At a recent luncheon honoring Dr. Doris Howell of La Jolla (founder of the Doris Howell Foundation for women’s health) fellow wellbeing advocate Dr. Anne Wallace gave a presentation on the past, present and future of breast cancer.
Director of the Breast Care Unit and Professor of Clinical Surgery at UC San Diego, Dr. Wallace opened with the point “this field is changing really rapidly.”
“If I gave this presentation six month ago, I’d have to change the whole thing,” she told the gathering at La Jolla Country Club. “There’s a lot to breast cancer, it’s not just a matter of diagnosing or doing reconstructing, it’s looking at a patient from a lot of different aspects.”
Who’s at risk?
Risk factors, as well as how those risks can be quantified, has changed dramatically over the years, Dr. Wallace reported. She said scientists know quite a bit about the role genetics play in the risk for developing breast cancer, but the scientific exploration of the “BRCA” gene has changed the game. She said someone with a BRCA gene — which actress Angelina Jolie famously announced she carries — has up to an 87 percent chance of developing breast cancer.
However, “This gene is associated with other cancers, too, like melanoma and prostate cancer or pancreatic cancer,” Dr. Wallace said. “Some women don’t have breast cancer in their family, but they might have these other cancers in their family, so we’re putting the word out ... to make sure you take a detailed family history.”
In addition to family history, other risks are also becoming clearer. “What we didn’t know until very recently is that there is a clear relationship between diet, obesity, exercise and alcohol (to the risk for developing breast cancer).”
When it comes to alcohol consumption, she said four drinks a week are considered cause for a slight risk increase, and seven drinks a week a significant risk increase. However, exercise can help decrease the risk of cancer.
Dr. Wallace said a woman’s body size factors in, too. An adult woman should not weigh more than five percent of what she did when she was 18 years old. “I always kid and say I would like to have a study that puts exercise against alcohol to see if you can exercise off your alcohol,” she joked.
Once risk is determined, there is a mathematical model some doctors use that takes in all risk factors and issues a number indicating one’s overall risk of developing breast cancer, she said.
Screenings and prevention
In an effort to further personalize the approach to breast cancer, once a person’s risk level is determined, doctors can implement different screening strategies, depending on the patient’s breast size and density.
She said in California, there is a law that mandates patients be told if their breasts appear dense on mammograms so they can be counseled on additional imaging techniques.
Dr. Wallace said she uses a MRI machine on many of her patients.