When we have children, many of us slip in the self-care department. We may not eat as well, not exercise like we did “pre-baby,” and don’t have time to go and see our own doctors. Simply put, our own care doesn’t come first. Parenthood immediately demotes our status…
All fine in some ways. It’s astonishingly wonderful to care so deeply about our children. That devotion still catches me off guard.
But we have to keep on top of our preventative screening. No reason not to when it may allow us a longer time to parent our children! So that’s where I come to breast cancer screening. As women, breast cancer will affect about 1 in 8 of us during our lifetime, the most common cancer in women after non-melanoma skin cancer. It can be highly curable if detected and treated early. Most women diagnosed with breast cancer are over age 50, but many are younger and some are new moms. There are some risks we need to know and scientific evidence that can help us do a better job caring for ourselves.
Share this widely, please.
Yesterday I teamed up with Dr Julie Gralow, the head of breast cancer oncology at the Seattle Cancer Care Alliance (SCCA) and the UW on Twitter for a 1 hour conversation about moms and breast cancer— lifestyle choices, genetic risks, screening, & coping with breast cancer. I learned a ton preparing for the chat and have already tried to think about changes I’ll make in my own life. When I finished the fast-paced hour conversation I sent a note to a friend on Twitter that I now had to head out for a run, pour out the wine in the house, call my friends to schedule mammography, and ask about a breast MRI. You’ll see why:
Lifestyle Choices May Decrease Breast Cancer Risk
- Alcohol consumption is associated with breast cancer. And it’s dose dependent meaning that for every increase in alcohol consumption on a daily basis, the more the increased risk of breast cancer. This is simply a reminder to moderate. One glass of wine really may be better than 3.
- Weight matters. Obesity increases your risk of breast cancer. If you’re overweight, chat with your doctor now about strategies and ideas to make change. No reason to wait–the longer you wait, the longer the risk maintains itself.
- Exercise matters, too. The reason? When you exercise, it causes your hormone levels to go down, thus helping to decrease risk for breast cancer. Data shows that exercise may be most protective in young, pre-menopausal women who are lean and/or or normal weight. Exercise isn’t just for weight control. I’m using this as a motivator to schedule the >4 hours of exercise a week I need going forward. Wish me luck.
The Pill, Babies, & Reproductive Risk For Breast Cancer
- It’s true, if you’re able to have your babies very early in life, it may be protective against breast cancer. Moms who have babies before 20 have a decreased risk. But pregnancy at any time has the benefit of lowering risk in the estrogen during pregnancy is lower and therefore lowers risk. It is also known that having babies later in life may increase our risk (>35 years of age). Little we can do to control this—but just know the risks & talk with your doc.
- Oral contraceptive pills (birth control) pills do not cause breast cancer.
- The less menstrual cycles you have in life, the less hormones around and the lower the risk of breast cancer Those girls who start periods later (>age 14) and those who enter into menopause early have lower risks.
- Breastfeeding: when you’re breast-feeding your estrogen levels are lower and so it decreases your breast cancer risk. AMAZING. Breastfeeding is good for mom, great for baby and decreases risk of breast cancer.
Genetics And Breast Cancer Risk
- There are genes that are passed between families that increase risk for breast cancer. Errors or changes in the BRCA1 & BRCA2 genes we know increases likelihood of cancer. You can test for changes in there genes with blood tests. If you have relatives, especially siblings or mothers and grandmothers with breast cancer, talk with your doctor about screening for genetic risks. It’s always great to see a genetic counselor, too.
- If you have a family history of breast cancer, it may make sense to have the family member with breast cancer tested for genetic studies first, then be tested if they are positive. Read more about genetic risks here.
Screening For Breast Cancer–Mammography, Ultrasound, And MRI
- Most women need annual mammography starting at age 40. If you have a family history of breast cancer, if you are BRCA1 or BRCA2 positive, or have other types of cancer, talk with your doctor about screening for you.
- Younger women have more dense, fibrous breasts. Our breasts get fattier as we age (oh the glory!!). This density, especially in younger women, makes mammography less sensitive and less able to pick up cancers. Believe it or not, some studies show that mammographies miss 20% of cancer at the time of the screen, especially in young women. If you have a family history of breast cancer, if you’re young and have risk factors, ask about getting a breast MRI. Breast MRI may be better at detecting cancer in young women with fibrous breasts.
