Miami Cancer Institute Expert: “You Can Reduce Your Risk of Breast Cancer”

As part of National Breast Cancer Awareness Month, Resource editors spoke with Jane Mendez, M.D., chief of breast surgery at Baptist Health’s Miami Cancer Institute, who answered some commonly asked questions about breast cancer and addressed recent advances in research and treatment.

Resource:  Some of the risk factors for breast cancer are genetic while others can be linked to environment or lifestyle – does one play a larger role than the other?

Jane Mendez, M.D., chief of breast surgery at Miami Cancer Institute

Dr. Mendez: Some risk factors for breast cancer are modifiable, such as diet, exercise, alcohol consumption, cigarette smoking, exposure to radiation, and use of hormonal replacement therapy. These are things we can work on, but it takes a lot of education.

The two main non-modifiable risk factors are age – it’s a known fact that breast cancer risk increases as we age – and gender. Although breast cancers can and do occur in a small number of men, 99 percent of them occur in women.

There are certain other conditions that we know increase the risk of breast cancer, such as having your children at a later age; having no children; having your period or menarche at an early age; or having menopause at a later age. All of these are associated with increased risk.

Another factor is having a known genetic predisposition for breast cancer. There are many genetic mutations associated with the disease, including PALB2, but BRCA1 or BRCA2 are the most prevalent, so if you’re a carrier of either of those genes, you definitely have an increased risk.

The other risk factor, of course, is family history. You can’t change your family history but you can and should be aware of it and make sure you share that information with your physician.

Resource: Is obesity a risk factor for breast cancer?

Dr. Mendez: We know that obesity is linked to an increased risk of breast cancer. Interestingly, estrogen deposits itself in the adipose tissue or fat cells, so the more adipose tissue we have and the farther we are from our ideal body weight, the higher the estrogen levels and the higher the possibility of developing breast cancer.

Resource: Has smoking been linked to breast cancer?

Dr. Mendez: Smoking has no direct link to breast cancer but it is associated with lung cancer, which is the number one cause of cancer mortality in women, so I advise patients to refrain from smoking as part of a healthy lifestyle.

Resource: Some claim coffee can cause breast cancer – any truth to that ?

Dr. Mendez: There are many myths out there and that’s certainly one of them. Coffee isn’t going to give you breast cancer. Neither will deodorant, hair dyes or cell phones – all of those are complete myths.

Resource:  What about hormone replacement therapy? Isn’t that considered a risk factor for breast cancer?

Dr. Mendez: Hormone replacement therapy has been controversial for many years but now we finally have data showing that long-term use of estrogen replacement therapy is indeed one of the risk factors for breast cancer. Still, even today, in spite of the data, I’m astounded to see how many women are on hormone replacement therapy. It’s a real challenge because it’s so ingrained in society and in gynecology practice. But there is definitely a danger to it and now that’s been proven so you should have a conversation with your physician about the associated risks and alternate therapies available.

Resource: Can lifestyle changes reduce one’s risk of developing breast cancer?

Dr. Mendez: You can reduce your risk of breast cancer. Watch the weight gain, especially in this pandemic. There are no perfect diet plans but the most important thing is to maintain healthy eating habits. Be conscious of the quality of the food you eat and how you prepare it, with the emphasis on light and healthy. The key word is moderation – in how you prepare the foods, and the quantities you eat.

Moderation also applies to alcohol consumption. Watch what you drink and how much you drink. Red wines have phenolic acids which are thought to protect against breast cancer, so if you’re going to drink something, a glass of red wine may be helpful.

Regular exercise can also help protect against breast cancer and other disease processes. Remember, you don’t have to go to a gym to get your exercise. Avoid a sedentary lifestyle, be more cognizant of moving about and find ways to get your heart rate up every day – walking, running or any type of aerobic exercise.

Resource: Is breast cancer preventable?

Dr. Mendez: Prevention continues to be key, but we can’t focus solely on the modifiable risk factors. We need to know about the non-modifiable ones so we can have increased surveillance. If a patient has any of those non-modifiable risk factors, then I can intervene to try to keep them without cancer. Those risk factors could qualify a patient for enrollment in my Breast Cancer Prevention Clinic at Miami Cancer Institute, which has very specific parameters for patients and seeks to keep high-risk patients cancer-free.

Resource: How important is early detection with a breast cancer diagnosis?

Dr. Mendez: We know that early detection leads to better outcomes, so keep up with your annual mammograms and your monthly self-exams. If you notice something, don’t delay – get it checked as soon as possible. And if you do get a breast cancer diagnosis, know that a multidisciplinary approach to your treatment can maximize the cure.

Resource: What are the most important things we’ve learned about breast cancer treatment in the last five years?

Dr. Mendez: Certainly, the advances in genetic medicine over the past five years have helped guide us clinically and allow us to tailor treatment with more objective information, and better understanding of the different types of breast cancer. For example, if you have triple-negative breast cancer, endocrine therapy isn’t going to help you in any way. So that’s where the conversation starts, but the good news is that there are a lot of options.

Resource: How do you see the diagnosis and treatment of breast cancer evolving over the next five years? Will the focus continue to be on genetics?

Dr. Mendez: Only five percent of breast cancers are due to known genetic predisposition, and 85 percent occurs sporadically. The remaining 10 percent can be tied to family history but we haven’t been able to identify a mutation for that – yet. So yes, we continue to learn about the genetics but that really applies to only a small percentage of breast cancer patients.

The most important challenge we have right now is with triple-negative breast cancer because so far we don’t have a specific target tailored to that particular cancer subtype. For cancers that respond to the HER2 protein, or those that are estrogen receptive positive, we have targeted therapies capable of treating these patients. But for triple-negative breast cancer, although we’ve made some improvements in our target treatments, the results are not what we’ve been hoping for and that is where much of the research is now focused.

Resource: What are the key points all women should keep in mind for preventing breast cancer?

Dr. Mendez: Follow the screening guidelines. Know your body. Know your family history. And if you see something, do something.

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