Cancer Risk

Breast and ovarian cancer survivors, especially those with, hormone-sensitive cancers, may worry about using ovarian stimulating hormones either during fertility preservation prior to cancer treatment or during survivorship. For fertility preservation purposes, embryo or egg banking are options for many young women. In this process, hormones are used to induce the ovaries to produce multiple eggs in one month (normally an ovary produces a single egg per month). Clinical hormonal stimulation protocols have been modified to work for women with hormone-sensitive cancers. The one study that looked at cancer recurrence rates for breast cancer survivors who underwent this procedure, found that these women did not have an increased risk for cancer recurrence compared to those who did not have ovarian stimulation.

Survivors of hormone-sensitive cancers may also discuss using this protocol with their fertility specialist. However, they may first wish to examine their ovarian reserve, the number of immature eggs in their ovaries, as chemotherapy, radiation, and surgery for cancer treatment may have significantly reduced this number.

Having one gynecologic cancer does not increase your risk of having other types of gynecologic cancer. However, women with a hereditary cancer syndrome are at increased risk of developing a gynecologic cancer. These syndromes include Hereditary Breast and Ovarian Cancer (HBOC) caused by a BRCA mutation as well as Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC). Women with HBOC syndrome have markedly elevated risks of breast cancer and ovarian cancer, with a lifetime risk of breast cancer of 50 to 85 percent and a 15 to 40 percent chance of developing ovarian cancer. There is also an increased risk of a second breast cancer diagnosis.

Lynch syndrome is associated with cancer diagnosis at an early age and the development of multiple cancer types, particularly colon and endometrial cancer. Until recently, the majority of attention and research related to Lynch syndrome has focused on colorectal cancer. However, women with Lynch syndrome have a 27 to 71% risk of endometrial cancer, which equals or exceeds their risk of colorectal cancer. This is significantly higher than the 3% risk of endometrial cancer in the general population. In addition, women with Lynch syndrome have a 8-11% risk of ovarian cancer, compared with 1.5% in the general population. The management of endometrial and ovarian cancer risks in women with HBOC or Lynch syndrome includes surveillance, chemoprevention and risk-reducing surgery.

Americans get risk screening all the time but we generally don't think of these tests in those terms. Assessment of cholesterol levels in the blood and blood pressure are risk assessments for heart disease and stroke. These are offered to essentially everyone and help to direct additional testing (advanced cardiac/vascular examinations) and treatment (cholesterol and blood pressure lowering medicines). There is no downside to risk assessment in all women and can help direct advanced breast imaging and closer follow ups as well as alleviating fear in some women who overestimate their risk of developing breast cancer. The risk assessment requires no blood draws and can be done in less than 5 minutes by a trained medical assistant.

I love this question because we as oncologists have changed our thinking in the past few years. My former recommendation was that patients with hormone receptor positive breast cancer avoid soy in any form. This was not necessarily based on any hard science, but rather a concern that the phytoestrogens in soy could theoretically promote breast cancer in women with hormone receptor positive tumors. Now we have some pretty convincing epidemiologic evidence that soy food consumption is beneficial in breast cancer survivors (note soy food—not supplements). In a meta-analysis done by Trock, et al.(Journal of the National Cancer Institute, 2006) soy protein intake was associated with a small but statistically significant decrease in the risk of breast cancer. Two other case-control studies (one in a European population and the other in a Japanese population) also showed no increased risk of breast cancer with soy or other phytoestrogen consumption (Am J ClinNutr, 2010, and Iwasaki, et al., JCO, 2008). The Shanghai Women’s Health Study also shed some light on the benefits of soy consumption and breast cancer prevention. In this study the highest consumption of soy was associated with the lowest risk of pre-menopausal breast cancer. In breast cancer survivors, soy intake was associated with a lower mortality and risk of recurrence with a 29% risk reduction for total mortality and 32% risk reduction for breast cancer recurrence (ER pos or neg).

Dysplastic nevi don't 'turn into' an invasive melanoma but are a marker for a patient that is a risk of developing a melanoma in the future. These patients are usually seen twice a year by their dermatologist.

Elevated levels of markers of chronic inflammation are associated with an increased risk of cancer (for more details: http://talkabouthealth.com/what-is-meant-by-the-term-inflammation-in-the-context-of-cancer-and-integrative-medicine). There is a difference between association and causation. While chronic inflammation and many diseases occur together, the exact mechanisms as to how inflammation might cause illness have not yet been worked out—but what an exciting area of research!

