by Jane, UK
In recent months there has been a lot of media portrayal about preventive mastectomy (also known as prophylactic mastectomy or risk-reducing mastectomy) re-ignited by Angelina Jolie’s high profile decision to have a preventive double mastectomy.
I have been wondering about this subject as I am a woman and also someone who in the past has had breast health issues.
From my own experience over many years of making lifestyle choices that support me and in taking far more care of myself, I have found that my general health and well-being has improved immensely – so too has my overall health as a woman.
Could lifestyle choices possibly play a role in supporting the prevention of diseases such as breast cancer?
“New figures show that breast cancer is now the most common form of the disease in Britain. This country also has the highest death rate for the disease in the world” (Harding 2013).
The recent media portrayal of preventive mastectomy has raised many conversations about cancer prevention and as I researched for this article I found there are many statistics, articles and blogs written about breast cancer and breast cancer prevention.
Cancer prevention is perceived as any action taken to lower the chance of getting cancer and, anything that increases the chance of developing cancer is perceived as a cancer risk factor.
In the case of breast cancer prevention in the recent media, there have been statistics that state preventive mastectomy may significantly reduce the chance of developing breast cancer in moderate and high-risk women, such as those who test positive for changes or mutations in certain genes (e.g. BRCA1 or BRCA2), bearing in mind “the US Preventive Services Task Force recommends that only women with a strong family history think about getting a BRCA genetic test which is only 2% of US women” (Fox & Aleccia 2013).
In amongst the many articles and websites women are also cited to be at risk if they:
- Have had previous breast cancer,
- Have a family history of breast cancer,
- Have breast changes that increase the risk of breast cancer (e.g. abnormal cells – lobular carcinoma in situ),
- Have had radiation therapy to your chest before the age of thirty (for example as a treatment for Hodgkins Disease),
- Have diffuse and indeterminate breast micro-calcifications or dense breast tissue.
Whilst there is current research into breast cancer and its causes, “much research is still needed to understand breast cancer – and its causes – fully” (Harding 2013). Such as examples the National Cancer Institute and the longitudinal Breakthrough Generations Study Breakthrough Breast Cancer set up in 2004 to investigate genetics (via blood samples), lifestyle (e.g. diet, alcohol intake, occupation) and environmental factors that may change the risk of a woman developing breast cancer.
In looking further at the risks of getting breast cancer, there are also often cited relative risks (as cited by GenesisUK) such as:
- Age at first menstrual period;
- Age at menopause;
- Age at first birth;
- Number of pregnancies;
- History of breast feeding;
- Use of the contraceptive pill; and
- Use of Hormonal Replacement Therapy (HRT).
Environmental chemicals have in the past also been suggested as relative risks to getting breast cancer, though as yet there don’t seem to have been any studies that show a direct link with developing breast cancer.
Studies Linking Lifestyle to Breast Cancer
Lifestyle choices are also cited as a possible relative risk for breast cancer (e.g. American Cancer Society, National Cancer Institute) and “statistics show us that nine out of ten of us are willing to make lifestyle changes to reduce our risk of disease” (Harding 2013).
The American Cancer Society suggests that women can lower their risk of developing breast cancer by considering their body weight, physical activity and diet – stating that some studies show that a diet rich in vegetables, fruit and fish for instance has been linked with lower risk of breast cancer.
GenesisUK suggests “there is now evidence that physical activity has a protective effect against breast cancer”, partly through controlling body weight and also due to the positive effect on body hormone levels, which could potentially lower the risk. GenesisUK also suggest that there are several studies that have shown breast cancer has been linked to alcohol intake and that women who are tee-total have a lower risk of breast cancer compared to those who drink alcohol, and the level of risk rises with the level of alcohol intake.
Genetics and Epigenetics
There is another level of lifestyle choices that could be considered here too. We know that genetics were a factor in Angelina Jolie’s decision to have preventive mastectomy, however, the other aspect of genetics that hasn’t featured highly in the websites, articles and media coverage on preventive mastectomy – epigenetics.
“Epigenetics is the mechanism by which environmental changes alter the behaviour of our genes” (McKie 2013). McKie suggests all sorts of life events can affect DNA methylation levels in our bodies, including diet, illnesses, ageing, chemicals in the environment, smoking, drugs and medicines. From these, McKie concludes that epigenetic changes produce variation in disease patterns – “we have studied identical twins who have different tolerances to pain and shown that they have different states of methylation. We have also produced similar results for depression, diabetes and breast cancer. In each case, we have found genes that are switched on in one twin and switched off in the other twin. This often determines whether or not they are likely to get a disease.” (McKie 2013)
Rankin suggests that “epigenetics research proves to us that environmental influences, including hormonal factors are affected by our thoughts, beliefs and feelings that affect how your genes express themselves” (Rankin 2013). Rankin goes on to suggest that studies have also shown that environmental factors can override certain genetic mutations, effectively changing how DNA is expressed, and that scientists are now learning that the genome is far more responsive to the environment of the cell – especially the hormonal environment created by our thoughts, beliefs and feelings, in that the way we are, we think, we feel and what we do affects us more deeply than we may realise – to the extent that our genetics can change.
