Women and cancer today

By Dr. Ananya Mandal, MDNov 11 2010

Unnecessary mastectomies

Experts have warned that women who have their breasts removed out of fear of a high hereditary risk of breast cancer may be doing so needlessly. Genetic tests like for the BRCA mutations have predicted a high risk of getting breast cancer in women with many breast cancer sufferers among their first degree relatives. Earlier studies suggest the risk of the mutation to predict the cancer 87% of the time. Now experts want that this is an overestimate.

Kelly Phillips, medical oncologist at Melbourne's Peter MacCallum Cancer Centre cited a long-running Australian study involving several hundred BRCA mutation carriers that had found 18 per cent had undergone a preventive double mastectomy to ensure they did not suffer the same breast cancer diagnosis as other family members. He explained that only 0.3 per cent of women at high risk either from a family history or a known BRCA mutation were using drugs such as tamoxifen or raloxifene for the same purpose, despite good evidence they cut the risk by about 40 per cent.

Associate Professor Phillips said, “In terms of trying to prevent breast cancer, prophylactic mastectomy is the gold standard…but clearly it can have major implications for a woman’s body image, social functioning, sexual functioning and relationships…It’s very important that a woman's risk is thoroughly assessed…that’s why we have family cancer centres, that specifically focus on the risk of breast cancer…We have all seen women who…have had breasts removed when the risk wasn’t particularly high…or who have had their breasts off without themselves being tested for the mutation.”

Mark Robson, clinic director of the clinical genetics service at New York's Memorial Sloan-Kettering Cancer Centre spoke at the Clinical Oncological Society of Australia's annual meeting in Melbourne while saying that the 87 per cent risk figure might lead a woman “to a decision she may regret years later”. Risks with mutations are still substantial he warns with 65 per cent in the case of BRCA1, and 45 per cent for BRCA2. But there are other measures like medications, removal of the ovaries and fallopian tubes that could reduce these risks by half. “You start to get down to a point where instead of an eight or nine out of 10 chance you will get breast cancer, it becomes three or four out of 10,” Dr Robson added.

Rising breast cancer

Considering all the 27 European Union countries, UK is at 5^th position when it comes to cancer deaths in women. But the expenditure on cancer in UK is lower in Britain than other leading economies. These figures were reported in the latest Social Trends report from the Office for National Statistics, which included detailed comparisons of Britain’s position within the rest of Europe.

The ONS report says, “Breast cancer is the most common form of female cancer in England and Wales. It is also the second most common cause of cancer deaths in women, after lung cancer.” When death rates from breast cancer in UK and Europe has fallen in general between 2000 and 2007 “…the death rate from breast cancer for women in the UK has remained higher than the EU in 2007 at 26.8 deaths per 100,000 inhabitants compared with 23.6.” The figures showed that the gap between the UK and the European average for cancer deaths among women had widened. In 2007, 153.7 women out of every 100,000 inhabitants died from cancer, 22.2 more deaths than the average across the 27 EU countries. This gap was wider than at any point since 2001.

Catherine Thomson, head of statistics at Cancer Research UK feels tighter screening is essential. She said, “Some progress has been made for breast cancer but our rates are still among the highest and there is clear room for improvement,” she said. The Department of Health has announced a new £200 million a year Cancer Drugs Fund to provide better treatment.

Endometrial cancer and exercise

In a study presented at the Ninth Annual American Association for Cancer Research (AACR) International Conference on Frontiers in Cancer Prevention Research, women who exercise for at least 150 minutes a week might have a reduced risk for endometrial cancer.

Hannah Arem, a doctoral candidate at the Yale School of Public Health in New Haven, Connecticut presented the study and said that regular exercise cuts the risk even for women who overweight. This is important in light of the fact that body mass index (BMI) “is one of the major risk factors for endometrial cancer,” she explained. She added that exercise that counted in the study’s tallies was “moderate- to vigorous-intensity sports/recreational physical activity.”

Endometrial cancer is the fourth most common cancer among women in the United States. Ms Arem said that exercise, hormones and lifestyle factors explain up to 80% of risk for endometrial cancer.

Ms Arem and her team examined data collected from a case–control study led by Herbert Yu, associate professor at the Yale School of Public Health. The team compared 668 women who had endometrial cancer with 665 age-matched control women. They were given questionnaires that collected data on physical activity levels in 29 different kinds of activities in the 2 to 5 years before the diagnosis of endometrial cancer. The activity was converted to metabolic equivalents (METs), which correspond to the intensity of exercise and allow for easier comparative analysis.

Results showed that in women exercising 7.5 MET hours per week (about 150 minutes of moderate to vigorous activity) risk of endometrial cancer was 34% lower than the risk women for who did not exercise at all. The study showed that women who were normal weight but inactive also had a 55% lower risk for endometrial cancer than inactive women who were overweight.

“Exercise is an important public health intervention for women at risk of endometrial cancer,” concluded Ms. Arem.