Should I Take Hrt If I Have A Family History Of Breast Cancer:
Because mood changes during the perimenopause and menopause are caused by altered hormones, the most effective treatment is to stabilise hormone levels by taking replacement estrogen . The right dose and type of estrogen can really help improve low mood and other psychological symptoms related to the menopause. Many women find that they feel calmer, their motivation and interest in things returns, along with a greater sense of energy, and they are generally much happier after a few months of being on HRT. There will usually be an improvement in other menopausal symptoms as well, such as hot flushes and night sweats, insomnia, vaginal dryness and many other symptoms.
Research has shown that if women are given HRT when they are perimenopausal, this can reduce the incidence of clinical depression developing. Many women who start HRT and have been incorrectly given antidepressants in the past, find that their depressive symptoms improve on the right dose and type of HRT, to the extent that they can reduce and often stop taking their antidepressants.
Most women will have history of breast cancer in their family because it is a relatively common disease. However, it is estimated that only about 10% of the breast cancers that are diagnosed every year have a genetic or familial cause. Women with a family history of breast cancer should discuss it with their doctor if they are considering HRT.
Risk Factors You Can Change
- Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.
- Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
- Taking hormones. Some forms of hormone replacement therapy taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives also have been found to raise breast cancer risk.
- Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.
- Drinking alcohol. Studies show that a womans risk for breast cancer increases with the more alcohol she drinks.
Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer, and changes in other hormones due to night shift working also may increase breast cancer risk.
Important Facts About Breast Cancer
It is unfortunate but nearly everyone will have a relative or loved one affected by the dreaded disease cancer. Cancer can strike virtually any of the internal organs and the skin but breast cancer is one of its most devastating forms. There are three very common forms of breast cancer and knowing about them and their symptoms could save someones life.
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Beliefs And Practices Through Antiquity
It is not surprising that written records and illustrations of breast cancer date back to antiquity since the location of the organ permitted easy identification. The Edwin Smith Surgical Papyrus, dating back to 3,0002,500 B.C., and possibly attributable to Imhotep , provides authentic accounts of breast cancer. A case was deemed incurable if the disease was cool to touch, bulging and spread all over the breast. In ancient Greece, a divinity was exhorted to offer relief from breast maladies, as evidenced by votive offerings in the shape of breasts in Greek temples that housed Asclepius, the god of medicine. Carcinoma , scirrhous and cacoethes in the medical lexicon owe their origins to Hellenistic writings. Hippocrates theory in c. 400 B.C. of the imbalance of humours as a cause of disease, and his classic descriptions of the progressive stages of breast cancer, represent early hypotheses on the cause of cancer.
Lessons From The History Of Surgery In Breast Cancer
There are three lessons to be gained from the history of surgery in breast cancer. First, to delve into history is to rediscover buried insights: Galens perceptive assessment that breast cancer is a systemic disease was echoed two millennia later in Fishers 20th century observations. Second, the evolution of therapeutic weaponry raises the fortunes of medical disciplines or minimises their supremacy as stand-alone choices for panacea or cure . Third, stooping to conquer is the mark of survival in contemporary medical practice. Surgery has won the day by adapting and playing a complementary role in modern cancer management as a stylised, scientific and patient-friendly craft.
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History Of Breast Cancer Treatment
People have known about breast cancer since ancient times. For most of that time, there were no effective treatments. However, in the last 120 years, advances in surgical and medical treatments have meant that today, 98 percent of patients with localized breast cancer survive at least five years after diagnosis. The following timeline shows the development of breast cancer treatments.
The Origin Of Breast Cancer Awareness Month
October is National Breast Cancer Awareness Month. It serves as an annual reminder of the importance of breast self-care. The question is, what does breast cancer awareness really mean? Up until the 1970s, breast cancer was a topic no one talked about. Women got the diagnosis, went through treatment and/or surgery, but kept quiet about it. There was virtually no awareness. This changed in 1978 when Betty Ford broke the silence.
In 1978, while she was First Lady, Betty Ford had finished a successful treatment for breast cancer. Across America, people were shocked and saddened by her news of breast cancer and having a mastectomy. They called her brave. They praised her honesty. But one person was touched more deeply than anyone could understand. Her name was Suzy. She was in her early thirties. The world would come to know her as Susan G. Komen.
After three years, in 1980 Susan died at age 36. But her legacy was just beginning.
Countway Cares … about honoring National Breast Cancer Awareness Month.