Is Double Mastectomy the only Preventative Option for Breast Cancer risk?
Considering this article so far, what do the many media articles and web pages suggest are the options for women in reducing their risk of breast cancer (aside from elective bilateral preventive mastectomy)?
For those with medium to high risk of breast cancer chemo-prevention is now available in the UK as recently announced by NICE, who suggest that ‘Tamoxifen or Raloxifene’ taken daily for 5 years can cut breast cancer risk by 40%, with a protective effect for up to a decade, although there can be side effects including hot flushes and blood clots.
There are also options for:
- Raising awareness – being breast aware, getting to know what your breasts look and feel like and what is normal for you in how your breasts look and feel.
- Health education – to raise awareness of diseases in the breasts and the possible symptoms, know what changes to look for e.g. lumps, pain, discharge from the nipple.
- Close monitoring – e.g. periodic mammograms and regular check-ups of a clinical breast examination performed by a health care professional.
- Avoiding menopausal hormone use (Keefe & Meyskens 2000).
In addition to the above, lifestyle choices are often cited as preventive to the development of breast cancer, e.g. limit or cut out alcohol consumption, bring a focus to diet by moving away from processed foods and undertaking regular exercise.
Where might epigenetics play a role here?
In some research on epigenetics (McKie, 2013; Rankin, 2013) there is growing suggestion that lifestyle choices do play a role in the prevention of illness and disease.
I know for myself as mentioned above, in gradually and tenderly making many lifestyle changes, such as my diet, my rest and sleep, in exercising and in stopping things that had a negative impact on my body (e.g. alcohol, dairy, rushing around, burning the candle at both ends), my health has and continues to improve. And the long term conditions I have had (endometriosis, eczema and asthma for instance) have dissipated.
In wondering about the prevention of illness and disease there is clearly much that needs to be considered in the context of each woman’s unique risk factors, level of concern and how she feels in knowing her body as only she does.
“You know your body better than any doctor does – and only you can know what’s right for you” (Rankin 2013).
Whilst I am not in the shoes of Angelina Jolie or others for instance who are at high risk of breast cancer, nor would I want to make light of the choices any woman in this position has made, for these are serious considerations, what I can say is that lifestyle choices have made an enormous difference to the quality of my health and life overall.
And if, as epigenetics purports, lifestyle and the way we think and feel has an impact not only on our health and well-being but also on our genes, then maybe it is a worthy consideration for all women (and men) – whatever their circumstance, state of health or risk factors are.
It just may be that we could reduce the risk not only of breast cancer, but also of other illness and disease. That is worthy of further research and consideration.
- American Cancer Society (2012) –”Breast Cancer Prevention and Early Detection“. Retrieved August 30, 2013
- Anderson, B. O. et al. (2008) “Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007”. Cancer, 113, 2221–43.
- Breakthrough Breast Cancer (2004) – Breakthrough Generations Study into the Causes of Breast Cancer – In Breast Cancer Risk Factors – The Facts. Joint Publication Breakthrough Breast Cancer & BMA. P 37
- Chan, Amanda. (2013, May 14) “Double Mastectomy: why Angelina Jolie had breast removal surgery“. Huffington Post. Retrieved from
- Dobson, Roger. (2013, June 9) “Professional women more susceptible to breast cancer“. The Independent.
- Fox, Maggie & Aleccia, JoNel. (2013, May 15) “More women opting for preventive mastectomy – but should they be?” NBC News.
- Genesis UK. Preventing Breast Cancer Charity – Retrieved August 30, 2013.
- Harding, Charlotte (2013, July 04) “10 ways to prevent breast cancer” (femail.co.uk). Mail online.
- Keef KA & Meyskens FL Jr. (2000) “Cancer Prevention”. In: Abeloff MD, Armitage Jo, Licther As, Neiderhuber JE, Editors. Clinical Oncology 2nd Ed. London: Churchill Livingstone, 2000
- McKie, Robin (2013, June 02) “Why do identical twins end up having such different lives?” The Guardian.
- National Cancer Institute (2006) – “Fact Sheet Preventative Mastectomy“ – Retrieved August 30, 2013.
- NHS Choices. (2012) “Breast Cancer (female) prevention“. Retrieved August 30, 2013.
- NICE Guidance. (2013) “Familial breast cancer: Classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer“. Retrieved August 31, 2013.
- Rankin, Lissa (2013, May 16) “Was Angelina Jolie ‘Medically Hexed?” Care2 Healthy Living.
- Roberts, Michelle (2013, June 25) “Breast Cancer: NHS to offer tamoxifen to at-risk women“. BBC News.
- World Health Organisation (2013). “Breast Cancer: Prevention and control“. Retrieved August 31, 2013.