It’s rare these days to meet someone who hasn’t been affected in some way by breast cancer, be it through their own personal struggle with the disease or that of a loved one. According to BreastCancer.org, one in eight women (around 12%) will battle invasive breast cancer in their lifetime, and it’s the second most deadly form of cancer (lung cancer being the first). That said, mortality rates have been decreasing steadily since 1989, with younger patients benefitting the most thanks to advanced screening methods. We spoke with breast-cancer surgeon Heather Halpin Richardson, MD, of Bedford Breast Center in Beverly Hills to see what information and best practices she could pass along that might help us stay safe. Here, the (sometimes surprising) things we learned.
How To Stay Safe From Breast Cancer
Age: "There are 2.8 million women living with a breast-cancer diagnosis in the United States, and most of them are over 40," says Dr. Richardson. "As we age, our chances go up; however, breast cancers later in life tend to be weaker and are less likely to be fatal. So older women are more likely to die with these cancers, not from them, whereas younger women are more likely to get breast cancers that are life-threatening and breast-threatening."
Genetics: "80 to 85% of people with breast cancer don't have relatives with breast cancer," says Dr. Richardson. "Breast tissue grows and dies over and over again in the course of our lives and sometimes as those cells are changing, one cell can make a mistake and create a bad cell that turns into cancer. Some people have very active tissue wherein there's a lot of opportunity, and a cancer just accidentally happens. Other people's immune systems—the security system for protecting and removing dangerous cells—just aren't there, so bad cells slip through. And then in the final subset of people—fewer than 5 to 10%—something was passed to them through their family that allows bad cells to happen more naturally."
Density of breast tissue: "Just as you would look at a fair-skinned person who spends a lot of time in the sun and a dark-skinned person who doesn't and say that the former is more likely to get skin cancer, there are certain general principles that may help predict risk," says Dr. Richardson. "If there's a lot of dense breast tissue—cancer-producing tissue—and if there's more activity in this tissue in life, cancer is more likely. Less dense tissue doesn't mean smaller breasts, by the way. Someone can have very large breasts that don't have a lot of milk-producing cells in them, so there aren't as many cells for cancer to spring from. Another person might have very small, dense breasts and have more glandular tissue (and less fatty tissue), which is more activated over time—she may have more of a chance of developing cancer."
Menstruation: "When the breast is more active, you have a higher chance of breast cancer," says Dr. Richardson. "Things that help protect you are things that keep you from having those hormonal stimulation cycles. So, an early first menstrual cycle (having more periods over the course of your life) is one potential risk factor."
Calculating your risk: "We look at the individual person and her family history—if you've had several aunts with breast cancer, a cousin with ovarian cancer and your breast tissue is very dense (it's hard to see through in a mammogram), we want to keep an eye on you. On the other hand, if you have no breast or ovarian cancer in your family, and your breast is very simple (very fatty without a lot of tissue in it), we're not as scared about something popping up."
Weight: "Certain lifestyle choices can calm the breast tissue and reduce unnecessary stimulation. A healthy body weight is one, because fat tissue adds excess hormones. Exercise fights off excessive hormones."
Early pregnancy: "Even though hormone levels are very high during pregnancy, a nine-month pregnancy stops the cycle, and it's thought that for this reason, earlier pregnancies and breast-feeding are protective against breast cancer. The tissue is doing what it's supposed to do rather than practicing over and over. So, having babies younger in life and breast-feeding is preventive."
Prophylactic mastectomy: "Fewer than 5 to 10% of people with breast cancer (not people, but people with breast cancer) have a gene that's associated with it, which can kind of predict that their chances are high. For some of these people, it makes sense for them to choose a preemptive mastectomy at a time when they can preserve their health. Other people decide their risk is low and the impact of the procedure is too high, and they decide not to do it. It's a personal decision. Overall, if you're in that category and your risk is high, I think it makes sense to do the surgery. At the same time, more people think they're in that group then actually are, so we have to make sure people understand their risk before they jump into an unnecessary surgery."