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Incidence Of Related Healthcare Visits
To determine the incidence of seeking health care among women with a certain family history of breast cancer, the following variables were abstracted from the published reports: the distribution of various family histories in general practice and the number of attendees in general practice who newly sought health care because of a family history of breast cancer. Two previous studies reported the variety in family histories of breast cancer in general practice, both from a large primary care centre which corresponded to five general practitioner practices and from a sample of 200 GP practices. These family histories of breast cancer were registered if a woman visited the GP with concerns about a personal risk of breast cancer. The distribution of the various family histories of breast cancer in general practice, as reported by these studies, is shown in table 2. The number of new attendees with a family history of breast cancer in general practice was obtained through the first study: in the five year period 19972001 the number of new attendees in general practice who sought care because of their family history of breast cancer was on average 3.1/1000 women/year . In the Dutch healthcare system, which is similar to that of the United Kingdom, practically every person is registered with a general practice, regardless of his or her medical condition. People who seek care usually start at a general practice.
Table 2
Is Breast Cancer More Common Today
Youve probably heard people remarking how there seem to be many more cases of cancer around these days than there used to be. It is very hard to tell whether breast cancer is actually more common in todays society, or whether our perception is skewed.
- We have much better diagnostic capabilities today so more cases are identified.
- More women are breast aware. Nowadays, women are more likely to perform breast self-examinations and get mammograms if they suspect that something is wrong. Women are more likely to receive routine clinical breast examinations at their doctors office, inevitably meaning that more cases are identified.
- Up until the 19th century, people died younger. Breast cancer develops more amongst older women, so this increase in life expectancy could be skewing perceptions.
- Women used to have more children at a younger age and breastfed for longer, all factors which lower the risk of breast cancer
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What Is A Family History
Having a family history means that you have one or more blood relatives with breast or ovarian cancer.
- They may be relatives who have died or relatives who are still alive.
- They may be first-degree relatives .
- Or they may be second-degree relatives , or third-degree relatives, which includes first cousins.
Some family histories are stronger than others. Here’s what determines whether your family history is strong:
- How closely related you are to relatives with breast or ovarian cancer. Cancer in first-degree relatives increases your risk the most.
- How many of your relatives had or have one of these cancers. The more relatives there are, the stronger your family history.
- How young these relatives were when they were diagnosed. Having any relatives who were diagnosed before age 50 adds to your risk.
- Whether you have both breast and ovarian cancer in your family. Having both adds to your risk.
- Whether you have a father or brother who had breast cancer. Breast cancer in men is rare, but when it happens in your family, it adds to your risk.
- Whether you have an Ashkenazi Jewish heritage. Breast and ovarian cancer rates are much higher among Ashkenazi Jews .
In the tables below, the figures are only rough estimates from research studies. Lifetime risk means the chance that you will get these cancers sometime during your life. These numbers may not apply to you, but they can give you an idea of how high your risk may be.
Breast Cancer Cell Lines
Part of the current knowledge on breast carcinomas is based on in vivo and in vitro studies performed with cell lines derived from breast cancers. These provide an unlimited source of homogenous self-replicating material, free of contaminating stromal cells, and often easily cultured in simple standard media. The first breast cancer cell line described, BT-20, was established in 1958. Since then, and despite sustained work in this area, the number of permanent lines obtained has been strikingly low . Indeed, attempts to culture breast cancer cell lines from primary tumors have been largely unsuccessful. This poor efficiency was often due to technical difficulties associated with the extraction of viable tumor cells from their surrounding stroma. Most of the available breast cancer cell lines issued from metastatic tumors, mainly from pleural effusions. Effusions provided generally large numbers of dissociated, viable tumor cells with little or no contamination by fibroblasts and other tumor stroma cells.Many of the currently used BCC lines were established in the late 1970s. A very few of them, namely MCF-7, T-47D, MDA-MB-231 and SK-BR-3, account for more than two-thirds of all abstracts reporting studies on mentioned breast cancer cell lines, as concluded from a Medline-based survey.
Metabolic markers
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Advancements In Identifying Population Risk
In addition to the impact of genetic analysis on breast cancer treatment, another significant advancement in breast cancer care is identifying specific groups at high risk of developing breast cancers or that are more at risk of dying from them.
Ensuring that these groups have adequate access to and guidelines for screening and other preventative measures is important in helping improve breast cancer survival rates and care.
An American Cancer Society report from 2017 indicated that while breast cancer survival is up, Black females are 42% more likely to die from breast cancer than White females.
Breast cancer rates have also been rising in Asian American females for multiple decades. Specifically, immigrant Asian American females have about a three times higher risk of developing breast cancer than Asian American females who lived more than half their lives in the United States.
Certain ethnicities, including Ashkenazi Jewish, are at a higher risk of carrying inherited breast cancer genes, like the BRCA1 and BRCA2 mutations. Researchers estimate that one in 40 individuals of this population carries a BRCA mutation.
