Hey, Mom & Dad, Early Life Can Be Important for Breast Cancer Risk

A little while back we developed a brief card focusing on the importance of early life exposures in determining breast cancer risk.  With this week marked by a new NIH report pushing for greater emphasis on breast cancer prevention (report) and the launch of our newest 8 Ways brochure, 8IGHT WAYS to Prevent Breast Cancer (link), we felt it'd be a good time to also re-introduce our parent and youth-focused card.

There's a growing body of evidence showing that certain factors early in life - like diet, activity, and weight - can have an important impact on a woman's breast cancer risk later in life. So, to help parents guide their daughters toward optimal breast health - as well as lifelong good health - we developed the "Hey, Mom & Dad" card (below). A high resolution file (PDF) can be downloaded: here. A regular resolution file (PDF) can be downloaded: here.

For details on the science behind the "Hey, Mom & Dad" card, please see the slideshow "Integrating Risk Across the Lifespan: The Case of Breast Cancer Prevention" and the "Prevention Papers: Breast Cancer Prevention."

Understanding Risks and Benefits of PSA Testing and the Importance of Shared Decision-Making

Prostate-specific antigen (PSA) testing for prostate cancer has long resided in a medical gray area.  It is a simple and quick blood test for a very common cancer, which accounts in large part for its steadfast popularity with doctors, health fairs, and the public.  But its benefits have been demonstrated to be ambiguous - so much so that the U.S. Preventive Services Task Force recommends against routine PSA screening, stating "that many men are harmed as a result of prostate cancer screening and few, if any, benefit."

The data on the lack of clear benefits of PSA testing, combined with real risks - like diagnostic biopsy and treatment for disease that may not have ever become serious or life-threatening - speaks at a minimum to a need for shared decision-making between patient and doctor about getting a PSA test. Yet, a recent study shows that up to 25 percent of MDs order PSA tests without discussing the issue with their patients.

And even in those doctors who do discuss the issue with their patients, how the issue is framed could have a real effect on whether or not patients choose to be screened or not, as a new paper in the Journal of the American Medical Association - Internal Medicine suggests.  When men were presented with a list of the potential risks or benefits clearly linked with "screening" or "no screening," 44 percent chose screening.  However, when the risks and benefits were not linked specifically with "screening" or "no screening," only 20 percent chose the PSA-like screening option.  This suggests that a more neutral presentation of risks and benefits has men weigh things differently than when risk and benefits are linked specifically to PSA screening.

As we've mentioned in previous posts, screening tests often get portrayed to the public much more in terms of their potential benefits than of their potential risks (here), so it's only natural that many people will lean toward choosing screening over no screening, even when the risks are presented clearly.

A screening test with such modest demonstrated benefits and real risks places a great burden on health care providers to fully explain the risks and benefits of PSA testing to their patients and to help them make the best, most well-informed decision possible.

While the test itself is easy to do, helping patients make a fully informed decision about getting tested is likely not.  The two, though, must go hand-in-hand.

8IGHT WAYS to Prevent Breast Cancer: The Extended "+plus" Version

As part of the launch of our new brochure 8IGHT WAYS to Prevent Breast Cancer, we've also posted an online version with more details on the science and causal mechanisms behind each "way." Still written in accessible language the "+plus" version simply provides more information for professionals and the public alike who want to delve a bit deeper into the science and rationale of our latest 8IGHT WAYS addition.

Link: 8IGHT WAYS to Prevent Breast Cancer (+plus)

New NIH Report on Breast Cancer Prevention and a New 8IGHT WAYS

A new report from NIH's National Institute of Environmental Health Sciences emphasizes the importance of cross-discipinary efforts to prevent breast cancer (report). As a complement to the findings of the report - Breast Cancer and the Environment: Prioritizing Prevention - we're excited to launch our latest publication in our 8IGHT WAYS series:  8IGHT WAYS to Prevent Breast Cancer.

Isn't it time to use what we know to prevent breast cancer?

In a recent analysis of updated data from the National Health Interview Survey, Dr. Erika Walters and colleagues report on the use of Tamoxifen and Raloxifene by US women (see report) ^1,2. These two selective estrogen receptor modulators bind estrogen receptors in breast tissue and reduce the action of estrogen on breast cells. Randomized controlled trials show that these two drugs significantly reduce the risk of developing invasive breast cancer ^3,4. The magnitude of risk reduction is thus well established. In these randomized trials a reduction in the order of 50% fewer breast cancers among women taking the drug is seen for each of these agents. Comparing the two drugs head to head showed a more favorable profile of side effects for Raloxifene compared to Ramoxifene ⁵.

