Why Overweight Women May Have an Increased Chance of Cancer

Why Overweight Women May Have an Increased Chance of Cancer_81946825 [Converted]Most of us are aware that being overweight has been associated with an increased risk of developing heart disease and hypertension, but it can also increase a woman’s chance of breast and uterine cancer.  By using a person’s height and weight, a BMI (body mass index) can be determined.  A measurement of 25 to 29 is considered overweight and 30 or higher is considered obese.  According to a recent study, 40% of American women meet the clinical definition of obesity.

The exact relationship between obesity and certain female cancers is not perfectly understood, but there seems to be three factors that may play a role:

  • A body being in a state of chronic inflammation is pro-carcinogenic, and obesity is considered a chronic inflammatory state.
  • There are enzymes in fat cells which increase the production of estrogen, and an elevated level of estrogen has been associated with a higher risk of breast and endometrial (uterine) cancer.
  • Fat cells produce hormones that may stimulate tumor growth.

Please speak to your health care provider to determine your BMI, and start using the walking shoes your loved ones gave you for the recent holidays!

-Dr. P

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What Are the New Breast Cancer Screening Guidelines for Average-Risk Women?

Nurse Assisting Patient Undergoing MammogramThe American Cancer Society (ACS) recently updated their breast cancer screening guidelines for women who are at an average risk of developing the disease.  It was published in the October 20, 2015 issue of JAMA (Journal of the American Medical Society).

Here are the recommendations:

  • Women with an average risk of breast cancer should undergo regular screening mammograms starting at age 45
  • Starting at 40, have annual screenings if the woman desires
  • For women aged 45 to 54, the screenings must be annual
  • For women over 55, mammograms every 2 years or annually if the women desires
  • Screen as long as the overall health of the women is good or if her life expectancy is 10 years or greater
  • For average-risk women at any age, ACS does not recommend clinical breast exams for breast cancer screening

These recommendations have refueled the debate over what are the best guidelines, and these differ from the other major health organizations.  It can be confusing, but I think it opens more discussions between women and their health care providers concerning the best way to screen for breast cancer for each individual.  Please continue to speak to your health care provider about your breast health and come up with a plan best suited for you.

-Dr. P

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A Tool to Measure Your Risk of Developing Breast Cancer

A Tool to Measure Your Risk of Developing Breast CancerMany women who are at an increased risk of developing breast cancer are not aware of their risk.  If you are at an increased risk, a pharmacologic preventive therapy (chemoprevention) is a consideration you should discuss with your health care provider.  It has been reported that the agents used can reduce the risk by 50%.

The Gail Breast Cancer Risk Assessment Tool is one of the models that has been developed to quantify a woman’s risk of developing breast cancer.  By answering a series of questions about lifestyle, obstetric and gynecological history, and family history, a 5 year and lifetime risk can be calculated.  If there is a moderate to high risk, lifestyle and pharmacologic interventions should be considered.

Tamoxifen (Nolvadex) and Raloxifene (Evista) are two agents that may be discussed to help in the reduction in breast cancer.  There are risks and benefits to both medications, which need to be considered.

-Dr. P

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Don’t Only Be Aware in October

As October quickly comes to a close, the breast cancer awareness campaign will also come to an end.  It is imperative that our fight against breast cancer should not be at the forefront of our minds only in October but be there day by day, all year long.  All of us have someone close who has suffered with this cancer, so all of us must encourage the women in our lives to pursue proper breast health.  Don’t hold back today; speak to someone dear to you about breast cancer and you may save a loved one’s life!Mother and Daughter Face To Face

-Dr. P

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Osteoporosis – Are You at Risk and How Do You Treat It?

…..Many menopausal women suffer from osteoporosis.  Osteoporosis is the thinning of bones which causes them to become weak, brittle, and more susceptible to fractures.  Women have an increased risk of osteoporosis throughout their lifetime.  Risk factors include:

  • Low body weight
  • Smoking history
  • Fair skin
  • Menopausal state

…..There are various methods of prevention and treatment for osteoporosis.  There are medications such as the bisphosphonates (Fosamax) and selective estrogen receptor modulators (Evista).  Supplements such as calcium and Vitamin D are important additives.  Helpful lifestyle Osteoporosis Treatment Preventionchanges include the cessation of smoking, decreased alcohol use, and weight-bearing exercises.

…..Evista is a medication used to treat osteoporosis in the selective estrogen receptor modulator class.  It mimics the beneficial effects of estrogen by increasing bone density.  Many studies have also shown that Evista decreases the risk of certain types of breast cancer.  The side effects of Evista are hot flushes, leg cramps, and infrequent blood clots or strokes.

