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Why Me? Understanding What Really Causes Breast Cancer · Meaningful Medicine with Novant Health

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  Amanda Wilde (Host): Meaningful Medicine is a Novant Health podcast bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Amanda Wilde with hematologist and oncologist, Dr.
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  Sandrine Crane.
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  We're talking about breast cancer, from how to think about risk
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  and prevention to the latest options in care and survivorship.
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  Dr.
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  Crane, thank you so much for being here today.
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  Sandrine Crane, MD: Thank you for having me.
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  Host: I want to start out with what are some of the biggest myths
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  or misconceptions you encounter about what causes breast cancer,
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  and what does the science show?
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  Sandrine Crane, MD: One of the most common myths that I encounter is whether or
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  not sugar contributes to breast cancer.
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  And sometimes it is even phrased as feeding cancer.
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  Anything that we consume, whether carbohydrate, proteins, and even lipids,
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  everything gets broken down to the same level of energy that the cells can use.
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  We use them for our own survival.
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  Cancer cells can also use the same type of energy, but there have not been any
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  studies that shows that sugar can increase risk of having breast cancer or even
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  worsen the outcome of breast cancer.
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  It is usually recommended to eat a healthy and balanced diet and limit
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  processed food as well as added sugars.
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  Another myth that I have encountered is whether or not deodorant or
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  even antiperspirant can increase the risk of breast cancer.
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  And there have not been any studies that have shown that this is a
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  risk factor for breast cancer.
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  And sometimes usually people will wonder why they are asked to hold or not use
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  deodorant on the day of their mammogram.
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  And this is to prevent particles from the deodorant being seen on a mammogram and
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  making it harder to pick up abnormalities.
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  Host: So, that's where that one got started.
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  I've also heard that genetics play such a large role.
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  Sometimes people feel like, "If I don't have the genetic factors, I don't really
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  have to worry about breast cancer."
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  Sandrine Crane, MD: That is also another myth.
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  Only about 5% to 10% of patients who have breast cancer have a genetic
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  predisposition to the breast cancer.
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  And only about 15% who have breast cancer and have a family member
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  who've had breast cancer in the past.
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  So, the majority of patients who have breast cancer have no genetic
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  predisposition and do not have a family history of breast cancer.
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  So, it is always important to undergo screening on time and as recommended.
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  Host: Well, let's get a little deeper into the risk factors.
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  And then, we'll talk too about how breast cancer care has evolved in recent
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  years and what the options are there.
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  But back to genetics and family history, they do influence breast cancer risk.
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  When should someone consider genetic testing?
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  Sandrine Crane, MD: It's always a nuanced conversation, but current
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  guidelines do recommend for anybody who is diagnosed with breast cancer before
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  the age of 50 to undergo genetic testing.
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  For family history reasons, if someone has a family member who's had breast
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  cancer before the age of 50, or a family member who's had pancreatic
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  cancer, or who has had ovarian cancer, or even advanced prostate
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  cancer, they are definitely people who should consider genetic testing.
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  There are new treatment options that are available to patients who
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  have specific genetic mutations.
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  So if a treatment consideration are being taken into account, genetic testing
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  is offered on an individualized basis.
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  Host: You mentioned lifestyle also earlier, like exercise and diet.
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  How meaningful are diet, exercise, and weight management when we talk about
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  affecting breast cancer risk or outcome?
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  Sandrine Crane, MD: So, we do have studies that show that maintaining an active
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  lifestyle is important to decrease the risk of breast cancer occurrence while
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  maintaining a normal body mass index.
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  And we also know that the same benefit also applies after someone
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  has been diagnosed with breast cancer.
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  So, exercise has been shown to decrease the risk of breast cancer-related
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  mortality, even all-comers mortality.
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  The current recommendation is for moderate exercise of about 150 minutes per week.
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  Weight-bearing exercise is about two days a week.
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  Those are definitely lifestyle changes that can make a difference.
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  Host: What other lifestyle factors like smoking and alcohol
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  use should patients consider?
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  Sandrine Crane, MD: So, we do know that breast cancer has a strong association
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  with alcohol misuse in terms of the diagnosis of breast cancer, even outcome
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  after a diagnosis of breast cancer.
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  So, it is recommended to not consume any alcohol.
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  But
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  if it is going to be consumed,
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  Sandrine Crane, MD: to limit to one drink per day.
