As part of National Breast Cancer Awareness Month, Resource editors spoke with Jane Mendez, MD, chief of breast surgery at Baptist Health’s Miami Cancer Institute, who answered some frequently asked questions about breast cancer and explained recent advances in research and treatment.
Source: Some breast cancer risk factors are genetic, while others can be linked to environment or lifestyle — does one play a bigger role than the other?
Jane Mendez, MD, chief of breast surgery at the Miami Cancer Institute
dr. Mendez: Some breast cancer risk factors are modifiable, such as diet, exercise, alcohol consumption, cigarette smoking, radiation exposure, and the use of hormone replacement therapy. These are things we can work on, but it takes a lot of education.
The two main non-adjustable risk factors are age – it is a well-known fact that breast cancer risk increases as we age – and gender. While breast cancer can and will occur in a small number of men, 99 percent of it occurs in women.
There are certain other conditions that we know increase the risk of breast cancer, such as having children later in life; have no children; having periods or menarching at a young age; or enter menopause later in life. All of these are associated with an increased risk.
Another factor is having a known genetic predisposition to breast cancer. There are many genetic mutations associated with the disease, including PALB2, but BRCA1 or BRCA2 are the most common, so if you’re a carrier of one of those genes, you’re definitely at increased risk.
The other risk factor, of course, is family history. You can’t change your family history, but you can and should be aware of it and make sure you share that information with your doctor.
Source: Is obesity a risk factor for breast cancer?
dr. Mendez: We know that obesity is linked to an increased risk of breast cancer. Interestingly, estrogen deposits in the adipose tissue or fat cells, so the more adipose tissue we have and the further we are from our ideal body weight, the higher the estrogen levels and the greater the chance of developing breast cancer.
Source: Is smoking linked to breast cancer?
dr. Mendez: Smoking is not directly linked to breast cancer, but it is linked to lung cancer, the leading cause of cancer death in women, so I advise patients not to smoke as part of a healthy lifestyle.
Source: Some argue that coffee can cause breast cancer – is that true?
dr. Mendez: There are many myths and that is certainly one of them. Coffee doesn’t give you breast cancer. Neither do deodorant, hair dye, or cell phones — those are all complete myths.
Source: What about hormone replacement therapy? Isn’t that considered a risk factor for breast cancer?
dr. Mendez: Hormone replacement therapy has been controversial for many years, but now we finally have data showing that long-term use of estrogen replacement therapy is indeed one of the risk factors for breast cancer. Yet, even today, despite the data, I am amazed to see how many women are undergoing hormone replacement therapy. It is a real challenge because it is so ingrained in society and in gynecological practice. But there is certainly a danger and now that it has been proven, you should have a talk with your doctor about the associated risks and alternative therapies available.
Source: Can lifestyle changes reduce a person’s risk of developing breast cancer?
dr. Mendez: You can reduce your risk of breast cancer. Watch the weight gain, especially in this pandemic. There are no perfect diet plans, but the most important thing is to maintain healthy eating habits. Be aware of the quality of the food you eat and how you prepare it, with an emphasis on light and healthy. The key word is moderation – in the way you prepare the food and the amounts you eat.
Moderation also applies to alcohol consumption. Watch what you drink and how much you drink. Red wines contain phenolic acids that are thought to protect against breast cancer, so if you’re going to have a drink, a glass of red wine can be helpful.
Regular exercise can also help protect against breast cancer and other disease processes. Remember, you don’t have to go to a gym to exercise. Avoid a sedentary lifestyle, be more mindful of exercise, and find ways to increase your heart rate every day — walking, running, or any kind of aerobic exercise.
Source: Is breast cancer preventable?
dr. Mendez: Prevention remains key, but we can’t just focus on the modifiable risk factors. We need to know about the non-customizable ones so we can have more oversight. If a patient has one of those non-modifiable risk factors, I can intervene to try to keep them cancer-free. Those risk factors could qualify a patient for enrollment in my Breast Cancer Prevention Clinic at the Miami Cancer Institute, which has very specific parameters for patients and strives to keep high-risk patients cancer-free.
Source: How important is early detection in a breast cancer diagnosis?
dr. Mendez: We know that early detection leads to better results, so keep track of your annual mammograms and your monthly self-exams. If you notice anything, don’t wait any longer – have it checked as soon as possible. And if you’re diagnosed with breast cancer, know that a multidisciplinary approach to your treatment can maximize healing.
Source: What are the most important things we’ve learned about breast cancer treatment over the past five years?
dr. Mendez: The advances in genetic medicine over the past five years have certainly helped us guide us clinically and enable us to tailor treatment with more objective information and a better understanding of the different types of breast cancer. For example, if you have triple negative breast cancer, endocrine therapy will not help you in any way. So that’s where the conversation starts, but the good news is that there are many options.
Source: How do you see breast cancer diagnosis and treatment evolving over the next five years? Will the focus remain on genetics?
dr. Mendez: Only five percent of breast cancers are due to known genetic predisposition, and 85 percent are sporadic. The other 10 percent can be linked to family history, but we haven’t been able to identify a mutation for that yet. So yes, we keep learning about genetics, but that’s really only true for a small percentage of breast cancer patients.
The main challenge we have at the moment is with triple-negative breast cancer, because so far we don’t have a specific target that’s tuned for that particular cancer subtype. For cancers that respond to the HER2 protein, or for cancers that are positive for estrogen, we have targeted therapies that can treat these patients. But for triple-negative breast cancer, while we’ve made some improvements in our target treatments, the results aren’t what we’d hoped for and that’s what a lot of the research is now focusing on.
Source: What are the most important points that all women should keep in mind to prevent breast cancer?
dr. Mendez: Follow the screening guidelines. Know your body. Know your family history. And if you see something, do something.