New pressure to reduce your risk of breast cancer

Breaking breast cancer

Breast cancer in women is more common in middle-aged and older women. Although rare, men can also develop breast cancer.

Percentage of new cases by age group

These efforts are part of a broader trend towards personalized medicine. These programs are too recent to have an impact on cancer diagnoses. But breast cancer experts say they are inexpensive, do not hurt, and encourage women to live healthier lives. They also give women much needed prevention advice beyond their annual reminder to have a mammogram.

"Routine screening and early detection are important tools for overcoming cancer, yet we know that it is still possible to improve the way we assess risk and motivate healthy lifestyle choices." Says Dr. Marisa Weiss, a breast cancer survivor and founder of Breastcancer.org, a non-profit organization. "People are much more likely to make and maintain healthy lifestyle choices every day if their risk profile and action plans are tailored to their particular circumstances."

Boston's Brigham and Women's Hospital offers a program called B-Prep for breast cancer risk assessment, education and personalized prevention for women presenting for breast problems or abnormal tests. It is also open to anyone who wants to know more about their personal risks. (Heredity accounts for 5 to 10% of breast cancer cases and the density of breast tissue increases the risk.Oral contraceptives and hormone replacement therapy may also play a role.)

As part of B-Prep, women complete a survey to assess their lifestyle, family history and other risk factors and receive a personalized assessment of their risks with exercise and diet recommendations. free training sessions and follow-up recommendations. Genetic counselors and physicians are available to discuss hereditary risk screening for people with a family history that increases the risk of breast cancer.

Patients who want help with weight loss are referred to Brigham and Women's weight management program and can consult the weight loss surgery program. They are also offered the opportunity to participate in clinical trials. One is to check if a 12-week exercise program can alter the inflammatory and immune markers associated with breast cancer.

Kathy Wood, a 61-year-old dentist from the Boston area, heard about the program after her annual mammogram in June. Although the results were negative, she was worried about the risks associated with the density of her breast tissue. Because this can make screening more difficult, additional imaging tests are sometimes recommended.

She completed the B-Prep survey and had a follow-up ultrasound, which was also negative. Last weekend, she attended a free four-hour B-Prep preparation forum, with presentations and Q & A sessions with experts on topics such as lifestyle, role of Exercise and diet in reducing risk.

"I went to know nothing and learned so much," says Wood.

She was happy to learn that her lifestyle could reduce her risk. She rarely drinks, maintains a healthy weight, and exercises regularly. But she says she is unaware of the dietary factors associated with several types of cancer discussed at the forum, including the role of carcinogens in some processed foods. "It makes you think about what your daily diet should be and what you put in your body," said Ms. Wood.

Dr. Tari King is Chief of Breast Surgery at Dana-Farber / Brigham and Women's Cancer Center and Director of the B-Prep Program. She says that one of the goals is to put risk data in perspective. For example, an average woman has an absolute risk of developing breast cancer by 12% in her lifetime. Drinking more than one alcoholic drink a day increases this risk between 14% and 15%.

"We do not try to encourage excessive consumption of alcohol, but we do not want women to feel that they can not drink a glass of wine or two after a particularly busy day. stressful, "said Dr. King.

At the Memorial Sloan Kettering Cancer Center in New York, a program called Rise (Risk Assessment, Imaging, Surveillance, and Education) creates a long-term personalized surveillance plan for women already considered at high risk for breast cancer. This includes people with a family history or previous radiation treatment on the chest wall. Participants fill out a detailed survey that includes questions about their lifestyle and can arrange sessions with a dietician.

"We are trying to personalize screening recommendations and risk reduction strategies, not a single approach," says Melissa Pilewskie, a breast surgeon and director of strategic planning and research for the Rise program.

A 2017 study by Dr. Pilewskie and published in the journal Breast Cancer Research found that 60% of high-risk women reported a possible area of ​​risk reduction. Of the 1,277 women who responded to the survey, only half satisfied national recommendations for physical activity, 40% were overweight or obese, and 18% reported consuming more than one drink a day. More than two-thirds qualified for genetic evaluation, but 40% did not report any prior testing.

Memorial Sloan Kettering's Oncology Oncology Department is also studying the appropriate level of exercise for cancer prevention. In one trial, women with abnormal breast tissue changes increasing the risk of invasive breast cancer will be assigned to treadmill walking for six months, ranging from 75 minutes per week to 300 minutes. A control group will receive usual non-prescription care for exercise.

After six months, researchers will repeat a biopsy to determine if the formation reduces the expression of genes known to promote breast cancer in normal breast tissue. They also hope to find the optimal amount of exercise to stimulate change.

"Many women enter the country and worry about the risk and want to know what they can do. We want to show them that these modifiable risk behaviors are science-based, "says Dr. Pilewskie.