- Ultrasound of the breast is not a screening test. However, if an abnormality is found on a mammogram, sometimes an ultrasound is used to help further determine if more testing is needed.
- Monthly self-breast exams are ways to track changes in your breasts, too.
Young Moms With Breast Cancer
- Young women with cancer are juggling incredibly precious balls in the air. Young Survival is a great resource for moms.
- Be open and honest with children about cancer. But remember, you don’t have to share every detail about a diagnosis, all at once. Let time help you understand what information your children need to understand about a cancer diagnosis. And know that children will form their own understandings, too. Be open to their perspective. As Dr Gralow says, “Children may learn fear of cancer from us. Be open and provide them information. Take them to the chemo room if they want to go. This will help normalize it for them.”
And one last thing as I near age 40. What about this? Have a big party and then team up with your friends for annual mammography?
elizabeth neary says
Just a word of caution on recommending mammo’s at age 40.
Here are the USPSTF’s recommendations, based on all that work:
Routine screening of average-risk women should begin at age 50, instead of age 40.
Routine screening should end at age 74.
Women should get screening mammograms every two years instead of every year.
Breast self-exams have little value, based on findings from several large studies.
Wendy Sue Swanson, MD, MBE says
Thanks, Elizabeth. My understanding is there is disagreement about recommendations (as you point out). Will try to get Dr Gralow to return here to comment.
Wendy Sue Swanson, MD, MBE says
I’m sticking with the age 40 recommendation based on information shared with me. The Seattle Cancer Care Alliance and Fred Hutch research institute do recommend starting mammo at age 40 and then having one every 1-2 years thereafter.
Here’s a link:
Also, new information just out this week about women with higher risk (BRCA1/2 and Family History) that women under 40 will do better with ultrasound, instead of mammo, for detection.
Here’s a link:
Deb zaret says
Also, get life insurance. Now. If you get diagnosed with cancer you will never be able to get it thereafter. Think it won’t happen to you? It happened to me. So, while I hope it won’t happen to you, I will say again, go get life insurance. This week. Then go get your annual physical and screening mammo!
Wendy Sue Swanson, MD, MBE says
Check out this tool to assess risk. It incorporates family history, your personal health history, timing of your period, and timing of your children’s birth.
Great, easy tool to inform us all!
I am extremely disappointed you did not even mention that various studies have found an increased risk of breast cancer for those on birth control; even the National Cancer Institute mentions this: https://m.cancer.gov/topics/factsheets/oral-contraceptives To say “birth control doesn’t cause cancer” may be true, but it certainly increases your risk, even slightly (according to some) and it seems to me to be dishonest not to mention that.
Julie Gralow says
The optimal age at which to begin screening mammography is a bit controversial, and we have conflicting guidelines. At the SCCA, we support the recommendations of both the American Cancer Society and the National Cancer Institute, which recommend beginning at age 40. Breast cancer risk increases with age, but there is no dramatic increase beginning at age 50. Is 45 a more optimal age? We don’t have the data to tell us. But we do know that about 20% of breast cancer diagnosed in the US is in women under the age of 50. Of course, the decision to undergo screening mammography should take into account a woman’s risk factors for breast cancer, as well as the possible benefits and risks of the procedure. It’s a personal decision. But there is no question that screening mammography saves lives. Here’s a link to the NCI recommendations:
Julie Gralow says
Regarding oral contraceptives and breast cancer risk, modern era epidemiological studies have generally not demonstrated a correlation. Three of the largest series include the Nurses’ Health Study (Hankinson et al, 1997), the Royal College of General Practitioners’ Study (Hannaford et al, 2007), and a case-control study done in part by researchers at the Hutch (Marchbanks et al, 2002) – none of these showed any significant increased risk of breast cancer for current or former users of OCPs. While a small increased risk has been reported in some other analyses, the overall conclusion is that there is no consistent association between use of the pill in reproductive years and future risk of developing breast cancer.
Could there be population of women at high risk for breast cancer who should stay away from OCPs? Maybe. But even in women with BRCA1/2 mutations with very high genetic risk for breast cancer, studies have actually shown that the pill decreases ovarian cancer risk, which is far more deadly.
Of course, oral contraceptive formulations used after the reproductive years as a form of hormone replacement therapy can increase breast cancer risk and this exposure should be minimized.