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Breast Cancer Awareness

Publication: The Best of Austin Magazine, Austin

“What’s my risk of breast cancer?” is a question many women ask their doctors. Doctors have tools to help assess a woman’s personal risk. Most women who get breast cancer have no known risk factors besides age. Many women with one or more risk factors never get breast cancer.

The Best of Austin magazine interviewed board certified internal medicine and medical oncologist Beth Hellerstedt, M.D. with Texas Oncology to learn more about the risk of breast cancer.

So is it impossible to know who will actually get breast cancer? There are tools that assess the risk, both short term and long term. Unfortunately, it is not possible to know with absolute certainty who is going to get breast cancer and who is not. The first thing that is most important about assessing breast cancer risk is knowing your family history. There is a subset of patients who actually have genetically inherited breast cancer risks, like genes that you would inherit for hair color or eye color. Angelina Jolie has been a great example of somebody who has been recently in the news with regard to breast cancer risk reduction. The test that she had, the BRCA test, can be performed on any patient that has the correct family history of being at risk for that gene.

Sometimes it’s difficult to know history going back several generations. I always encourage someone to get the most accurate assessment of their family history possible. Researchers continue to look for factors that might affect a woman’s risk of getting breast cancer.

What should I do if I know I’m at risk for breast cancer? The first thing to do is to have a discussion with your primary physician about risk. There are certain statistical tools that calculate risk, as well as considering whether or not more specific genetic testing is right for you. An oncologist maybe involved if your primary physician feels that your risk merits a discussion.

What is a preventive mastectomy, and what types of procedures are used in preventive mastectomy? A preventive mastectomy means that tissue is not currently known to have any cancer, but there is significant risk that the patient will develop cancer over time. That kind of surgery is generally reserved for patients like Angelina Jolie who have known genetically inherited mutations that increase their risk so much so that it would be a better option for them to have the surgery. For most patients, doing a mastectomy is not something we discuss routinely.

How effective is preventive mastectomy in preventing or reducing the risk of breast cancer? In patients who have the BRCA genes, doing a mastectomy prior to breast cancer will reduce the risk of developing breast cancer by 90% and higher. That’s as close as we can get, It’s the best reduction that can be achieved.

What alternatives to surgery exist for preventing or reducing the risk of breast cancer? One of the most important options for risk reduction is anti-estrogen pills, Tamoxifen, which patients are most familiar with. Tamoxifen is a pill that you take every day for 5 years, and it can reduce the risk of developing breast cancer by 50% or higher.

What other factors may help guide the decision to take drugs to lower the risk of breast cancer? Every drug has the potential for side effects. You have to carefully review the side effects of that medication and make sure that patient does not have other medical factors that may be important. For example, Tamoxifen is associated with a slightly increased risk of blood clots, so if a patient has already had a blood clot or a strong family history of blood clots, then we would have to assess that patient to see if that medication would be appropriate. We don’t want to run the risk of another potentially harmful event.

What are the side effects of taking drug to reduce my risk? How could these affect my quality of life? For some women the medications that we use for risk reduction can cause them to have symptoms like hot flashes and sweats which can be disruptive of their daily routine. There are a variety of things we can do both medical and not medical to decrease the potential side effects, and many women do notice that the side effects tend to improve over time.

What separates your practice from other practices in the Austin area? We have a very well developed program for genetic risk assessments so that we can accurately take a family history, and determine if genetic counseling is appropriate. If the genetic counseling is appropriate, then we inform the patient as to what the genetic testing is, what the implications of the results are -- positive or negative -- so that patients can make informed decisions. If the genetic test shows they have a genetic predisposition, like Angelina Jolie, then we have a referral system by which we go through their risk reduction options, and continue to follow them throughout their medical history. If you don’t have a genetic predisposition, we talk about potential risk reduction options like Tamoxifen, and go through the patient’s medical history and follow that patient to check for side effects and other problems. We also continuously monitor that patient with breast exams, and make sure they have the appropriate imaging like mammogram, ultrasound, MRI in the right timeframe.

Isn’t there a big misconception that breast cancer is genetic? There’s a misconception that genetics is the only risk factor for breast cancer. Certainly family history plays a role, but there are other factors like how much estrogen exposure you have had in your lifetime from things like birth control pills, how many other exposures like hormone replacement. Even weight and alcohol use play a role in increasing the risk of developing breast can­cer. Family history, while important, is certainly not the only part. A vast majority who are diagnosed with breast cancer, upwards of 70%-75%, have no family history. They are truly the first one in their family to have ever been diagnosed. There’s another misconception that if you have someone in your family with cancer, you automatically have a high risk of the gene for breast cancer. Only 1%-2% of breast cancer patients have the gene. A very significant minority of about 20% of patients with breast cancer do have family history, but do not have the gene. Unfortunately, women get a false sense of security that they are not going to develop breast cancer when they don’t have a family history. About 70% of women who are diagnosed will not have a family history.

Many women don’t investigate their risks because they are anxious about what they may find out. Most women, if they have a chance to talk about risks with their physicians, no matter what the out­come, are relieved to know that there are things they can do to manage the risk. We can explain the risk so that you can understand the things you can control such as weight, exercise, alcohol intake, and living a healthy lifestyle. You can control your risk prevention.

If you’re looking for ways to lower your breast cancer risk, focus your efforts on a healthy lifestyle. Well-balanced meals and regular physical activity can help you to maintain a healthy weight. Limit alcohol to no more than one drink a day. Whether these steps will specifically protect you from breast cancer is not certain. But living a healthy lifestyle is a cornerstone of disease prevention.

Dr. Beth Hellerstedt:

Beth Hellerstedt, M.D. specializes in medical oncology. She is board certified in internal medicine, hematology and medical oncology. Dr. Hellerstedt was awarded the Glaxo Smith Kline Research Fellow at the University of Michigan Medical Center in 2001-2002, the National Service Research Award from the National Institutes of Health in 2001-2002, the Bronze Beeper Award, Excellence in Resident Training in 1999, and Elected Member of the Alpha Omega Alpha Medical Honor Society from the University of Pittsburgh School of Medicine in 1997.

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