Interesting Article in NY Times Nov. 13 Health

Interesting article.  For what it's worth, my take on the reason single nutrient studies never prove anything is that you can't take extracted Vitamin E, for example, and give it to otherwise unhealthy or even moderately healthy individuals and expect a result.  Vitamins are not found singularly in nature, and we need to get them from whole foods or supplements that are manufactured with this in mind (retaining all the micronutrients that are found with the Vitamin E, etc.).  And to see any real benefit, I think it's very important to consider the whole picture of what one is eating -- not just adding a single, sometimes synthetic, test-tube manufactured, nutrient.

And the "threat" to perhaps lose interest in doing future research is kind of absurd.  First the drug co's give us bc pills and HRT that totally mess up our hormones, then someone speaking for them complains about some of us making usually well-informed, personal decisions not to continue to mess with our hormones via Tamox & A/Is?  Also, I think the price factor was really down played.  I'll bet if they priced them more reasonably, they'd have a lot more users (although not  me).    JMHO on the article, and in no way a criticism of anyone who feels good about doing estrogen-blocking meds and not supplements.  This is a personal disease, and our decisions about how we deal with it and our bodies should all be respected.    Deanna

Hey, my risk of having breast cancer in the next 5 years is less than 1%!  . . . oh, wait. nevermind.

Except for that part, I really liked the article. But then it supports my feeling that this is all a crapshoot and we really don't have much control over if/when we get cancer or it comes back (see risk factor above). 

When I first went to a gym after bc treatment, the trainer/sales guy asked what I wanted to accomplish. I told him that I wanted to exercise 30 minutes 5 times a week to cut the chance of bc recurrence by 50%. And this sales jock kind of guy said "Don't look at it that way, because then if it comes back you will feel like a failure and taking care of yourself is never a failure. Look at it like getting as strong and healthy as you can so that you have more resources whatever happens to you next."  Whoa. Wisdom where you least expect it.

revkat wrote: Hey, my risk of having breast cancer in the next 5 years is less than 1%!  . . . oh, wait. nevermind.

 Ha, ha -- me too!!!

Otter - I was a bit annoyed about popping the 'magic pill' too. I know personally of several ladies who relapsed and taking it for the prescribed 5 years; one died this August. So much for it's wonderful efficacy.  Last week, I dropped a friend off at the hospital for a complete hysterectomy after being on the 'magic pill' for just over 1 year.  Her uterus was the size of a football and full of fibroids.  I'm not saying it caused the fibroids as the medical community is fairly slick with avoiding that topic.  However, IMO taking it if you have fibroids (which you probably don't know you have), is like adding fuel to a fire and they really start to grow and cause problems. 

Looks like the blame the is being put back onto the patients for not taking these wonder drugs.  All the more reason why we as patients need to DEMAND SAFER drugs with BETTER EFFICACY.  Enough already with a few percentage points here and plastering the news like it's some major break through in cancer.  We are tired of the long term and dangerous side effects of these drugs.  We are not stupid. We have learned to be cautious because they taught us not to trust the medical community.  There are plenty of stories here of women who were dismissed by their doctors with issues and later diagnosed with real medical problems. 

I am suspecting a pharma tie to the article.  Sounded like a scolding parent. "You people had better start taking the meds we have made just for you or we will have to stop producing any new ones."  Shame on us!?

It's kind of a bizarre concept for me - "ok, you had a healthy checkup, all is well. This is the medicine you need to take."

That's just not the way people think. Maybe they should call their drugs supplements and then healthy people would take them.. LOL. Just kidding! 

Anyway, I can't remember the exact number, so someone jump in and correct, but isn't it true that some 80% of us who get BC don't have the risk factors? 

It seems the term  "high risk"  is proving to be based on some questionable data. 

swim, I forgot about that comment by Brawley ("...the crucial period may occur early in life - girls who gain weight when they are young, he said, tend to start menstruating earlier, which increases their breast cancer risk because it adds years of exposure to the body's estrogen. It may be that weight loss in adulthood does not help.")

I guess he hasn't been reading the same reports we've been reading.  I wish I could put my hands on those papers I've seen that say weight gain, or even failure to lose excess weight, once you've been dx'd, can result in a greater risk of recurrence.  If it wasn't so warm and sunny outside right now, I would spend an hour searching for that stuff.  Maybe later...

I think Brawley is just speculating -- giving his own opinion -- kind of like when he speculated to a NY Times reporter that the American Cancer Society was planning to issue revised guidelines that would back way off the current recommendations about regular mammograms. Other people affiliated with the ACS said they had never heard there would be changes to the guidelines, and they were the people who were supposed to write them. The ACS pretty much retracted Brawley's statement after that.

otter 

Okay <sigh>, I've been doing some homework tonight. This is not a real literature review -- I just looked sort of randomly for papers that said something about adult weight gain or weight loss and BC risk, especially after menopause.   What I found was very interesting... and completely the opposite of what Dr. Brawley was claiming in the NYT article.