Large 'birthmarks' or 'congenital nevomelanocytic nevus' (CNN), known commonly as the congenital hairy nevus, denotes a pigmented skin lesion present at birth and are a risk factor for developing a melanoma. Based on diameter, CNN are characterized as small (< 1.5 cm), medium (1.5-19.5 cm), and large or giant (>20 cm in adolescents and adults or predicted to reach 20 cm by adulthood). For small CNN, risk rates have been reported between 0.8% and 4.9% up to ~50% for giant CNN. A study of the Dutch nationwide pathology database reported an incidence rate of 12.2% of developing melanoma in patients with any sized CNN. Malignancy should be suspected with focal growth, pain, bleeding, ulceration, significant pigmentary change, or pruritus.

Being a vegetarian is not a 100% guaranteed that you will not get cancer. It is a healthier lifestyle, however, there are many variables that can cause cancer and breast cancer. Add to the equation, eating meat in an earlier life, environmental factors, genetics/family history, obesity, smoking, lack of exercise and history of drinking alcohol. All these factors can cause breast caner.

Moreover, know where your fruits and vegetables come from. Many of our fruits and vegetables that we eat have been treated with pesticides, (which in turn places more estrogen in our bodies, which can cause breast cells to grow abnormally).

Be aware of what vegetables that have a high estrogen content in them. Such as sweet potatoes and “true yams” are totally different vegetables from two separate botanical families. Yams are brighter, orange color and are served more frequently in stores and restaurants, have a higher estrogen component in them. Yet women who maybe at risk for breast cancer are not aware of this factor

Furthermore, there are studies that have shown curcumin and black pepper have cancer-fighting properties to help to reduce breast cancer. Other measures that can be taken to reduce breast cancer is to lower or eliminate the consumption of alcohol. Check your Vitamin D levels, it appears that women who have a low Vitamin D level are more at risk for breast cancer.

In addition to, these factors that I have mentioned above, one must get adequate sleep, exercise, and take time for you.

As I discuss in detail in my evidence-based book, A Cancer Prevention Guide for the Human Race (http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913), the overwhelming majority of disease prevention research, including cancer prevention research, is based upon low-level types of research, including survey-based public health studies and retrospective clinical studies. While these methods of research are rather quick and inexpensive to perform, the data that they produce is highly prone to various forms of bias. That is to say, their conclusions are often not highly accurate. On the other hand, prospective, randomized, placebo-controlled clinical research trials, when performed properly, provide the highest level of research evidence available. However, because this type of research is so demanding, and so expensive to perform, very few cancer prevention studies are performed using this high-level approach. With this in mind, it’s important to acknowledge that the vast majority of research on Vitamin D (http://www.cancercenter.com/cancer-center-news/news/vitamin-D-deficiency.cfm) as a cancer prevention agent is based upon methods that produce rather weak (and often contradictory) data. However, among all of the known vitamins, it is fair to say that only Vitamin D is still a reasonable contender as a potential cancer prevention agent, and particularly for people with low levels of this vitamin in their blood. Specifically, based upon available research data, Vitamin D appears to be potentially most effective as a prevention agent for colorectal cancer, with most studies suggesting a 25 to 30 percent reduction in the risk (http://www.doctorwascher.com/vitamin-d/vitamin-d-significantly-reduces-colorectal-cancer-risk.html) of colorectal cancer in patients who take Vitamin D supplements. In terms of recommending a daily dose for Vitamin D supplementation, there is no consensus as to how much Vitamin D should be taken as a supplement, although healthy patients can usually tolerate 1,000 to 3,000 IU per day without serious side effects. However, unfortunately, I cannot make specific recommendations regarding the optimal amount of daily Vitamin D intake at this time. Moreover, Vitamin D can be toxic when taken in high doses, and can lead to kidney stones, kidney failure, calcifications in the soft tissues of the body, GI tract ulcers, and other serious health problems. Therefore, if you are considering the addition of daily Vitamin D supplements as part of a cancer prevention lifestyle (as I discuss in my book), I recommend that you first discuss this with your personal physician. I would also recommend routine testing of your Vitamin D levels, to reduce the risk of Vitamin D toxicity.

