Last week, the Institute of Medicine (IOM) issued a new report on breast cancer and you will want to take note of their recommendations.
Entitled “Breast Cancer and the Environment, a Life Course Approach,” the goal of the undertaking (which was sponsored by Susan G. Komen fo the Cure) was to examine how a woman’s genes interact with her environment outside of her DNA to increase breast cancer risk. For the purposes of this report, environment was defined broadly to encompass all non-inherited factors, including:
- How a woman might grow/develop throughout her lifetime (including body fat, abdominal fat, weight gain as an adult)
- what she eats and drinks (alcohol consumption, use of supplements)
- Physical, chemical and microbial agents encountered (e.g. dyes, BPA, parabens, tobacco smoke, metals, dioxins, pesticides, industrial chemicals)
- her participation in physical activity
- Social and cultural practices
- Any medical treatments or interventions (e.g. combination hormone therapy, oral contraceptives, radiation)
Although research has long focused on the potential interaction between breast cancer and the environment, rarely has it concluded in determining or explaining preventive actions that a woman might take to counteract risk. That’s why I wanted to share some of the key findings on Flashfree.
First a bit of context:
Breast cancer, like many adult cancers is believed to develop as a result of accumulating damage to cells and tissues caused by internal and external factors. According to researchers, timing is everything. In other words, it is possible that a woman’s susceptibility to developing breast cancer increases at key periods during her life; this means when she is exposed to various contributing factors may be important. Overall, girls born in the U.S. have a 12% risk of developing invasive breast cancer sometime during the lives and among White women who are currently age 50 , 24 out of 1,000 can be expected to receive a diagnosis within the next 10 years; this figure declines slightly in women who belong to other ethnicities, including Black women (22 out of 1,000), Asian women (20 out of 1,000) and Hispanic women (17 out of 1,000).
The researchers write that trying to “determine which environmental exposures may influence rates of breast cancer poses substantial challenge,” explaining that how breast cancer develops, where it originates and how it progresses are not entirely clear. They also emphasize that by solely focusing on exposure to these factors during adulthood, it is very possible that they are missing other critical windows earlier in a woman’s lifetime or while she is growing up, that could influence breast cancer risk later in life. Still, even without these missing pieces, they have made some key recommendations that a woman might take to reduce her risk for breast cancer from environmental exposures:
- Avoid inappropriate exposure to medical radiation, especially x rays and gamma rays (i.e. ionizing radiation)
- Avoid combination menopausal hormonal therapy unless medically appropriate (note that not only does this include HRT but also long term use of oral contraceptives)
- Avoid or end active smoking
- Avoid passive tobacco smoke
- Limit or eliminate alcohol consumption
- Maintain or increase physical activity (e.g. increasing specific exercise types or frequency or a combination of the two)
- Maintain weight or reduce overweight or obesity before menopause starts
- Limit workplace and general exposure to chemicals that have been linked to breast cancer
Importantly, some of these steps are not without risk or ramification. For example, avoiding exposure to radiation could result in a loss of clinical information that might be otherwise useful. Likewise, they point out that eliminating alcohol drinking could increase heart disease risk. And, increasing physical activity levels always raises the risk for injury.
The Committee who drafted the IOM report concluded that these steps are only the tip of the iceberg, and that there are still only limited opportunity for evidence-based preventive actions. Moreover, these steps are truly individualistic; what will work for one woman may not work for another. And, any risk reduction may be minimal at best. Still, it is heartening that researchers are starting to tease out how our environment affects our health, if not for us, then for our daughters and granddaughters. Ultimately, we need a better understanding of the relationship between breast cancer risk and environmental factors, of the changes that the breast undergoes through a woman’s lifetime, timing and windows of opportunity. Meanwhile, try to change the course of your life by changing the life of your environment. It can’t hurt.