…..Speak to your health care provider to see if Evista can be of benefit for you to treat osteoporosis and prevent breast cancer.

-Dr. P

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Why Finding Out if You Have Cancer Genes Is Imperative

…..Breast cancer and Lynch syndrome genes are carried by over one million people in the United States, and these two conditions are associated with the most common hereditary gynecological cancers.  At present, only a very small percentage of the women who carry these genes have been identified.  Therefore, the protocols that can be used to decrease the risk of dying from the cancers that these genes can cause are not being instituted.

…..GenesOur family history will be the first indication that these genes may be a part of our genetic pool, and this can lead to testing for our carrier status.  If identified, the cancer screening tests start earlier for the individual carrier and for their relatives in future generations.

…..We must remember that, based on family history, about ten percent of women are at an increased risk for a gynecological cancer.  Due to the increased risk of breast, ovarian, colorectal, and prostate cancer, which is determined from the family history, a more intense and earlier testing program may be needed.

…..A woman with a first degree relative with breast cancer has an increased risk for developing that cancer, and it is greater if that cancer was found in that relative before the age of 50.  A first degree relative is a parent, brother, sister, or child.

-Dr. P

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Another Way to Reduce Your Risk of Developing Breast Cancer

Pink Breast Cancer RibbonSome women at a high risk for breast cancer may reduce their chance of developing invasive breast cancer with the use of the medication called tamoxifen.  Chemoprevention is the use of a medication to reduce cancer, and it may be considered in a patient who is at high risk of developing breast cancer.

In a high risk population, the risk reduction with the use of tamoxifen has been reported to be 49%, and this has resulted in the FDA approving tamoxifen as the first drug for breast cancer prevention.  In addition, studies have also found that another medication, called raloxifene, to be of benefit in menopausal women.  Of course there can be serious side effects with these medications, so their use may be limited.

If you are at a high risk of developing breast cancer, start a discussion with your medical team about the possible use of chemoprophylaxis!

-Dr. P

Read more about tamoxifen in my post: How Does Tamoxifen Treat Breast Cancer?

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How Does Tamoxifen Treat Breast Cancer?

…..Science HealthTamoxifen is a common endocrine treatment for both early and advanced breast cancer in pre- and post-menopausal women.  Some breast cancer cells are stimulated to grow in the presence of the estrogen hormone.  The estrogens bind to special areas in the cancer cells called estrogen receptors, and once the estrogens are attached, the cancer cells’ growth is enhanced.  These breast cancers are called estrogen receptor positive.

 …..Tamoxifen breaks down in the body into a compound that also binds to the estrogen receptor in the cancer cell, but it does not stimulate the cancer cell to grow.  Since the binding site is filled, any available estrogen cannot attach to the cancer cell and stimulate its growth.

…..After the diagnosis and treatment of a breast cancer that was estrogen receptor positive, many patients would be placed on 5 years of tamoxifen treatment, and this would reduce the recurrence of the disease.  New studies may cause oncologists to change the protocol to 10 years of tamoxifen treatment due to the findings of better long-term outcomes.  There are currently ongoing studies which should shed more light on the possibility of modifying the protocols.

…..I would like to touch upon two other points.  As with all medications, tamoxifen can have side effects.  Endometrial cancer is increased with the use of tamoxifen, and so oncologists follow patients closely for this potential problem.  Lastly, another group of medications, called aromatase inhibitors, is now being used more frequently with these patients, but worldwide tamoxifen remains widely used.

-Dr. P

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Breast Cancer – Early Detection Can Save Your Life

…..October is Breast Cancer Awareness Month, and hopefully we are all aware of the high risk of breast cancer that surrounds us.  We know that 1 in 8 women will develop breast cancer in their lifetime, and all of us have someone close who has suffered with this cancer.  In my own family, we lost Mary Ann’s mom, who was my wife’s mother, to this terrible disease.

…..Early detection saves lives, and it is all of our responsibility to encourage the special women whom we love to practice good breast health, which should include:

  • Monthly self breast examsBreast Cancer Pink Ribbon Patch
  • At a minimum of once a year, breast exams from your health care provider
  • Yearly mammograms starting at age 40
  • Special follow-up programs if there is a strong family history of breast cancer

…..As a gynecologist, breast health has been a daily and major part of my professional life.  I encourage all of my patients to be their own best advocates when it comes to breast health.  Do your self-exams.  Do the recommended breast studies.  Once the studies are done, get the results and understand what the results are.  Do the follow-up studies and follow-up consults that are advised.  If there is a problem, see the breast specialists.  Get second opinions if there is ever a doubt.  Let us all work together to defeat this foe!

-Dr. P

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