Here are some of the many papers that reported an increased risk of BC in women who gained weight during adulthood, or conversely, had a decreased risk if they lost weight.  I'm just going to give the citation and a link to the abstract, and maybe a brief quote.

1) Cummings, S.R. et al.:  Prevention of breast cancer in postmenopausal women: approaches to estimating and reducing risk. J Natl Cancer Inst 101(6):384-398, 2009. (http://jnci.oxfordjournals.org/cgi/content/abstract/101/6/384) --

"Breast density was strongly associated with breast cancer (relative risk [RR] = 4.03, 95% confidence interval [CI] = 3.10 to 5.26, for BIRADS category IV vs category I; RR = 4.20... for >75% vs <5% of dense area) ... Estradiol was also associated with breast cancer (RR range = 2.0–2.9, comparing the highest vs lowest quintile of estradiol...). Most studies found that exercise, weight reduction, low-fat diet, and reduced alcohol intake were associated with a decreased risk of breast cancer. Tamoxifen and raloxifene reduced the risk of estrogen receptor–positive invasive breast cancer and invasive breast cancer overall. ..."

2) Sprague B.L. et al.: Proportion of invasive breast cancer attributable to risk factors modifiable after menopause. Am. J. Epidemiol. 168(4):404-411, 2008. (http://aje.oxfordjournals.org/cgi/content/abstract/168/4/404) --

"The summary PAR [population attributable risk] for factors modifiable after menopause, including current postmenopausal hormone use, recent alcohol consumption, adult weight gain, and recent recreational physical activity, was 40.7%. Of the individual modifiable factors, the highest PARs were observed for weight gain (21.3%) and recreational physical activity (15.7%) ... The summary PAR for factors not modifiable after menopause, including family history of breast cancer, personal history of benign breast disease, height at age 25 years, age at menarche, age at menopause, age at first birth, and parity, was 57.3%. These findings suggest that a substantial fraction of postmenopausal breast cancer may be avoided by purposeful changes in lifestyle later in life."

3) Eliassen, A.H.: Adult weight change and risk of postmenopausal breast cancer. JAMA 296:193-201, 2006 (http://jama.ama-assn.org/cgi/content/abstract/296/2/193) --

"Compared with those who maintained weight, women who gained 25.0 kg or more since age 18 years were at an increased risk of breast cancer (relative risk [RR], 1.45...), with a stronger association among women who have never taken postmenopausal hormones (RR,1.98...). Compared with weight maintenance, women who gained 10.0 kg or more since menopause were at an increased risk of breast cancer (RR, 1.18...). Women who had never used postmenopausal hormones, lost 10.0 kg or more since menopause, and kept the weight off were at a lower risk than those who maintained weight (RR, 0.43...). ... These data suggest that weight gain during adult life, specifically since menopause, increases the risk of breast cancer among postmenopausal women, whereas weight loss after menopause is associated with a decreased risk of breast cancer...."

4) Lahmann P.H. et al.: Long-term weight change and breast cancer risk: the European prospective investigation into cancer and nutrition (EPIC). Br J Cancer 93(5):582-9, 2005. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361598/) --  

"Changes in weight [since age 20] were not associated with premenopausal breast cancer risk. In postmenopausal women, weight gain was positively associated with breast cancer risk only among noncurrent hormone replacement therapy (HRT) users ... Compared to women with a stable weight (+/-2 kg), the relative risk for women who gained 15-20 kg was 1.50 .... Weight gain was not associated with breast cancer risk in current HRT users, although, overall, these women experienced a much higher risk of breast cancer compared with nonusers. Our findings suggest that large adult weight gain was a significant predictor of breast cancer in postmenopausal women not taking exogenous hormones."

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And, here's a paper that reported an inverse relationship between weight at age 12 and risk of BC (i.e., the opposite of what Brawley suggested)...

5) Bardia A. et al.: Relative weight at age 12 and risk of postmenopausal breast cancer.  Cancer Epidemiol. Biomarkers Prev. 17(2):374–8, 2008. (http://cebp.aacrjournals.org/content/17/2/374.full) --

"Compared with women with average weight at age 12 years, there was no association of below average weight with risk of breast cancer (RR, 1.02...), whereas women with above average weight had a lower risk (RR, 0.85 ...). There was no evidence of an interaction between weight at age 12 years and family history .... The inverse association of above average weight with risk of breast cancer was strongest for PR- tumors (RR, 0.62...), intermediate for ER+ (RR, 0.80...) and ER- (RR, 0.77...) tumors, and weakest for PR+ tumors (RR, 0.90...). These associations were not modified by a family history.... ".

