BREAST ABNORMALITIES

Abnormalities or Breast Conditions Suggesting a Higher Risk. Some breast formations or abnormalities should be watched and include the following:

Dense breast tissue is associated with a higher risk for breast cancer. Studies suggest that in women with highly dense tissue have two to six times the risk of women with the least dense tissue. Genetic factors play a large role in breast density. Hormone replacement therapy also increases breast density.

Benign proliferative breast disease or atypical cell growth, known as atypical hyperplasia, is a significant risk factor for breast cancer.

Benign Breast Conditions. Benign breast conditions are much more commonly seen on mammograms than cancer. And in the great majority of cases they pose no risk. Some common benign breast abnormalities that pose few or no risks include the following:

Cysts. These mostly occur in women in their middle to late reproductive years and can be eliminated simply by aspirating fluid from them.

• Fibroadenoma. These are solid benign lumps that occur in women between the ages of 15 and 30.

• Breast abscesses during breastfeeding

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• Nipple discharge. Discharge from the nipple is worrisome to patients, but is unlikely to be a sign of cancer. Unexplained discharge still warrants evaluation, however.

• Mastalgia. This is breast pain that occurs in association with or independently from the menstrual cycle. About 8 - 10% of women experience moderate to severe breast pain associated with their menstrual cycle. In general, breast pain does not need assessment unless it is severe and prolonged.

The following physical characteristics have been associated with increased risk:

Obesity increases the risk for all types of estrogen receptor-positive breast cancers. Women who gain weight after menopause are most at risk. (On a positive note, losing weight after menopause decreases breast cancer risk.) In postmenopausal women, estrogen is produced in fat tissue. High amounts of fatty tissue increase levels of estrogen in the body, leading to faster growth of estrogen-sensitive cancers.

Estrogen is involved in building bone mass. Therefore, women with heavy, dense bones are likely to have higher estrogen levels and to be at greater risk for breast cancer.

Some studies have found a greater risk for breast cancer in taller women, possibly due to the higher estrogen levels associated with greater bone growth. In one study, regardless of their actual height, women who reached their full height at age 13 or younger had a higher risk than those who attained maximum height at age 18, reflecting higher estrogen levels at an earlier age.

Environmental Factors

Exposure to Estrogen-like Industrial Chemicals. Chemicals with estrogen-like effects, called xenoestrogens, have been under suspicion for years. There has been particular concern with pesticides containing organochlorines (DDT and its metabolites, such as dieldrin) and pyrethroids (permethrin), but at this time evidence of any causal association is very weak.

Exposure to Diethylstilbestrol (DES). Women who took diethylstilbestrol (DES) to prevent miscarriage have a slightly increased risk for breast cancer. To date, this risk has not been seen in their daughters (commonly called "DES daughters"), who were exposed to the drug when their mothers took it during pregnancy.

Radiation Exposure. Heavy exposure to radiation is a significant risk factor for breast cancer. Children receiving high-dose radiation therapy face an increased risk for breast cancer in adulthood. Low-dose radiation exposure before age 20 may increase the risk for women with BRCA genetic mutations.

Viruses

Researchers theorize that viruses may be involved in some types of breast cancers. A study of breast cancer samples taken from Tunisian women in North Africa found similarities with a virus known to cause breast cancer in mice. The samples were compared with those taken from women living in other global regions. The researchers suggested that a human breast cancer virus may be more prevalent in specific parts of the world.

Insulin-Like Growth Factor

Insulin-like growth factor 1 is an important growth hormone during development in the womb and childhood. It has powerful properties that increase cell proliferation, and high concentrations have now been linked to cancers, including premenopausal breast cancer. In fact, it may be one of the factors that are responsible for the association between height and breast cancer. More research is needed to verify a possible role of insulin-like growth factor 1 in breast cancer development.

Prevention and Lifestyle Factors Exercise

Several studies suggest that regular exercise, particularly vigorous exercise, may offer some modest protection against breast cancer. Exercise can help reduce body fat, which in turn lowers levels of cancer-promoting hormones such as estrogen. Exercise can also help women who have been diagnosed with breast cancer. Studies indicate that both aerobic and weight training exercises benefit the body and the mind, and improve quality of life for breast cancer survivors. Even moderate exercise can help improve survival. A 2005 study in the Journal of the American Medical Association reported survival benefits for women diagnosed with breast cancer who walked 3 – 5 hours per week at an average pace. 

Dietary Factors

Much research has targeted the role of diet in breast cancer, either as a risk factor or as a factor for patients already diagnosed with cancer.