The FDA approved the use of Tamoxifen for primary prevention of breast cancer in both premenopausal and postmenopausal women at high risk. This approval was in 1998. In 2007, the FDA approved Raloxifene for primary prevention of breast cancer among postmenopausal women.

The National Health Interview Survey data show that the use of these two drugs for primary prevention is extremely low. Based on the interview data it is estimated that n 2010 only about 100,000 women are using these drugs specifically for breast cancer prevention. Approximately 300,000 women are using Raloxifene for prevention of osteoporosis.

In a previous analysis of the US population projections we estimated that 8 million women ages 50 to 69, are at sufficient risk to justify use of these agents for prevention of breast cancer (see article). The reduction in breast cancer would exceed any excess side effects. Among these 9 million women some 21,000 cases of breast cancer could be prevented each year. See related post.

There are many barriers slowing our progress from scientific understanding of the causes and prevention of cancer to implementing what we know ^6,7. This example highlights some of this delay. Randomized trials published in 1998 and 2004 led to FDA approval for indications to use drugs to prevent breast cancer. Now in 2013 we are still missing the opportunity to prevent thousands of breast cancers. Other strategies like avoiding postmenopausal hormones and increasing physical activity and weight loss can add to the reduction. All theses strategies remain underutilized. Isn’t it time to use what we know to prevent breast cancer?

Related posts

Untapped benefits of physical activity and weight loss in breast cancer prevention

Breast cancer prevention

References cited

1.      Waters EA, Cronin KA, Graubard BI, Han PK, Freedman AN. Prevalence of tamoxifen use for breast cancer chemoprevention among U.S. women. Cancer Epidemiol Biomarkers Prev. Feb 2010;19(2):443-446.

2.      Waters EA, McNeel TS, Stevens WM, Freedman AN. Use of tamoxifen and raloxifene for breast cancer chemoprevention in 2010. Breast Cancer Res Treat. Jul 2012;134(2):875-880.

3.      Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer - report of the National Surgical Adjuvant Breast and Bowel Project P-1. J Natl Cancer Inst. 1998;90:1371-1388.

4.      Martino S, Cauley JA, Barrett-Connor E, et al. Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst. Dec 1 2004;96(23):1751-1761.

5.      Vogel VG, Costantino JP, Wickerham DL, et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: Preventing breast cancer. Cancer Prev Res (Phila). Jun 2010;3(6):696-706.

6.      Colditz G. Cancer culture: epidemics, human behavior, and the dubious search for new risk factors. Am J Public Health. 2001;91:357-359.

7.      Colditz GA, Wolin KY, Gehlert S. Applying what we know to accelerate cancer prevention. Sci Transl Med. Mar 28 2012;4(127):127rv124.

HPV's Cancer Links May Be Broader Than You Think

With the use of the the human papillomavirus (HPV) vaccine gaining in popularity, the direct link between HPV infection and cervical cancer is gaining a much broader public understanding.  What's less well known to people, though, is that HPV is linked to more cancers than just cervical cancer.  As detailed in a new article in the medical journal CA: A Cancer Journal for Clinicians, in addition to cervical cancer, HPV infection can increase the risk of vaginal and penile cancers, as well as anal and oropharyngeal cancers. Oropharyngeal cancer includes cancer that can affect the tongue, throat, tonsils, and soft palate, and its rate is quickly increasing. Vaccination against HPV can help protect girls and boys against many of these cancers and is routinely recommended to begin at ages 11 and 12 for both boys and girls but can also start later and still be effective. 

For more on HPV and cancer:

American Cancer Society
Human Papilloma Virus (HPV), Cancer, and HPV Vaccines -- Frequently Asked Questions

Photo: stevendepolo

Coke, Calories, and Obesity: Junk Food Greenwashing?

The new two minute Coca Cola video ("Coming Together")  touting the company's efforts to combat weight gain while urging everyone to "come together" to work against the rising tide of obesity is at once daring and laughable.  There is a great deal to critique in the well-produced ad (seeking praise for developing new artificial sweeteners, for one), yet it's the overarching point that "all calories count" that is the most apparent exaggeration.

Yes.  The body does treat the energy from calories pretty much the same once they are consumed, but as we wrote in a recent news piece, calories from sugary soda are unique.  They're much more easy to over-consume than calories from many other sources, and they can have unhealthy effects on the response of insulin and related hormones. And soda is well-established as the prime contributor to weight gain in the US - the theme of last year's PSA campaign from the New York City Department of Health (see below).

Should Coke be praised for its modest moves toward fighting obesity? Some may say "yes," yet the messages that all calories are the same and that everyone needs to "come together" to fight obesity seems a PR move aimed simply at deflecting growing criticism rather than a real effort to improve the health of kids and adults the world over.  It is a company built on selling sugar water. To expect it to significantly veer toward health promotion would be little more than delusion.