I’m getting a little weary of the new story that comes out what seems like every other week about something that is “associated” with an “increased risk” of breast cancer. I worry that some women might feel to blame for their breast cancer diagnosis, and that others might feel empowered because since they don’t meet the new risky criteria, they are safe and can forgo screening. I feel like a lot of those studies end up with little validity– they scare, they place blame, they confuse. So I headed to the CDC to see what changes a woman’s risk for breast cancer, I decided I’d let them comb through all the data and vet all the studies.
They found that breast cancer risk is decreased by being older when you start menstruating, having babies– at a younger age– and breastfeeding them, getting regular exercise, and maintaining a healthy weight. (For the record, I was the last of my friends to get my period, had my first baby at 27– not super young, but well before my doctor would have to pronounce me of “advanced maternal age”, and I nursed my babies for a total of 26 months. I’ve always been at a healthy weight and have been regularly exercising for at least the last four years.) A woman’s breast cancer risk is increased if she has taken hormone replacement therapy, has a personal or family history of breast cancer, has had radiation therapy to the chest, was exposed to DES in utero, has dense breasts, drinks alcohol, or works the night shift. (Again for the record, no personal history of breast cancer or benign breast disease, one (ONE!) aunt with breast cancer, no radiation therapy, no hormones or DES, maybe dense breasts, I don’t work the night shift, and I don’t drink alcohol. Not a drop. Never have.)
Basically, if I were reading the CDC document as a how-to list to avoid cancer, I would have checked almost every single box. Of course, I am also far younger than the average woman diagnosed with breast cancer, and triple negative breast cancer (with which I was diagnosed) is far more prevalent in the African American population. And yet, I had breast cancer. I “did” everything right– right down to getting my period super late and being white. And yet, I had breast cancer. I’m not sure why I bring this up– it’s not very actionable data, after all. I guess it’s to say that even most of the associations that have been validated are not something we can really do anything about, and even if we could change some of these factors, they’re not a guarantee, either. Though valid, the association isn’t that strong. Yes, I would love to know what causes breast cancer. But given all the research and time that has gone into its study, I think it is fair to say that it is not one thing that causes all breast cancer. Which means that it will not likely be one thing that prevents or cures all breast cancer. Certainly, research into the causes of breast cancer will lead to better prevention and treatment of the disease. But in the meantime, women are diagnosed with breast cancer everyday, and we don’t know why. I guess that’s why, even though data indicate that mammography may not be the holy grail it was once thought to be*, I’ll still err on the side of mammograms. Overdiagnosis and overtreatment aren’t insignificant issues, either to the healthcare system, or the individual. But neither is cancer. Somehow, I think until I knew for sure that checking off all the boxes on my list would keep me safe, I’d risk a few extra pokes of a biopsy needle, or even a few rounds of chemo.
*This is a good discussion for the patient on the debate on screening mammograms from the Mayo Clinic