+++++++++ 

If it wasn't so late already, I'd get off my butt and go for a walk!

otter 

Wow, Otter.  Are you going to send those abstracts to the Times reporter?

One more thing annoying me:  the article says, about tamoxifen, that it caused "about two additional cases of uterine cancer per 1,000 women per year."  In the context of the article, to me, it almost sounds dismissive of that risk!

And yet, as I recall, the Women's Health Initiative (WHI) report in July 2002 caused a drastic decline in prescription of postmenopausal hormone replacement due to an increased risk of breast cancer, described as 8 additional cases per 10,000 person-years.  Correct me if I'm wrong, but that sounds like a lower risk than the risk of uterine cancer posed by tamoxifen, right?
(see: http://jama.ama-assn.org/cgi/content/full/288/3/321)

Good point, cmharris59.  The study quoted in the article as showing tamoxifen "cuts the risk of breast cancer in half" in women considered "high risk" only showed that benefit for ER+/PR+. The number of ER-/PR- breast cancers was equivalent in the tamoxifen and placebo groups.

Ann ~  Thanks for posting both of those links.  I'm anxious to read more of Dr. P's blog, which I hadn't come across before, and I found quite a few of the NYTimes comments very interesting and well written, especially those that got 100+ thumbs ups.  Good to know that so many folks have the analytical ability to see an article like this for what it is, and felt passionate enough about it to express their thoughts on it.    Deanna

C, I'm thinking about this:  "Although I was told by one doc that becasue I was pregnant once and had the miscarriage late in the second trimester that it counted as pregnancy for BC risk factoring."

I used to think that, too; but I've read since then that the pregnancy has to be carried to term for it to really "count".  (I've also read even more recently that it's lactation .... um, I mean breastfeeding, that really makes a difference.)  I guess I find it perplexing that being childless -- no, the correct term is "nulliparous" -- is a risk factor because we had more months of estrogen exposure than a woman who had a child.  So, would someone with, say, 18 children (of her own) be at negative risk, perhaps?  (Just kidding.)

Why would there be such a dramatic difference in BC risk between someone who's had [(50 - 13) x 12] = 444 menstrual cycles (assuming perfect regularity), and someone who's had 444 menstrual cycles minus 9 for each pregnancy and minus another 3 to 6 for breastfeeding each baby?  Having a couple of kids doesn't look like it would make that much difference, mathematically.  Of course, those kids "count" the most if they're born early in one's childbearing years. If we wait until our mid-30's or later, they don't count either.  So, I guess if we only consider the menstrual cycles (estrogen exposure) that occurred between age 13 and the start of pregnancy #1 as being the critical ones, taking out that 12 - 15 months of cycling would have more of an impact.

Or am I now doing too much speculating -- the same thing the good Dr. Brawley was doing?  Am I the only one who muses occasionally that this BC adventure might be Nature's way of retaliating because I "chose" not to have children?  Did anyone else here know that dogs get mammary cancer, but it can be prevented almost completely, by spaying them before their first "heat" cycle?

Where's that thread I just saw about dark chocolate reducing stress hormones?...

otter 

You know, reading all of this, (or a lot of it) makes me wonder if me taking birth control pills for about 35 plus years...(including estrogen) added to my chance of this breast cancer?  I had so much trouble, while I was younger, with SKIN problems, like hives, welts, etc...Finally went back on the pill, and it quit!  That was after a hysterectomy!   Then Estrogen, until my doctor decided I didn't need one anymore.  That was about 12 years ago...I am now 72.  I don't know WHEN I ever went through menopause!  Although I can BET I must have, somewhere along the line...Never even had a hot flash...I gave thanks to the "pill," for helping with that!  But now, I'm not so sure it didn't contribute to finding cancer, which I will see Monday, about when they will do surgery!  My Mom had breast cancer at age 60 I think....And she never even took the pill, & very little estrogen!  And after a mastectomy, she lived a long life!  But I'll ask the surgeon, tomorrow what SHE thinks!  Maybe my treatment plans will take into account my past hormone use?   It's like the more information I read, the more questions I have! 

Otter,

Actually, my doctor's reasoning (this was not my oncologist btw, it was a PCP from years ago) had to do with how much milk had been produced in the breasts rather than exposure to estrogen. Since I had been lactating for awhile before the miscarriage, it was thought to decrease my risk.  I have never put much credence to it, in fact, I rarely mention it as most people that I know do not even know that I was pregnant. 

I still never expected to have BC just because of my family history of longevity and lack of any cancer histories in our family.

C