Women’s Health with Minoos Hosseinzadeh, M.D. What Every Woman Should Know About Breast Cancer
Breast cancer is the second most common cancer among United States women, after skin cancer. It is the second leading cause of death from cancer among the same group, with lung cancer being the first. In fact, one in seven women will be diagnosed with breast cancer in her lifetime, assuming that she lives to be 90. The incidence of breast cancer in women increases with age; from birth to age 39 the risk is one in 231; from age 40-59, the risk is one in 25; from age 60-79, the risk is one in 15. Because approximately 80 percent of women who get breast cancer have no known family history of breast cancer, the most critical element in increasing survival is early detection.
High-risk Factors to Consider
First-degree relatives (mother, sisters, daughters) with breast cancer
Onset of first period before age 12
Menopause after 50 years of age
Late age at first full-term pregnancy (over age 30)
No full-term pregnancies
Never breastfed a child
Hormonal replacement therapy
Denser breast tissue
Hereditary breast cancer – BRCA1 and BRCA2
Hereditary breast cancer accounts for approximately five to ten percent of all breast cancer cases. Two of the most commonly tested genes are BRCA1 and BRCA2. Women with mutations in BRCA 1 are estimated to have a 65 percent chance of developing breast cancer by age 70 and a 45 percent chance if they have mutations in BRCA2. Genetic testing when indicated is now available. The good news is that cutting edge fertility diagnostic tools now enable physicians to test for the presence of BRCA1 and BRCA2 in embryos, with the use of Preimplantation Genetic Diagnosis (PGD).
Factors that can Help Modify or Lower Risk
Weight: Weight gain of 22 pounds or more after menopause is associated with an increased risk of 18 percent, whereas losing 22 pounds after menopause is associated with 57 percent lower breast cancer risk.
Exercise: Vigorous exercise for 45 to 60 minutes on five or more days per week.
Alcohol use: Drinking two alcoholic drinks a day increases the risk of breast cancer by 21 percent.
Preventive (prophylactic) surgery: Removal of both breasts and/or ovaries in women who are carriers of BRCA mutations reduces the risk of cancer formation.
When to Seek Medical Attention
The most common presentation is that of a painless lump, but other findings include breast pain, redness, swelling and nipple discharge. In some cases the nipple may have lesions or become inverted, which should serve as a cue to immediately consult a physician. Diagnostic guidelines include monthly breast self-examinations; annual mammograms in women over age 40; magnetic resonance imaging (MRI), which is especially important in women at high risk; and breast biopsy. Although treatment options will be individualized according to the stage and type of breast cancer, they may include surgery to remove the lump or the breast; radiation therapy; hormonal therapy in the form of SERMs and/or aromatase inhibitors; targeted therapy such as Herceptin in patients with an over expression of the HER2/neu oncogene; and traditional chemotherapy.
OCPC Readers: Email questions to Women’s Health with Dr. Minoos at DrMinoos@OCPCmagazine.com. ____________________________________________________________________________
Dr. Minoos Hosseinzadeh is a nationally recognized specialist in reproductive endocrinology at the largest and most-established locally-based fertility center in Orange County, Calif., Coastal Fertility Medical Center (http://www.coastalfertility.com). Double-board certified in Obstetrics and Gynecology and Reproductive Endocrinology & Infertility, she is also a member of the American Society of Reproductive Medicine, Society for Reproductive Endocrinology and Infertility, American College of Obstetrics and Gynecology and the Royal College of Physicians and Surgeons. She has presented at several national and international fertility meetings and authored numerous papers on hormone replacement therapy and age-related female infertility.
