Women's Health Matters

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Breast Cancer

In August 2009, our guest expert was Dr. Steven Narod, director of the Familial Breast Cancer Research Unit at Women’s College Research Institute.

In the field of breast cancer research, Dr. Narod is the most cited scientist in the world. His current research focuses on translating what we know about hereditary cancer into more effective ways to prevent and treat both breast cancer and ovarian cancer. His research studies include women from families with and without genetic mutations related to breast cancer. Some of his current projects include studies looking at risk factors associated with hereditary breast and ovarian cancers, investigating the role of BRCA2 mutations in ovarian cancer, and investigating how CHK2 gene mutations contribute to breast cancer risk.

Here are his answers on Breast Cancer.

Q: Recently, my 59-year-old mother was diagnosed with fairly advanced breast cancer. Attempting to be proactive with my health, I spoke to my own health practitioner about mammograms (I am 29). I was told that mammograms are rarely useful on younger women because the density of breast tissue makes it difficult to detect any growths. This is a little discouraging since women are constantly being told to keep on top of their health. At what point do you think it is reasonable to request a mammogram once someone has a family history? At what age and at what frequency should I have one?

A: I agree with your doctor. You are not considered at high risk based on your mother’s breast cancer at age 59. If there are additional family members with breast or ovarian cancer, you should consult with a genetic counsellor. MRI is becoming the standard of care in women at high risk of breast cancer.

 


Q: What is the relationship between oral contraceptives and breast cancer risk? I have heard that oral contraceptives increase your risk of breast cancer, but I have also heard that they do not. Also, is there a relationship between duration of oral contraceptive use (years) and breast cancer risk? Does this risk decrease when you stop taking birth control pills? Thank you for your help.

A: There is a weak relationship between the use of oral contraceptives and breast cancer, but the overall increase in risk is very modest. In general, women who take the pill should not consider themselves at high risk, and women with other risk factors need not avoid the pill.

 



Q: I understand that fibrocystic breasts (a benign condition) tend to be caused by elevated levels of estrogen and that women with this condition tend to have denser breasts. Are women with fibrocystic breasts more likely to develop breast cancer? Is there anything particular that women with fibrocystic breasts should be doing to prevent breast cancer?

A: Having fibrocystic breasts does not increase your risk for breast cancer.

 


Q: My mother died of breast cancer. She was ER- (estrogen receptor negative) and PR- (progesterone receptor negative). There was no HER2 testing back then. I have breast cancer and I am triple negative. My doctor will not give me the BRCA genetic testing. I think that it is more than coincidence that mother and daughter have ER- breast cancer. Do you think I should be tested? (I was 57 when I was diagnosed and my mother was 63 at diagnosis.)

A: Based on your family history, the chances of your having a mutation are low (about 5 per cent). Some would recommend testing at this level of risk and some would not. In Ontario, this would not qualify you for testing unless there were additional cancers in the family.

 


Q: I am a 60-year-old woman who had uterine cancer three years ago. I am cancer-free now due to a total hysterectomy. I continued to have extreme hot flashes, so my doctor put me back on estrogen and progesterone. I am on the lowest dose of both and it seems to be eliminating the hot flashes. Will my chances of getting breast cancer increase by taking HT and how long do you think I should stay on it?

A: In most cases, women will be offered estrogen without progesterone after a hysterectomy. Estrogen alone does not appear to have an impact on the risk of breast cancer. I would recommend you ask your doctor specifically if the progesterone is necessary.

 



Q: When you counsel women who are BRCA gene carriers, do you provide nutritional recommendations? Do you participate in any research linking the relationship between diet and cancer prevention? Can you refer patients to a dietitian within the hospital for an in-depth consulting session?

A: I’m afraid there is not a lot to offer on this topic. I do recommend the use of vitamin D, and we are currently conducting research on DIM (diindolylmethane), a compound found in broccoli and other vegetables.

 


Q: I am 52 years old and last week I found a lump on my left breast measuring 4 cm x 2 cm. I was diagnosed with fibrocystic mastitis. What are the precautions and care for this?

A: I’m sorry, but this is not within my field of expertise. I suggest you discuss it with your surgeon. Fibrocystic mastitis is not a risk factor for breast cancer.

 


Q: Is cancer in situ hereditary?

A: No, it isn’t.

 


Q: How worried should I be about getting breast cancer if my mother got it at age 79? Does that elevate my risk above someone whose mother doesn’t have breast cancer?

A: If your 79-year-old mother is the only family member affected, then your risk of breast cancer is not elevated.

 


Q: What is the best kind of hormone therapy for surgically induced menopausal women who do not have cancer, but are BRCA2+?

A: The therapy will depend on the symptoms you are trying to control. However, hormone therapy is not a risk factor for breast cancer in BRCA2 carriers.


Q: I am 46 years old and have been premenopausal for about a year. I have fibrocystic breasts. I have been having night sweats and insomnia. My doctor is proposing hormone therapy. I would like to know whether or not hormone therapy increases the risk of breast cancer.

A: Long-term (10 or more years) use of combination estrogen/progesterone therapy is a risk factor. However, estrogen alone appears to be safe.

 

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