How Weight (BMI) Impacts Breast Cancer Risk in BRCA Mutation Carriers
Individuals with BRCA1 and BRCA2 gene mutations put people at a higher risk of developing breast and ovarian cancer. A recent research article by Bhardwaj et al., sheds light on the impact of Body Mass Index (BMI) on breast cancer risk for BRCA mutation carriers.
Obesity, (having a BMI of 30 or higher), is a known risk factor for breast cancer among women in the general population after menopause. However, for women with a BRCA1 or BRCA2 mutation, the relationship between BMI and breast cancer risk has been unclear due to conflicting findings in previous studies.
How a High BMI impacts Breast Tissue
In the study, researchers investigated the impact of BMI on the breast tissue of BRCA mutation carriers. They found a positive correlation between BMI and DNA damage in normal breast epithelial cells in high BMI individuals. In other words, a higher BMI increases DNA damage, potentially also increases the risk of breast cancer.
The researchers further explored the mechanisms behind this link. They discovered that obesity-associated factors, such as estrogen biosynthesis, are activated in the breast adipose microenvironment of BRCA mutation carriers. These alterations affected neighboring breast epithelial cells, contributing to increased DNA damage.
Benefit of Estrogen Therapy
Estrogen, a hormone known to play a significant role in breast cancer development, is influenced by obesity-associated factors. In breast tissue explants cultured from BRCA mutation carriers, blocking estrogen biosynthesis or estrogen receptor activity reduced DNA damage. This suggests that targeting estrogen may have a protective effect against breast cancer in this higher-risk population.
Potential Targeted Therapies
The study also explored the impact of other obesity-associated factors, such as leptin and insulin. These factors increase DNA damage in BRCA heterozygous epithelial cells. However, inhibiting the signaling of these factors with specific interventions decreased DNA damage. This opens up potential avenues for reducing breast cancer risk in BRCA mutation carriers through targeted therapies.
To strengthen their findings, the researchers conducted experiments on mice. They found that increased adiposity (body fat) was associated with mammary gland DNA damage and increased tumor development, further supporting the connection between BMI and breast cancer risk.
The results of this study support the link between elevated BMI and breast cancer development in BRCA mutation carriers. Therefore, maintaining a healthy body weight is particularly important for reducing breast cancer risk in this population. Additionally, pharmacologically targeting estrogen or metabolic dysfunction may offer possible preventive strategies.
This study brings us valuable insights into reducing breast cancer risk for individuals with BRCA mutations. By maintaining a healthy weight, avoiding processed foods, and exploring targeted interventions, BRCA mutation carriers can take proactive steps towards better breast health.
Breast Cancer Patients Long-Term Quality of Life After Breast Conservation vs. Mastectomy and Reconstruction
Women facing surgery after a breast cancer diagnosis have the option of removing the entire breast (mastectomy) or only the affected breast tissue (lumpectomy). Regardless of which type of surgery a patient chooses, research shows both groups of women are equally satisfied with their breasts 10 years after surgery.
However, there were two areas where breast conservation patients and mastectomy patients differed: women who had a lumpectomy along with adjuvant radiation therapy (also known as “breast conservation”), reported better psychological and sexual well-being 10 years after surgery than those who underwent mastectomy and reconstruction.
“These findings may inform preference-sensitive decision-making for women with early-stage breast cancer,” explains Dr. Benjamin D. Smith, of The University of Texas MD Anderson Cancer Center.
According to a similar study, these findings “have substantial implications for patient decision-making, given that more women eligible for breast-conserving surgery are opting for a mastectomy,” shares Dr. Sudheer Vemuru, of the University of Colorado School of Medicine, Aurora.
“Overall, the preponderance of evidence suggests superior short-term and long-term patient-reported outcomes in patients with early-stage breast cancer undergoing breast-conserving surgery compared with mastectomy,” adds Dr. Vemuru.
Regardless of what type of surgery a patient ultimately chooses to have, if they are fully informed of ALL their options, they are far more likely to be satisfied with their overall outcome and feel they made the best choice for them. Patients and medical providers must work together to decide what surgical procedure(s) best meets the patient’s outcome goals and lifestyle.
Questions to Ask Your Doctor When Considering Breast Conservation vs Mastectomy and Reconstruction
If you don’t understand what your physicians or nurses are saying, don’t be scared to let them know your concerns. When you see your doctor, you may want to bring another person with you and have them take notes to help you remember what was said. Here are some questions to ask to better understand your options:
- Is breast-conserving surgery (lumpectomy) an option for me? Why or why not?
- What are the pros and cons of breast-conserving surgery versus mastectomy, with or without reconstruction?
- How many surgeries like mine have you done?
- Do I need lymph nodes removed? If so, how many and what are the risks?
- How long will I be in the hospital?
- How should I care for the surgery site? Will I need someone to help me?
- What will my breasts look and feel like after my surgery? How will the procedure impact my feeling?
- What will the scar(s) look like? Can they be hidden around the areola or in the breast crease?
More questions for your breast surgeon can be found here.
The Importance of Shared Decision Making
Shared decision-making occurs when the health care professional and patient work together to make a treatment decision that is best for the patient. The best decision takes into account evidence-based information about treatment options, the physician’s knowledge and experience, and the patient’s preferences and values. Multiple studies show this collaborative approach improves patient outcomes and satisfaction.
Shared decision-making is a method where both the patient and physician participate in the medical decision-making process together. To arrive at the best treatment plan for the patient, this approach considers all evidence-based treatment options and associated risks, the physician’s expertise, together with the patient’s preferences, values, and expectations.
Download the latest version of the Breast Advocate app here.
Low Vitamin D Levels Increase Breast Cancer Risk in Minority Women
Low vitamin D levels may play a role in developing breast cancer, particularly in minority women.
The immune-boosting benefits of vitamin D are well-known and several prior studies have looked at the impact of low vitamin D levels on various diseases.
According to a new study, Black and Hispanic American women with low vitamin D levels have a greater risk of breast cancer than those with adequate vitamin D levels. Having enough vitamin D may therefore help decrease the risk of breast cancer in minority women.
Study Results
Katie O’Brien, Ph.D., and colleagues looked at blood samples from 290 Black and 125 Hispanic women who later developed breast cancer. They also collected samples from 1,010 Black and 437 Hispanic women who did not develop breast cancer.
Over a nine-year period, women with sufficient vitamin D levels had a 21% lower breast cancer rate than women with vitamin D deficiency. The study found the link between vitamin D and breast cancer risk was highest in Hispanic women, who had a 48% decreased risk of breast cancer if they had sufficient vitamin D levels.
Enhanced Health Benefits
“Because women who identify as members of these groups have lower vitamin D levels, on average than non-Hispanic White women, they could potentially receive enhanced health benefits from interventions promoting vitamin D intake,” explains study co-author Katie O’Brien, of the U.S. National Institute of Environmental Health Sciences. “However, questions remain about whether these associations are truly causal and, if so, what levels of vitamin D are most beneficial.”
How to Increase Your Vitamin D levels
Spending enough time outdoors in the sunshine is very important as your body naturally produces vitamin D when your skin is exposed to direct sunlight. Taking a regular supplement can also help increase your vitamin D levels, along with including certain foods in your diet, such as:
- Oily fish (eg salmon, sardines)
- Red meats
- Eggs (especially egg yolks)
- “Fortified” foods (eg some breakfast cereals)
More Information
To learn more about vitamin D and cancer prevention, visit the U.S. National Cancer Institute.
