Other than skin cancer, breast cancer is the leading cancer among women in the United States. Breast cancer accounts for 30% of all female cancers. Dr. Carole Myers, a professor emeritus in the University of Tennessee College of Nursing, talks with Dr. John Bell, the director of the University of Tennessee Medical Center of Cancer Institute, to profile breast cancer in women in the United States and to help with better understanding trends in the occurrence of the disease and treatment.
WUOT’s Carole Myers: I understand the average risk for a woman in the United States for developing breast cancer is 1 in 8, or 13%. This is a bit frightening, however the converse is true that there is a 7 in 8 chance that a woman will not develop breast cancer. Help us balance the fear breast cancer poses to most women with hope, is that possible?
Dr. John Bell: I think the good news is women should not fear a diagnosis of breast cancer in 2023 and going forward. There’s hope because of all of the progress that’s been made in the past 50 years. It is just amazing.
Could you highlight maybe one or two of those strides that have been made in the past 50 years?
We can start with screening. There are much better screening modalities now then there were in the past. We can talk about better diagnostic equipment. No woman goes to the operating room, that I am aware of, that doesn’t know their diagnosis and has been able to sit down with their providers and talk about what’s the best treatment plan for them going forward.
One of the things that women are concerned about when they get a breast cancer diagnosis is ‘Am I going to die from breast cancer?’ and what their survivability is. So, what can a woman do to improve her chances of survival if she is diagnosed with breast cancer?
First, don’t be afraid. Don’t be afraid to ask questions. Don’t be afraid to ask for second opinions. The stakes are high, clearly, but there should be some reassurance, comfort, in knowing that if you have an early diagnosis of breast cancer your chances of being alive and well in five years are well over 90% and in 10 years well over 80%. So, it is not a death sentence when you get a diagnosis of breast cancer in 2023 and going forward. So, early diagnosis is key and don’t be afraid because there are treatments out there to treat you.
So let me understand. Again, I am trying to think of things that I can do. How do I assure an early diagnosis?
We can screen people for earlier diagnosis. There are however some lifestyle modifications that we encourage people to practice that we know can reduce their risk of developing breast cancer, so called modifiable risks for breast cancer.
Let’s talk about those modifiable risks. What can a woman do to decrease her risk of breast cancer?
So, we know that obesity predisposes women to breast cancer, we know that excessive alcohol intake, we know that lack of exercise, we know that sedentary lifestyle, we also know that when a woman first has her pregnancy or if they do or do not breastfeed it can also have an impact. We do see that the later one waits to have their pregnancy; it does increase their risk somewhat, but again it’s not significant.
What about diet? Are there any practices that put you at an increased risk or converse diet practices that reduce your risk, as far as what you eat?
We do see that people that eat so-called Mediterranean-like diets which are rich in fruits and vegetables, specifically cruciferous vegetables. We do see that populations, these are big epidemiological studies where we looked at these groups of patients that people that have that kind of lifestyle their incidents rates are lower than they are here in America.
I like that you sort of mentioned that it’s a constellation of things that you do lifestyle wise, it is not just all these things stacked on one another. That those modifiable risk factors are interrelated.
And you can even expand that to hormone replacement therapy, especially the post-menopausal state, lengthened duration of taking birth control pills, all these things that we have to think about as we grow from our teens to our 20’s and our 30’s that could have an affect on our risk factors going forward in our 40’s and 50’s and 60’s.
Let’s revisit the idea of hope, Dr. Bell. What are some of the promising developments in breast cancer diagnosis?
What I think is one of the most exciting things coming down the research pipe is called liquid biopsy and it is not yet ready for primetime but it is in testing phases right now and clinical trial phases where women can literally go in and have a tube of blood drawn and ask the question ‘Do I have any circulating breast cancer cells in my body or precancerous cells or fragments of cells that have been destroyed by our own immune system?’ Along with a blood test would be like a sensor. You go into the doctor now and they put the little thing on your finger and they test your oxygen level and your heart rate and stuff. I believe someday we will have sensors to pick up those cells before we even have to stick a needle in somebody and draw a tube of blood.
How about vaccines? Are there any being done for vaccines for breast cancer?
Yes, there is. There are some vaccines and trials now, mostly in Europe, where people who have a known genetic predisposition for breast cancer are in vaccine trials. Again, these are trying to rev up our own immune system. We also know that women who have been previously diagnosed with breast cancer who have been through treatment and are at high risk for a recurrence, there are some vaccine trials looking at those patients as well.
Great, so there’s hope. What about in treatment advances? What’s hopeful there?
Treatment, in my career, has come 180 degrees. I mean we used to have a handful of medications that we could offer women and it was like one-size fits all. These were the medications we gave women with breast cancer and some of them worked and some of them didn’t. But now because we have unlocked the key to the human genome we look at molecular markers of cancers. We look at their cell surface markers. We look at all these different things and we can actually create or use medications that are targeted to these genetic targets in the breast cancer cells or on their surface. So, we have targeted therapies. We have immunotherapies. We have anti-hormonal therapies. We have a whole armamentarium of treatments now that we didn’t have 20 years ago. It’s really an exciting time.
Dr. Bell, any parting words for our listeners?
Get your screenings. Talk to your doctor. If you need a biopsy don’t be afraid. Get your biopsy and find out what you are dealing with because knowledge is power.
This transcript has been lightly edited for content.
