Listen in to the full podcast or read from the partial transcript below as Michal Whiton, MD, oncologist and Chair of the Breast Cancer Steering Committee at Skagit Regional Health and Aaron Yu, MD radiologist with Skagit Radiology, discuss who is most at risk for breast cancer, the benefits of 3D mammography and more

Cheryl Martin (Host): Screening mammograms can help reduce the death rate from breast cancer among women. But who's most at risk and what are the benefits of 3D mammography? Those answers and more coming up next. 

This is Be Well with Skagit Regional Health. I'm Cheryl Martin. And on this episode, I'm pleased to have with me Dr. Michal Whiton, radiation oncologist and Medical Director of the Breast Institute at Skagit Regional Health; and Dr. Aaron Yu, a radiologist and Medical Director at Skagit Imaging Pavilion. Let me begin with you, Dr. Whiton. Who is most at risk for breast cancer?

Dr. Michal Whiton: Well, breast cancer is the most common cancer that we see in women, and it's actually the second most common cause of cancer death in women. The statistic that is quoted most commonly is one in eight. So one in eight women will develop breast cancer in their lifetime. But not all women have the same risk of developing breast cancer. So who is most at risk is a question that many seek answers to.

There are certain factors that increase the likelihood that a woman will develop breast cancer, and some of these can be modified and controlled and some cannot. The risk factors, the two strongest risk factors, are being a woman and advancing age. So the older we get, the more at risk we are of developing cancer, not just of the breast, but of other cancers as well. Having a family history of breast cancer is also a common risk factor and one we can't control or having a personal history of benign breast disease or a history of already having a malignancy in the breast. Anyone who has had prior radiation to the chest, most commonly given as a younger adult for a lymphoma or having a history of lymphoma that required radiation to the chest increases risk. And then, how much estrogen a woman's body is exposed to in her lifetime is also of great importance in the risk of developing breast cancer. And a less less commonly known, risk factor is drinking more than one alcoholic beverage a day. So these are the risk factors that we know of. Some, again, can be controlled and some cannot.

Cheryl Martin (Host): Dr. Yu, what are the early signs or symptoms of breast cancer?

Dr. Aaron Yu: The early signs and symptoms of breast cancer that we frequently encounter would be if somebody feels a new lump in the breast or armpit. It may or may not be tender or you may feel enlarged lymph nodes in the armpit. Some other potential findings would be you may see some skin changes such as dimpling or even thickening. Other things that may occur would be you may notice that the nipple turns inward, that you can't get it to come out with pressure or squeezing it. And also, nipple changes whether you may see some redness of the nipple itself, some associated scaling or even thickening. And one of the other things besides having these symptoms is that if a patient ends up getting treated for this and it doesn't get better. Those are some red flags to keep an eye out for when you have these type of findings and it just doesn't respond to your typical treatment.

Some other things that patients may notice would be blood or discharge from the nipple or focal breast pain. And then, one other thing that sometimes may be a little bit harder to detect, but if you notice that one of the breasts becomes larger than the other, or if it starts getting smaller, those may be some findings that somebody should go in and get it checked out by their primary care provider.

Cheryl Martin (Host): Is breast cancer preventable, Dr. Whiton?

Dr. Michal Whiton: You know, as I mentioned, we know what the primary risk factors are for breast cancer. Some again, we can control and some we cannot. The risk factors that we have some control over relate to our estrogen exposure. So, when a woman starts menstruating, the monthly bursts of estrogen in our system begin and they last until menopause. So, if someone has an early onset of menstruation and a very late menopause, that would increase the exposure of estrogen in their system over their life.

In a similar realm when a woman becomes pregnant, that turns off those bursts of estrogen monthly and helps reduce a lifetime of estrogen exposure. So if someone has their first pregnancy early in adulthood as opposed to late in adulthood or not at all, that can affect your estrogen exposure over time. Once menopause occurs, if a woman chooses to use estrogen replacement to mitigate the symptoms of menopause, again that's a risk factor for breast cancer and one that we can control. So, whether or not to use hormone replacement at the time of menopause is something that needs to be discussed with a patient's physician to determine if it's appropriate for them because of the increased risk. But again, that's a way to prevent that particular risk, is only using hormone replacement if necessary.

One thing that is not well known is having fatty tissue on our body is also a source of converting estrogen precursors in our body into actual estrogen. And so, there's an enzyme in our fatty cells that converts those precursors and that is our primary source of estrogen production after menopause. So keeping body weight to a healthy level, reducing excess fatty tissue on the body, again that's a risk factor we can control and it reduces the amount of estrogen that the body is just producing in the fatty tissue. Some studies have been done looking at estrogen levels in patients who are overweight in the post-menopausal area as opposed to being lean in the post-menopausal time period. And the levels of estrogen can be 50% to a 100% higher in overweight women as opposed to lean women. So again, that's one of the risk factors that help control our risk of just exposure to estrogen over time.

And there have been studies looking at regular exercise and maintaining a healthy weight. There was a study in Norway done about 20 years ago that queried over 25,000 women. And the outcome of that study was they found that women who exercise regularly at least four times a week had a 37% reduction in the risk of breast cancer. So, exercise, maintaining a healthy weight, attempting in the control that we do have over our weight to minimize our fatty tissue, all helps reduce the risk.

Again, just to note about alcohol, there is clearly a link between alcohol consumption and the risk of developing breast cancer. And the risk is highest for women who consume three or more drinks per day. So the American Cancer Society recommends that women really limit alcoholic beverage consumption to no more than one alcoholic drink per day. And of course, the less, the better. So those are some ways to control the risk.

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