"We live in this Western world where so many people come across toxins in plastics and beauty products," says Dr. Richardson. "It's hard to get statistics on the effects because they're everywhere we look. It's hard to say, 'This population doesn't come into contact with these things and this population does.' We're seeing a lot of undeniable effects of hormones on the environment and on us—children are going into puberty earlier. The water we drink has significantly more hormones in it, from hormone therapy getting washed into our water supply. Even receipt paper, that slick feeling you get from it, has endocrine disruptors in it. The good news is that for the most part, if something happens from coming into contact with all these chemicals, we have solutions. But prevention is the best thing. Anything you can do to refuse disposable plastics, stick with a plant-based diet over meat and dairy—anything that's going to be friendly to the environment is going to be friendly to our bodies. It would be great to stop cancers from forming. I would love to be put out of a job."
"We often check out issues that aren’t cancer, like a rubbery lump that's tender and tends to come and go," says Dr. Richardson. "Or a little bit of liquid from the nipple, especially if it's clear or sticky and comes from both sides or from a couple of ducts when you're examining and you squeeze hard. Those are usually healthy things produced when the tissue swells and shrinks. Things we worry about are changes in the skin, where it's red or pulled in or dimply. Or a firm lump that doesn't change much—it's sort of there and stays there. Also, any discharge from the nipple that's bloody or comes out when you barely touch it or comes from one side and one place—that's the kind of thing we would want to really look at. Any symptom you've had that's different from anything you've had before, we'd love to check it out."
"Your ob-gyn is a great place to start. He or she can get a general idea of history and breast-tissue texture," says Dr. Richardson. "If your tissue is average and your family history is average, you can follow general guidelines for annual screenings. If you have relatives with breast cancer however, especially early onset (a 20-year-old whose grandmother had breast cancer at 80 is not a big concern, but someone whose aunt had breast cancer at 42, we need to be on top of), you should think about intensive screenings. Subtract 10 years from your relative's age of diagnosis, and that’s when you should start screening regularly. There are several online tools you can use to calculate your risk. Myriad has a risk predictor—plug in your family history and other information and it tells you whether or not you're at risk for a genetic mutation and should get screened."
"Once a year at 40 is what the majority of doctors recommend," says Dr. Richardson. "I see a lot of people in California who don't want the compression and radiation exposure, and if you're working with a doctor who is comfortable with your risk level, it may be completely reasonable to back away from a yearly exam. For somebody who doesn't have a specialist watching her closely, an annual mammogram is still the best way to spot cancer. It catches about 90%, ultrasounds catch 92%, and if you combine the two methods, they catch 97% of breast cancer. One is not better than the other—they see tissue differently, and when we put them together, we get magical overlap.
The good news is that breast-cancer deaths are down, and treatment success is higher than ever. Most patients live a long life and don't die of breast cancer. The biggest challenge in screenings is figuring out what to pull back on—what can we do less of to avoid toxicity and unnecessary biopsies. There is a big weight on doctors and patients to make everybody feel like cancer is a ticking time bomb, that there are weapons of mass destruction strapped to our chests. We're trying to find the balance of making people aware and keeping people healthy without creating anxiety. We don't want to miss anything, but we don't want there to be incredible worry or incredible pain and suffering as a result of us trying to make sure everyone stays healthy, either."
"There's the Young Survivors Coalition for younger women," says Dr. Richardson. "If you're diagnosed at 35 and you're single, you're going to have different needs than if you're diagnosed at 57 and have your kids and grandkids and husband around to help. Things like fertility preservation and social support are more important for a younger patient than for a patient in her 50s. If there's a genetic component, FORCE is a good option. The familial issue means we're potentially talking about other diseases on top of breast cancer. If you're diagnosed and there's a documented vein of cancer running through the family, suddenly you have healthy people being considered for additional procedures, doctor visits and tests. FORCE is a good resource for this group. Finally, BreastCancer.org is great, particularly for dispelling disinformation."