Those are excellent questions, and they are the basis for my evidence-based book, A Cancer Prevention Guide for the Human Race (http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913), which is the only current research-based cancer prevention book written specifically for lay readers. First, let me start by noting that the overwhelming majority of disease prevention research (http://www.doctorwascher.com/tag/prevention), including cancer prevention research, is based upon rather “low-level” types of research, including survey-based public health studies and retrospective clinical studies. While these methods of research are relatively quick and inexpensive to perform, the data that they produce is highly prone to various forms of bias. That is to say, their conclusions are often not highly accurate. On the other hand, prospective, randomized, placebo-controlled clinical research trials, when performed properly, provide the highest level of research evidence available. However, because this type of research is so demanding, and so expensive to perform, very few cancer prevention studies are performed using this “high-level” research approach. With this in mind, even rather conservative estimates of cancer risk associated with lifestyle and dietary factors suggest that somewhere between 40 and 60 percent of all cancer cases are directly linked to modifiable lifestyle, dietary, and environmental factors. (Some important cancer risk factors cannot be modified at this time, including the genes that we inherit from our parents, increasing age, and gender.) What is especially important to note is that some of the very worst cancer killers are the very same cancers that are most closely linked to modifiable lifestyle and dietary factors, including lung cancer, breast cancer, pancreatic cancer, esophageal cancer, stomach (gastric) cancer, and other common major cancers. At this time, we are able to effectively cure approximately 60 to 65 percent of all cancers. However, for many of the “bad actor” cancers, the likelihood of cure, even with aggressive treatment, remains very low at this time. As I say in A Cancer Prevention Guide for the Human Race, “…an ounce of cancer prevention is worth a ton of cancer cure!”

In terms of lifestyle and dietary factors that have been linked to a reduced risk of cancer, there is a rather large number of potential cancer prevention cancer agents that one can consider (for a complete discussion of this rather complex topic, please see my book, A Cancer Prevention Guide for the Human Race - http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913). Here at Cancer Treatment Centers of America®, Nutritionists and Naturopathic Physicians are experts on how diet and supplements can affect cancer prevention and treatment. The most consistent research findings suggest that the following aspects of what I call a “cancer prevention lifestyle” are associated with the greatest decrease in cancer risk: Mediterranean diet (a diet low in meat and other animal products; rich in fresh fruits, vegetables and whole grains; and the modest use of polyunsaturated or monounsaturated cooking oils such as olive oil and canola oil) (http://www.cancercenter.com/cancer-center-news/600.cfm) ; avoidance of obesity and diabetes; avoidance of tobacco; and three to five hours of at least moderate physical activity per week. Regarding nutritional supplements and vitamins as cancer prevention agents, most of the available research data with respect to nutritional supplement and vitamin use in patients with a generally healthy diet suggests that there is likely to be very little, if any, benefit in terms of significantly reducing one’s risk of developing cancer. While the data remains contradictory, the only vitamin for which compelling research data is available to suggest a role in cancer prevention is Vitamin D (particularly with respect to colorectal cancer prevention). Vitamin E and beta-carotene, when taken as supplements, may actually have adverse health effects, while several large prospective, randomized, placebo-controlled clinical trials have shown that Vitamin C supplements do not appear to decrease cancer risk (or cardiovascular disease risk), either. In women who are at high risk of developing breast cancer, various anti-estrogen medications can be taken to significantly reduce their lifetime risk of developing this form of cancer. The diabetes drug metformin and the curry spice turmeric have also been shown to have potential anti-cancer effects, and these two agents are currently being intensively studied, as well. In summary, there probably aren’t any “magic bullet” anti-cancer agents available at this time. However, the evidence-based strategies that I describe in A Cancer Prevention Guide for the Human Race have been associated with a 40 to 80 percent reduction in cancer risk in large public health studies from the United States and Europe.

I really try to have them focus on 1. achieving a healthy weight 2. consuming a healthy diet 3. Avoiding chemical exposure as much as possible 4. Relieving stress in their lives 5. Making sure to manage any side effects of meds (like hormone blockers) so that they continue to take them 6. Stay up to date on all other cancer screening. My favorite book about these topics is Anti Cancer a New Way of Life by David Servan-Schrieber, MD, Phd

Hello there! I'm sure my surgical team did some tests, and I was told that I would get a "copy" of the study I took part in when it was done, but I never received it. I would have like to know what it said. I don't even know now where or if I could obtain it. It was at University of Alabama Birmingham. Things have changed alot medically, but I still would like to know. They even sent someone out to my house to interview me. I was counting on the information!