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  Smoking also has an association with the breast cancer diagnosis and even the
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  outcome after breast cancer diagnosis.
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  We know that sometimes the carcinogens that are produced from smoking can
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  even affect how certain medications and chemotherapy agents function or help
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  patients and sometimes can actually lead to resistance to medication.
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  So, we are always working with patients if they are smoking or
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  drinking to try and address those lifestyle choices and decrease the
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  risk of breast cancer recurrence.
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  Host: Another risk that is often brought up is hormone-related.
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  I think hormone-related questions are common.
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  Do birth control pills and menopausal hormone therapy
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  factor into breast cancer risk?
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  Sandrine Crane, MD: Yes, they do.
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  So for premenopausal women, who use estrogen-based medication, that
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  can increase the risk of breast cancer and specifically estrogen
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  receptor-positive breast cancer.
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  The same also applies for the use of estrogen and combined progesterone
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  hormonal replacement after menopause.
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  In post-menopausal setting, those hormones are recommended to address
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  the symptoms related to menopause.
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  Sometimes it might be hot flashes.
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  It might be mood changes and even maintaining bone density.
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  If those medication are to be considered, we usually recommend for them to be used
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  in the least amount possible and for the least amount of time that's possible.
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  Host: How should people think about risk versus responsibility?
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  I mean, how do you balance giving patients actionable advice
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  without making them feel blamed?
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  Sandrine Crane, MD: It's a balance.
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  Very often, after diagnosis of breast cancer, you might sometimes encounter
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  a patient who's blaming themselves, because everybody always wonders,
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  "What did I do or what did I not do that has led to this diagnosis?"
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  Even though we know that smoking, alcohol misuse, and sometimes use of
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  estrogen-based medication can increase the risk of breast cancer, I think it's
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  best to focus on what can be done in the future to decrease the risk of breast
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  cancer recurring or even improving the outcome of breast cancer treatment.
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  And we know that there are things that we can incorporate, including assistance with
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  smoking cessation, counseling about any lifestyle modifications that can be taken.
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  Host: So when someone is diagnosed, you will meet them where they
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  are to work on those things.
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  You just mentioned one of the common misconceptions.
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  It might be that "I caused this or the products I used weren't healthy for me."
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  Are there any other common misconceptions you want to bring up about prognosis
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  or treatment once someone is diagnosed?
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  Sandrine Crane, MD: So, some of the misconceptions, sometimes they have
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  to do with prognosis in general.
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  Breast cancer is still a very common type of cancer in women.
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  Probably one out of eight women will have breast cancer in their lifetime.
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  People might think that it is a death sentence of being
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  diagnosed with breast cancer.
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  There are new medication and therapies that have changed the overall outcome
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  of patients who have breast cancer.
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  I reassure patients that we will walk through this journey together, and we
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  have different ways that we can support them, make sure they know that they're not
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  going to go through this by themselves.
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  Host: And another reassuring point is that breast cancer care is
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  continually evolving and getting more and more specialized in recent years.
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  What innovations give you the
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  most hope for patients now and in the future?
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  Sandrine Crane, MD: Research have made significant leaps in terms of
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  improving breast cancer outcomes.
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  There are new medication that are targeted.
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  Some of them have been out for the last maybe 10 years.
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  So, the CDK4/6 inhibitor that have changed the outcome of estrogen-positive breast
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  cancer, both in the metastatic setting, even in early stage of breast cancer.
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  We also have newer drugs that are antibody-drug conjugate that are very
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  well-tolerated and also target and deliver the chemotherapy to the cells.
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  The overall survival of patients, who have early stage, even advanced breast
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  cancer, have improved significantly.
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  And that gives me great hope.
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  Host: So, a lot of hope now and looking into the future.
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  Sandrine Crane, MD: Yes.
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  Host: Well, thank you for this conversation, Dr.
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  Crane.
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  Really appreciate your time and the insights you've shared and all
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  the work you do at Novant Health.
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  Sandrine Crane, MD: Thank you.
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  Host: Dr.
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  Sandrine Crane is a hematologist and oncologist at Novant Health.
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  To find a physician, visit novanthealth.org.
• 10:24
  For more health and wellness information from our experts,
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  visit healthyheadlines.org.
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  This is Meaningful Medicine, a Novant Health podcast.