers protection against inflammation and cancer and encourages the growth of healthy gut bacteria? Nobody’s totally sure, but I’ll be sure to keep eating Waldorf salad, snacking on walnuts, and adding them to my baked goods any chance I get.
Nakanishi M, Chen Y, Qendro V, et al. Effects of walnut consumption on colon carcinogenesis and microbial community structure [published online May 23, 2016]. Cancer Prev Res (Phila). doi:10.1158/1940-6207.CAPR-16-0026
Wang W, Yang M, Kenfield SA, et al. Nut consumption and prostate cancer risk and mortality. Br J Cancer. 2016 Jun 9. doi:10.1038/bjc.2016.181. [Epub ahead of print]