me, me, me…me also

Are you like me when upon hearing about a fatal car accident and wonder if the passengers were wearing their seatbelt?

No judgies – but merely a way to measure my own risk ratio. The same applies with my CJ. People have asked me all kinds of questions – do I have breast cancer in my family? Did I test positive for the BRCA gene (the Angelina ‘faulty gene’)? How many years was I on the pill? In other words, what risky behavior did I knowingly or unknowingly engage in that may have contributed to my chances of getting it? I’ve wondered this too.

Over the course of the last 6 months, I’ve probably spent about 100 hours online researching breast cancer, read about 8 books on the subject, posted 60 or so blog updates, and talked to many breast cancer survivors. Just as there are “armchair travelers,”  I guess you could say I’m an “armchair oncologist.”

Recently, I came across a chart on risks from the Breast Cancer Institute, and I am reposting it here. What’s most interesting to me is how this chart plainly and simply points out the direct relationship between increased estrogen exposure and increased breast cancer risk.

It takes about 8-10 years to go from one cancer cell to two, from two to four, four to eight, to then a group of cells about ½”  in diameter, if that cancer has an average doubling time. (rate of growth) And here comes the really interesting part:  self exams can only find cancer that is greater than ½”, but mammograms can detect tumors ¼” in diameter! Meaning, possibly 2-3 years earlier than by self exam.  We all know that early detection of small tumors (generally which are more differentiated) leads to an increased likelihood that they are have not metastasized to lymph nodes, and are therefore more curable than large tumors. That is why early detection with mammography results in increased survival.

Here’s some fun math: My tumor was 5 mm on the mammogram in October 2013, which means it was just less than ¼” – ok. Eventually, the pathology from my surgery in November determined that the tumor size was actually closer to 1.1 cm, which translates to just under ½”. No wonder I never felt it from self exams! And it begs the question, now that we can guesstimate the general “vintage” of the cancer cells growing in my body by back-dating it 8-10 years ago.

IDC Established circa 2004-2006?

What was I doing in those years? And more importantly – what had I been doing prior to those years when the one cancer cell went to two, and so on, and so on in my left breast? I can tell you some of the exposures to increased estrogen production:

  • 10 years on birth control pills, check
  • fertility assistance, check
  • pregnant at 30, first children at 31, check
  • late term miscarriage, check

I swear it’s like that epic scene in GroundHog Day where Bill Murray asks Andie McDowell what traits she’s looking for in a man.

“What are you looking for? Who is your perfect guy?”

“Well, first of all he’s too humble to know he’s perfect.”

“That’s me!”

“He’s intelligent, supportive, funny…”

“Intelligent, supportive, funny….Me…”

“He’s romantic and courageous.”

“Me also.”

“He’s got a good body but he doesn’t have to look in the mirror every two minutes….. He’s kind,  sensitive, and gentle. He likes animals and is not afraid to cry in front of me….He’ll change poopy diapers.”

“Do he have to use the word poopy?”

“Oh, and he plays an instrument and he loves his mother.”

“I am really close on this one. Really, really close.”

Watch it here. It’s one of M and my all-time fave movies.

Factors Which INCREASE Breast Cancer Risk

Factor Mechanism
Increases estrogen exposure by impairing liver function
Benign proliferative breast disease
Result of increased estrogen exposure
BRCA genes
Inherited defects in cancer defense genes
Cigarette smoking Benzopyrenes damage DNA
Contraceptive steroids (in pills, patches, vaginal rings, IUDs or injectable forms)
Increases estrogen exposure
Early menarche Increases estrogen exposure
Female sex Increased estrogen exposure
High socio-economic group Delayed childbearing
Higher education Delayed childbearing
Hormone replacement therapy (HRT)
Increases estrogen exposure
Increasing age
Premenopausal: Increases estrogen exposure
Postmenopausal: Impairs immune function
Induced abortion
Leaves increased number of immature breast lobules and increases risk of premature births
Increases estrogen exposure
Late childbirth (over 30 years old)
Increases exposure of Type 1 & 2 lobulesto estrogen before first birth; long susceptibility window
Late menopause Increases estrogen exposure
Nulliparity (never bearing children)
Maturity of breast lobules does not occur
Premature birth before 32 weeks
Leaves increased number of immature breast lobules
Increases estrogen exposure
Postmenopausal obesity Increases estrogen exposure
Radiation Damages DNA
2nd trimester miscarriage
Leaves increased number of immature breast lobules

 Factors Which Decrease Breast Cancer Risk

Factor Mechanism
Breast feeding
Decreases estrogen by decreasing number of menstrual cycles and/or ovulation
Cruciferous vegetables (e.g., broccoli, Brussels sprouts or DIM supplements)
Indole-3-carbinol decreases estrogen exposure by causing estrogen to be changed to an inactive metabolite of estrogen
Early menopause
Decreases estrogen exposure
Decreases estrogen exposure
Having children (especially starting at a young age)
Decreases number of immature breast lobules
Late menarche Decreases estrogen exposure
Omega-3 fatty acids (e.g., olive, flax seed, walnut oils)
Oophorectomy (removal of ovaries before menopause)
Decreases estrogen production
Soy isoflavonoids (phytoestrogens)
May block estrogen receptors

Factors Which Have No Effect on Breast Cancer Risk

Factor Reason
Saturated fat
Saturated fat intake not related to obesity
Spontaneous abortions
(miscarriages) in the first trimester
No increased levels of estrogen as found in healthy pregnancies
So there you have it, on the eve of my surgery tomorrow – I’m signing off. I report to CPMC Davies campus around 10:00 am, and my surgery is scheduled for 11:30. I get to go home tomorrow, so I think I’ll be firmly ensconced in my CCC around 4 or 5 pm.

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