In the News

by Julie Ohnemus, M.D., The Eureka Reporter, 10/16/06.

October is Breast Cancer Awareness Month and an opportunity to focus on the most common diagnosed cancer in Humboldt County women.

There is reason to celebrate. Nationwide, the death rate due to breast cancer has been slightly decreasing, which is attributed to better treatments and earlier detection. The Humboldt Community Breast Health Project was founded in 1997 in part because Humboldt County posted California's highest death rate for breast cancer. Since then, there has been a gradual improvement. According to the 2006 County Health Status Profile, Humboldt County has progressed to now being one of five California counties to meet the Healthy People 2010 National Objective of a lower death rate. This should offer us hope and motivation in making lifestyle changes to reduce the risk of developing breast cancer.

As we don't know the causes of breast cancer, it is difficult to have true prevention. However, there are proven ways to reduce risk, beginning with early detection. A number of risk factors do not lend themselves to modification. There's not much modification to be done for the risk factors of being female, aging, and a personal history of breast, uterine, ovarian, or colon cancer. Therefore, part of our focus should be on early detection, which is currently best achieved by mammography and an annual clinical breast exam.

Mammography has been shown to reduce breast cancer mortality by 20 percent to 30 percent. However, it is limited: an estimated 5-17 percent of breast cancer cases are not found by mammography, and, conversely, 10 percent of the time it can have false findings that appear suspicious but prove to be benign. That is why national prevention organizations recommend annual mammograms for women after the age of 40 and an annual clinical breast exam starting at the age of 30. If your mammogram and breast exam are done within a six-week period of each other, they can be linked to lessen the mammogram's limitations. Those women with the risk factor of a family history of breast cancer may need higher surveillance, which should be discussed with your medical provider. However, nine of 10 women who develop breast cancer do not have a mother, father, sister, or daughter with the condition. All women need to consider themselves at risk and develop self breast awareness.

Risk factors that are modifiable primarily focus around healthy behaviors. Those proven behaviors which put us at risk include obesity, lack of exercise, alcohol consumption and usage of hormone replacement therapy for the long term. These risk factors all have a common denominator: increased lifetime exposure of breast tissue to circulating estrogen in our bodies.

As we age, it is harder to keep weight under control, because our metabolism slows down and we tend to get less exercise. Medicine is beginning to understand the implications of obesity. Among adults, the impact of being obese is equivalent to aging 20 years. While we've known obesity increases risk for diabetes and heart disease, it is now proven to increase risk of developing a number of different cancers, specifically breast cancer in postmenopausal women. Because fat tissue is the primary source for circulating estrogen, simply being overweight prolongs one's exposure to estrogen, and increases the likelihood of developing breast cancer. Also, a recent study showed that overweight women were more likely to die from breast cancer compared to women with a normal weight.

Part of our frustration with weight is having effective strategies for a healthy weight. There is no quick fix. It all begins with using common sense - being conscious of diet by balancing energy intake (food and beverage intake) with energy expenditure (physical activity), a higher intake of fruits, vegetables and fiber, and appropriate portion sizes. Weight is easier to control with healthy diet choices and physical activity.

Physical activity has been shown to decrease women's risk of breast cancer. Evidence suggests that 45 to 60 minutes of moderate activity (walking at a pace of 2-3 miles per hour) on five or more days of the week may be optimal to reduce risk of breast cancer or its recurrence.

More than 40 studies have shown alcohol consumption is associated with an increased breast cancer risk. This is thought to be because alcohol increases estrogen levels in the body when it is metabolized in our liver. The six biggest studies showed that one drink a day increases one's risk by 10 percent, but 2-5 drinks a day increase it by 40 percent4.

Regarding the publicized risk of hormone replacement therapy, after four more years of following the postmenopausal women in the big study known as the Women's Health Initiative, it has been shown it is safe if a women needs HRT to control her menopausal symptoms for five years or less. However, for the long term, if a woman still has her uterus and she requires estrogen plus progestin, then there is a 24 percent rise in the incidence of breast cancer. If she has had a hysterectomy and only requires estrogen, there is not an increased risk of breast cancer. So HRT is no longer recommended for the long term, but only to temporarily treat symptoms.

For subgroups of women with particular breast findings or an inherited genetic predisposition placing them at a higher risk, there are other options. These include taking medications such as tamoxifen or raloxifene, or choosing bilateral mastectomies. The medications carry risks while surgery may be too extreme a measure. Options must be weighed carefully. The benefits may not exceed the risks to otherwise healthy women hoping to prevent breast cancer.

Finally, risk reduction also includes supporting public policy for legislation to: 1) encourage healthy lifestyles/education in our community; 2) provide for early detection and treatment for the uninsured and underinsured women; and 3) support cleaning up our environment and decreasing usage of xenoestrogens, which are synthetic chemicals that imitate or enhance the effect of estrogens.

Susan Love, M.D., a national breast cancer expert, recommends October be "Breast Appreciation Month." If we focus on positive steps to take, our actions will replace our fears, and we will be healthier for it.

For more information about breast health and breast cancer, phone the Humboldt Community Breast Health Project at 707-825-8345. Located at 987 Eighth Street in Arcata, HCBHP is a community resource of education, hope and support for women experiencing a breast health concern, breast cancer or gynelogical cancer and is open to the public Monday-Friday from 9 a.m. to 2 p.m. Evening appointments can be made by special arrangement. For information about financial assistance for screening, HCBHP can help by connecting you to local resources.

(Dr. Julie Ohnemus is a founder and medical consultant of the Humboldt County Breast Health Project and the medical director for the North Country Clinic.)

(Opinions expressed in columns are not necessarily those of the Eureka Reporter or its staff.)