Breast cancer: what is my risk?

Most women don’t just broach the subject of breast cancer after age 50 when the first invitation for a mammogram arrives in their mailbox. Breast palpation is an early part of the annual appointment with a gynecologist.

Many women also regularly feel at home for changes. Some skip certain deodorants because they are said to contain carcinogenic substances, while others avoid alcohol. Some women are carriers of a genetic mutation that makes them very likely to develop breast cancer. Many people know this since American actress Angelina Jolie had her breasts and ovaries removed and she received a lot of media coverage for this.

Women with a family history, such as Angelina Jolie, are most likely to be diagnosed with breast cancer. Women in your family have already been diagnosed with breast or ovarian cancer; they may be carriers of an altered gene that can trigger this type of cancer.

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What genes play a role in breast cancer?

A total of eleven such genes can currently be examined, but not all increase risk equally. The greatest danger arises from the BRCA1 and BRCA2 genes. Women with this genetic mutation have a 50 to 80 percent risk of developing breast cancer in their lifetime. “For comparison: in a woman without a genetic predisposition, it is twelve percent,” says Dr. Joke Tio, chief physician at the Breast Center at the University Hospital Münster.

When does it make sense to clarify this risk through a genetic test?

“For example, if a patient is very young, before the age of 36, or if the same tumors appear over several generations,” explains Prof. Dr. Annette Hasenburg, Director of the Obstetrics and Health Clinic and Polyclinic at the woman from the University Medical Center Mainz and a specialist in gynecological oncology.

Then a detailed consultation is important: Have there already been cases of breast cancer in the family? And how many, including the paternal line? It is important to know the genetic risk because it is hereditary, which means that a mother can transmit the genetic defect to her daughter. Men can also carry the breast cancer gene, inherit it, and, rarely, get sick themselves.

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A genetic test at a registered human geneticist or specialized center provides certainty. If this test shows an increased likelihood of a disease, affected women should take advantage of intensified early detection. This includes an ultrasound twice a year, an annual magnetic resonance imaging (MRI), and starting at age 40, a mammogram every one to two years.

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Does health insurance cover the cost of a genetic test?

If there is evidence of a family history, mandatory health insurers will cover the costs of genetic testing and intensified early detection. A mastectomy can reduce the risk of developing the disease, but it also helps many people psychologically: the fear of cancer is reduced. “However, it cannot be said in general that breast removal is always recommended in the case of a genetic defect,” emphasizes Tio.

What influence do hormones have?

The so-called mammary carcinoma develops in the mammary gland and can grow in the deep tissue of the breast. The density of the breast tissue may also influence the risk of developing the disease less than at the time of diagnosis. If the breast density is high, the glandular tissue, shown in white, can hardly be distinguished from the tumor, which is also shown in white.

In the course of life, the breast changes, more fatty tissue is formed. This is X-ray permeable, a change can be better recognized. High breast density may mean that tumors are not detected by mammography until they are at an advanced stage. That is why an ultrasound is often part of the exam to detect any abnormalities at an early stage.

The growth of breast cancer depends on hormones. This means that the female hormone estrogen in particular can stimulate the growth of tumor cells. “Therefore, it is also being discussed whether an earlier first period and later onset of menopause, i.e. longer estrogen production, have an influence,” says Annette Hasenburg. “The risk is increased, but only slightly.” Pregnancy and lactation, on the other hand, lower it.

Many women take hormones at some point in their lives, primarily to prevent or treat menopausal symptoms. More and more people view this critically and want to do without it, also because of the cancer risk. A distinction must be made here: so far, no connection to breast cancer risk has been found for hormonal contraception, the birth control pill. On the other hand, the pill reduces the risk of uterine or ovarian cancer. However, this only applies to combined preparations, not to other hormonal contraceptives such as the hormonal coil or vaginal ring.

An increased risk of breast cancer has been shown from taking hormone replacement therapy for hot flashes during menopause. The risk increases the longer and the higher the dose of hormones a woman takes. The lowest possible dose is recommended for up to five years.

“If you take it for five years, the risk increases by a factor of about 1.2 to 1.4, which means that about 12 out of 1,000 women between the ages of 50 and 55 will get sick without taking hormones, and 16 out of 1,000 with hormone therapy. That’s a small increase in risk,” says Dr. Susanne Weg-Remers, Head of the Cancer Information Service at the German Cancer Research Center in Heidelberg. Finally, the influence of hormones on the breast cancer “It’s not yet clear whether the therapy triggers breast cancer or feeds an existing cancer, so to speak,” explains Joke Tio.

dr  Joke Tio is chief physician at the Breast Center at the University Hospital Münster

dr Joke Tio is chief physician at the Breast Center at the University Hospital Münster

Since breast cancer is often hormone-dependent, hormones may cause it to grow faster. However, scientific evidence for this is lacking. “Based on this data situation, we carefully considered when to use hormone replacement therapy. It helps a lot with pronounced menopausal symptoms,” Tio says, emphasizing, “It is absolutely important to check your breasts regularly during treatment.”

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Alcohol and lack of exercise increase risk

When it comes to breast cancer in particular, there are still myths that are disturbing but have long since been disproved. For example, that aluminum salts or preservatives (parabens) in deodorants trigger the disease. “There is no convincing evidence for this and you don’t have to worry if you’ve used a deodorant with aluminum salts,” says Susanne Weg-Remers. No risk could be detected for parabens either.

The influence of alcohol and lack of exercise on the risk of breast cancer has been proven, but is not as well known. This applies in particular to alcohol: the risk increases with each glass of wine or beer, even with small amounts. Studies assume that alcohol is responsible for 7 out of 100 cases of breast cancer in women in Germany. The ethanol it contains and the decomposition product acetaldehyde can cause cancer by damaging genetic material and disrupting repair mechanisms.

“With regard to tumor diseases, you should avoid alcohol if possible,” says Weg-Remers. It is essential not to exceed certain amounts, which means for women: a maximum of one eighth of a liter of wine or 0.3 liters of beer per day and at least three days of abstinence per week. Those who do not drink alcohol at all have the lowest risk.

Better yet, avoid alcohol and exercise. Many people don’t realize how important lifestyle is to cancer risk. “Being overweight after menopause in combination with alcohol increases the risk of breast cancer,” says Weg-Remers. Lots of exercise, quitting smoking, and not drinking alcohol can reduce it.

Alcohol Risk: Cancer Cases in Women Attributable to Alcohol

Alcohol Risk: Cancer Cases in Women Attributable to Alcohol

Body weight is an important factor. “We see that the risk of cancer increases significantly with weight, especially in women after menopause,” says Annette Hasenburg. “However, we also see that physical activity can significantly reduce the likelihood of disease or tumor recurrence.” Diet starting today for low risk? No, enough exercise and a balanced diet would go a long way, says Hasenburg: “The greatest potential for reducing risk lies in a healthy lifestyle.”

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