The first question I get asked when talking about my diagnosis is always the same: “Do you have any family history?” Nope, I shake my head vehemently and then I shrug, “But I do now.”
I get why people ask. I’ve been there. It’s the same reason why we ask upon hearing of a horrific car crash or bike accident: “Was she wearing a seatbelt?” or “Did he have a helmet on?” People want to make sense of senseless tragedy and misfortune. Understanding risks and risky behavior help us feel better about our own potential connection to an awful situation.
Unfortunately for the ones who ask, my answer is not the reassuring one they seek. You see, I am the poster child for It Could Happen To You. No family history, check. Routine mammograms, check. Tested negative for the BRCA gene, check. Give or take 10 pounds, (ok, ok, maybe 15, sigh) I’ve maintained a healthy (ok, “ish”) body weight, and had a fairly healthy lifestyle that included moderate exercise. In other words, I’m just like you and most every other 40-something who’s struggling with work/life balance, navigating carpool logistics and scrambling to get more green vegetables on her kids’ plates.
Did you know that family history only accounts for 5% to 10% of breast cancer cases that result from inherited mutations, including those in the breast cancer susceptibility genes BRCA1 and BRCA2? And while Angelina may have put breast cancer genetic risks on the map, even more interesting perhaps is that only about 15%-20% of familial breast cancers are attributed to BRCA1 or BRCA2 gene mutations of which Angelina tested positive for. (She only tested positive for 1 of them.)
I’m not dissing Angelina’s choice at all – I’m just merely pointing out that all of this attention paid to “faulty genes” (her words) may be misleading. The importance of family history has been overstated over other relative risk factors. (Remember the old nature vs nurture debate?)
According to the American Cancer Society, the following factors increase the relative risk for breast cancer in women:
- alcohol consumption
- Ashkenazi (Eastern European) Jewish Heritage
- early menarche (<12 years)
- height (tall)
- late age at first full-term pregnancy
- late menopause (>55 years)
- never breastfed a child
- no full-term pregnancies
- obesity/adult weight gain
- long term oral contraceptive use
- current or long term use of menopausal hormone therapy containing estrogen and progestin
- dense breasts
Here are ways to reduce your relative risk per the ACS:
- reduce alcohol intake – alcohol increases estrogen and androgen levels and has been related with increased risk for ER+ breast cancers
- increase physical activity – women who get regular physical activity have a 10%-20% lower risk of breast cancer compared to women who are inactive, with stronger evidence for postmenopausal than premenopausal women
- maintain healthy weight – excess weight is linked to higher estrogen levels because fat tissue is the largest source of estrogen in postmenopausal women
As for me, today starts day 1 of Tamoxifen. I saw Dr K this morning and will go back in 2 weeks. While my left side has shown great improvement, we’re still not ready to begin the next stage of reconstruction. But I’m so grateful to be past the hurdle and challenges of the last few weeks.