The medical community has also been learning more about males who get breast cancer. Typically one in 1,000 males will be diagnosed with breast cancer. These cancers are typically diagnosed at a more advanced stage and have fewer effective treatment options. Males with the BRCA mutations are at a higher risk of developing breast and several other cancers.
A Brief History Of Breast Cancer
The female breast has always been a symbol of beauty, fertility and femininity. In disease, however, it has challenged physicians since antiquity. Surgery, which ruled the roost for cancer therapy, inevitably caused disfigurement when the knife was applied to the breast. The history of breast cancer is a complex maze of attempts to understand the wily nature of this hormone-responsive cancer and the will of physicians to conquer it by physical removal , cell destruction or targeted therapy to cell receptors . It is also a saga of intense exploration to find the tools to enable early diagnosis. The story of the domination of surgery over two millennia and its evolution from fatalistic choices to minimal damage is told in the succeeding paragraphs. The pathobiological basis of breast cancer that changed chirurgical practice from crudity to finesse is woven through the narrative.
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Having A Family History Of Breast Cancer
Multiple genes, including the BRCA genes, can cause inherited breast cancers to run in families.
The BRCA mutations are the best known and increase the risk of developing breast, ovarian, and other cancers. But this risk can be mitigated to an extent with lifestyle changes, preventative surgeries and therapies, regular checkups, and screening scans for cancer development.
It also isnt a given that youll develop breast or another cancer just because you have a BRCA mutation, another inherited cancer syndrome, or a family history of breast cancer.
Having a family history of breast cancer means some of your blood relatives have had breast cancer. If that relative is closely related, like a mother or sister, or developed breast cancer before 50, there may be more reason to suspect a genetic link.
But this doesnt mean that you will necessarily have breast cancer or that you have a genetic variant thats likely to increase your risk. A family history of breast cancer is just a signal to your doctor that this may be worth watching or testing.
Only about 10% of breast cancer patients have a family history of the disease, so its not as telling of an indicator as you might think.
Prevalence Of Family Histories Of Breast Cancer
In the simulated population, the prevalence of family histories of breast cancer was assessed. For the classification of various risk groups for breast cancer, we determined five different family histories for the women with at least one relative with breast cancer . Within each of the five groups we determined the percentage of women who had a relative with breast cancer affected under the age of 50 and at the age of 50 or older, to define the family histories more precisely.
Table 1
Family histories of breast cancer in the general population of women aged 3050
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Category : At Or Slightly Above Average Risk
95% of women are in this group.
Women in this group have:
- No family history of breast cancer, or
- Family history of breast cancer occurring in:
- One first-degree relative at age 50 or older, or
- One second-degree relative at any age, or
- Two first or second-degree relatives over the age of 50, on different sides of the family, or
- Two second-degree relatives on the same side of the family, both with breast cancer at age 50 or older
The risk of developing breast cancer in this group is the same or only slightly higher than the average woman in the general population.
90% of women in this group will not develop breast cancer.
Breast Cancer Treatments In The 21st Century
Breast cancer treatment is becoming more personalized as doctors learn more about the disease.
Its now seen as a disease with subtypes that have different patterns and ways of acting on the body. The ability to isolate specific genes and classify breast cancer is the beginning of more-tailored treatment options.
Special tests can also tell doctors more about breast cancer.
For example, the Oncotype DX gene profile test can examine part of a tumor to find out which genes are active in it.
Doctors can determine which patients with early stage breast cancer can be treated with antiestrogen therapy alone, and who would need the addition of chemotherapy.
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Family History Of Breast Cancer
Family history of breast cancer is not a contraindication for breast conservation because the rate of local recurrence in patients with first- and second-degree relatives with breast cancer is not significantly higher compared with women with no family histories. However, testing for genetic mutations BRCA1 and BRCA2 can identify those patients who are at a significant risk of metachronous breast cancers. Overall, there is no difference in survival in patients who are BRCA1 and BRCA2 positive compared with those who are negative.88,89 However, the rate of contralateral breast cancer was sixfold higher in BRCA mutation carriers versus controls .90
One of the issues often raised with newly diagnosed breast cancer patients is the timing of genetic testing relative to surgical intervention.91BRCA testing in the United States currently takes 3 weeks to complete, and this waiting period may not be acceptable to some patients. If the patient has decided that she would proceed with breast conservation if negative, one approach that can be used is to proceed with breast conservation surgery while waiting for BRCA test results. Radiotherapy is not initiated until BRCA results are available. If the patient is BRCA negative, she can then proceed to radiotherapy. If she is BRCA positive, the patient can proceed to mastectomy if she so desires.