Fats: Although some studies have found an association between high-fat intake and breast cancer, the most recent data suggest that fat from any source (vegetable oils or animal products) plays an insignificant role in increasing the risk for breast cancer. According to some studies, monounsaturated fats (found in olive, peanut, and canola oils) may even be protective.

Vitamins and Chemicals in Fruits and Vegetables. Many fresh fruits and vegetables contain chemicals that may be cancer fighters. Experts are investigating whether any specific vitamins, nutrients, or teams of them may be specifically valuable.

Examples include:

Isothiocyanates stimulate enzymes that convert estrogen to a more benign form and may block steroid hormones that promote breast and prostate cancers. They are found in broccoli, cabbage, Brussels sprouts, cauliflower, collards, kale, kohlrabi, mustard greens, rutabaga, turnips, and bok choy.

• Polyphenols, found in apples, onions, and green tea, may be beneficial, although this is controversial. (Chemicals in green tea in particular have been studied for cancer-fighting effects in breast cancer.)

• Lycopene, found in tomatoes may have cancer-fighting properties.

• There is some evidence that foods containing folate (folic acid) may be protective. It is found in avocado, bananas, orange juice, asparagus, fruits, green leafy vegetables, dried beans and peas, and yeast. It is also added to commercial grain products.

• Low levels of vitamin D may increase breast cancer risk, especially in older women. Vitamin D is activated by sunlight and obtained from fortified milk.

• Foods high in vitamin C have also been associated with a lower risk (although there is not evidence of protection from any vitamin supplements, including C or E).

Dairy Products and Other Protein Foods. Studies suggest that dairy products may also play a protective role in premenopausal women. If this is eventually verified, it is not clear if protection comes from calcium and vitamin D in these foods or if there are others factors involved. Women who increase their intake should choose low- or no-fat dairy products.

One study reported that women with breast cancer who had a high intake of protein from both poultry and dairy products had a better outlook than those with a lower intake of these foods. In this study, red meat appeared to have no effect one way or the other. Other studies, however, have found a higher risk of breast cancer in women who consume higher quantities of flame-broiled meats, particularly women who are sensitive to chemicals released during the process. Fish may offer some protection.

Iron. Animal studies have linked a higher incidence of breast cancer with iron-rich diets, and in humans, high iron stores have been associated with a higher risk for breast cancer. Estrogen appears to increase iron levels in cells, and iron produces oxidants (damaging particles) that are associated with cancer. More research is needed to confirm these findings, however.

Phytoestrogens are estrogen-like substances found in plant products. These include soybeans, black cohosh (an herb), whole wheat, berries, and flaxseed. In general, the evidence on their effects on breast cancer is unclear.

Most research has focused on soy. In general, Asian women have a lower incidence of reproductive and breast cancers as well as a higher intake of soy. For example, a 2000 Asian study reported an association between high levels of soy compounds in the urine and a significantly lower risk for breast cancer. A 2001 study in China reported that high soy intake during adolescence was associated with a lower risk for breast cancer later on.

The effects of phytoestrogens, however, in all cases are far from settled. Of concern are studies that report breast cell proliferation with low levels of genistein (one of the important isoflavones compounds in soy). In one study, the compound actually reversed the protective properties of tamoxifen, a drug used to prevent breast cancer in high-risk women. In general, women at risk for breast cancer, especially women who take hormone replacement therapy, should avoid consuming large amounts of plant products with high levels of phytoestrogens until more is known about their effects.

Several studies have reported a higher risk for breast cancer in women who consume alcohol. A well-conducted 2003 analysis of many of these studies suggested that for every daily drink there was a 7% increase in breast cancer. By age 80, women who consumed two drinks a day had a 10% increased risk for developing breast cancer. Based on these findings, researchers suggested that about 4% of breast cancer cases in developed nations may be attributed to alcohol. (Women who drink and who take hormone replacement therapy have an even greater risk.) Some research indicates that alcohol in such amounts increases levels of growth factors that can stimulate breast cancer cells. However, light to moderate drinking has benefits for the heart that most likely outweigh the cancer risk in most women who have no other risk factors for breast cancer or alcohol abuse.

Several studies have reported that breastfeeding is associated with a lower risk for cancer in premenopausal women. Some studies also suggest that some protective effect from breastfeeding may last beyond menopause. Studies also indicate that the longer the mother breastfeeds, the better. In fact, some experts believe the high rates of breast cancer in developed countries may be partly due to a lack of or shorter duration of breastfeeding