Sunday, October 27, 2013

Breast cancer prevention should begin early in life


Breast cancer remains the second leading cause of cancer death among women. In the US it is estimated that 40,000 women will die from breast cancer in 2013. Just over 232,000 women will be diagnosed with breast cancer. Importantly, nearly a quarter of these new cases are diagnosed among women who are less than 50 years of age.

There are important successes with regard to detection and treatment of breast cancer. The rate of mortality has decreased by 30% over the last 20 years. The steady increase in incidence together with the aging population means that we have ever more total new cases of breast cancer diagnosed here and throughout the world.

Clearly, prevention is a much better choice than more diagnosis and treatment. It should be our first choice! We have the knowledge and tools to prevent more than half of breast cancer and avoid the pain and suffering that it causes. Prevention strategies will have the greatest impact when initiated early in life and sustained, but it is never too late for a woman to act.

Compelling scientific evidence shows that alcohol, obesity, and lack of exercise all cause breast cancer. Our recent posts here point to diet during adolescence and early adult years also offering important insights for prevention. Alcohol intake before first pregnancy increases risk of breast cancer throughout life. Further insights may help us understand how modifying other aspects of diet in this time frame could prevent the adverse effects of alcohol or reduce their impact on breast cancer risk.

Vegetable protein intake (including peanuts and peanut butter) show promise as does high soy intake through childhood and adolescence. We need to act on these findings now to bring prevention to women in their early adult years since much of breast cancer risk is set well before women enters menopause. We illustrate this in the figure below showing how reducing alcohol intake and sustained levels of physical activity from early life substantially reduce lifetime risk of breast cancer.

While higher levels of physical activity and weight loss after menopause can substantially reduce risk of breast cancer, we have not embarked on sustained population-wide efforts to increase physical activity and achieve sustained weight loss among middle aged women. Other strategies, such as selective estrogen receptor modulators (Tamoxifen and Raloxifene) are recommended to be considered by postmenopausal women at high risk. However, we should not wait till a quarter of breast cancers in a population of women have been diagnosed to think about starting prevention.

We have failed to harness our existing scientific knowledge to deliver effective prevention strategies. Its time to start!

See: 8IGHT WAYS to Prevent Breast Cancer

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