Managing Breast Cancer Risk

October is Breast Cancer Awareness Month, and we are excited to feature several guest bloggers on this topic.  The first is Dr. James Holland, Distinguished Professor of Neoplastic Diseases  at Mount Sinai School of Medicine and the T.J. Martell Foundation’s Founding Research Scientist:

Every woman must think of breast cancer as a risk that can be managed better by attention than by negligence.

–  Starting at age 50 (and many think at age 40) mammograms are of great value in early diagnosis.

–  Other supplementary diagnostic methods include sonography and magnetic resonance imaging.

–  Self examination can help; professional examination is much better.

Early diagnosis markedly improves curability.

–  Although there are some known genetic predispositions, they account for less than one in ten breast cancers, and thus no woman is exempt.

– Although breast cancer occurs in men, the great preponderance in women establishes that estrogen is a critical component of its development.

– Post-menopausal hormonal replacement increases risk.

On prevention:

– Exercise is one preventive, and is free.

– Drugs that diminish estrogen effect on breast tissue, such as tamoxifen or raloxifen are valuable in women at high risk.

– We do not yet have a universal preventive, however.

Improved treatments:

– For early breast cancers removal of the entire breast is rarely needed.  Preservation of the breast is psychologically advantageous.

– After surgery, and sometimes even before, hormone therapy, radiation therapy,  chemotherapy and immunotherapy may all have roles to play in specific instances.

– Cure is possible most of the time, and even in the minority who are not cured, there are usually major benefits of treatment.

The day will come when we know how to prevent many if not most breast cancers without seriously compromising normal life (as has been true for lung cancer by tobacco avoidance, for skin cancer by sunshine avoidance, and for penile cancer by circumcision). Until then, alert attention, not fear, is the best path for today’s woman.

James F Holland MD
Distinguished Professor of Neoplastic Diseases
Mount Sinai School of Medicine


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