Since my uterus was not fully developed in the womb (the mouth, or opening), while I was in-utero, I have wondered if my mother had gene abnormalties, because she had cervical cancer at 36 (I was 12). Her's was caught in a Pap Test early and treated. She did well. But that was so long ago. If both occurrences happened today, I believe at least some of the outcomes would have been different, in a positive way.

My mother did smoke, and drink alcohol occasionally while pregnant. And while there are differences in opinion about this, some medical, some take offense to the suggestion; I believe it has to have a negative effect just by common sense. Especially with two babies at the same time are needing nutrition from the mother.

p.s. Would love to hear from you on this (if you have any thoughts)!

I have already described my thinking in this regard in a recent blog that surrounded the publication of an English study that clearly and unequivocally demonstrated the protective value of non-steroidal anti-inflammatory drugs in patient at high risk for colon cancer (http://robertanagourney.wordpress.com/category/colorectal-cancer-2/). To a large degree, cancer can be viewed as a wound that will not heal. Wound healing is a paradigm of inflammation. The more we can do in our lifestyles, diets, and therapies to reduce inflammation, the better.

The day I was diagnosed with breast cancer my doctors told me I had to stop taking the pill. When I asked why they told me becasue, "they can cause breast cancer". I went straight home and opened up the pill pack pamphlet folded up in the lid, the one I never read for 15 years, and it says it right there in black and white. I firmly believe that the Rx manufacturers are required to disclose this for a reason and I bet if you talked to enough breast cancer survivors you would learn that this is a huge common denominator. I don't believe it is any coincidence. Dr. Malcolm Pike, epidemiologist at SLoan Kettering Cancer Institute has said he believes the risk increase is closer to 21%, not the "claimed 2%"

Great question. Not many. Most ovarian cancer just happens because of bad luck. Less than 25% of ovarian cancer is caused by an inherited identifiable genetic mutation. Certainly a patient with a family history of ovarian cancer should be evaluated to determine if she qualifies for BRCA testing. This can be done either by a formally-trained genetic counselor or by less-formally-trained healthcare providers who have been educated about risk assessment for various cancers including ovarian cancer. Ovarian cancer happens to about 1% of women with no risk factors. If a first degree relative has ovarian cancer, the risk goes up to 4%. If the patient has a BRCA mutation, the risk can be as high as 44%. With Lynch syndrome, a combination of uterine, colon, ovarian, and a few other cancers, the risk is between 10-15%. Women who have never had a baby, who had early menarche and late menopause, and who have never taken the pill are at slightly higher risk given that there ovaries never took a break from ovulating. There is controversy over whether "super ovulation" (using medications to increase the number of eggs ovulated) used in infertility patients increases the risk of ovarian cancer. Patients with any of these factors are evaluated regularly and advised to report any changes in bowel or bladder habits or pelvic symptoms that might be associated with ovarian cancer (see prior question).

Hard question to answer. In addition to BRCA, did anybody undergo BART testing? This test is for large DNA rearrangements and is done through Myriad Genetics. If it has been done, then your family falls in a high-risk familial breast cancer category. I would treat y daughter's breasts as if there were a BRCA mutation in the family and offer annual MRI alternating with mammogram and sonogram every 6 months. In between I would suggest that she have clinical breast exams, one by her gynecologist and one by a breast surgeon. If she is exceedingly anxious or is hard to examine, I would consider prophylactic mastectomies with immediate reconstruction. It cannot totally eliminate the risk of cancer, but brings it down to less than that of the general public. The reason risk still exists is that a minute amount of breast tissue remains after a mastectomy and could still result in a breast cancer, but there is nothing better available at this time.

Most women choose close surveillance, seeing their breast specialist twice a year for breast examinations along with screening. In addition to that, you may be referred for chemoprevention or hormonal treatment such as tamoxifen or if post-menopausal (raloxifene, exemestane).
It is not necessary to have a mastectomy for ADH alone.

High risk lesions such as atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) and LCIS (lobular carcinoma in situ) or lobular neoplasia when identified on a needle biopsy are often followed by an open excisional biopsy as there is a 10-20% incidence of an associated cancer.

Patients can be offered chemopreventive agents such as tamoxifen or raloxifene. However, most women are generally followed twice a year with physical examinations and annual mammograms.

I'm assuming you mean LCIS (lobular carcinoma in situ or lobular neoplasia) discovered by a core needle biopsy. Yes, it is advisable to the lesion removed as there is a 10-20% incidence of an associated invasive cancer.