Breast Cancer Risk

 

Breast Cancer: Who is at Risk?, Role of Genetics, Testing, and Pricing Strategy

Shanyu Gowda and Dr Lopamudra Das Roy

Published 2020

@BreastCancerHub, All Rights Reserved

Introduction

Breast cancer is the most common cancer in American women, except for skin cancers. Currently, the average risk of a woman in the United States developing breast cancer sometime in her life is about 13%. This means there is a 1 in 8 chance she will develop breast cancer. The American Cancer Society's estimates for breast cancer in the United States for 2020 are: About 276,480 new cases of invasive breast cancer will be diagnosed in women.  About 48,530 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).  About 42,170 women will die from breast cancer. [1]

Breast cancer is a type of cancer that starts in the breast. Cancer starts when cells begin to grow out of control. Breast cancer is a metastatic cancer and can commonly transfer to distant organs such as the bone, liver, lung and brain, which mainly accounts for its incurability. Early diagnosis of the disease can lead to a good prognosis and a high survival rate. [2]

Breast cancer cells usually form a tumor that can often be seen on an x-ray or felt as a lump. Breast cancer occurs almost entirely in women, but men can get breast cancer too. It’s important to understand that most breast lumps are benign and not cancerous/malignant. Non-cancerous breast tumors are abnormal growths, but they do not spread outside of the breast. They are not life threatening, but some types of benign breast lumps can increase a woman's risk of getting breast cancer.

It is always important for any breast lump or change to be checked by a healthcare professional to determine if it is cancerous and if it might affect your future cancer risk. [3]

Who is at risk?

Women are much more likely than men are to develop breast cancer as it is the second leading cause of cancer deaths among women.  [2]

A history of Breast conditions such as lobular carcinoma in situ (LCIS), atypical hyperplasia, or simply having Breast Cancer in the past in the other Breast can increase your risk of getting Breast Cancer. A family history of Breast Cancer may increase your risk but the majority of people diagnosed with breast cancer have no family history of the disease. [4] The main gene mutations that can increase the risk of breast cancer are called BRCA 1 and BRCA 2. They may greatly increase the risk but nothing is set in stone. Excessive alcohol consumption can elevate the level of estrogen-related hormones in the blood and trigger the estrogen receptor pathways which can lead to breast cancer. [2]

Also, radiation exposure to the chest, obesity or high fat diet, and smoking can increase the risk of breast cancer. [4]

Role of Genetics

An estimated 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family. This is mainly due to the gene mutations known as BRCA 1 and BRCA 2. Both of which significantly increase the risk of both breast and ovarian cancer. [4]

If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed through your family. [4] Some of the other gene mutations that can increase your risk of developing breast cancer include HER2, Epidermal Growth Factor Receptor (EGFR), c-Myc, and the three members in the Ras gene family. [2]

Also, consider asking your doctor for a referral to a genetic counselor who may be able to discuss the benefits, risks and limitations of genetic testing. [4]


Prevention/Testing

Survival rates are much higher in the developed countries than in the developing countries , due to lack of early detection programs with late presentation of the disease, inadequate diagnostic and treatment facilities in the developing countries. Early detection improves the outcomes or survival rates of breast cancer, hence screening of asymptomatic, apparently healthy women is very essential, especially when there are risk factors such as the history of breast cancer in immediate relatives. [6]

A number of screening tests are being employed but the three main screening tests are breast examinations, mammography and ultrasound. Another very important screening is genetic screening which is when doctors test your DNA to see if you have any specific gene mutations that may lead to a higher risk of Breast Cancer. The awareness of breast cancer and the importance of screening have increased over the years, however the bane of unaffordability still persists. Poor participation in screening programs has persisted despite the increase in awareness. [6]

Talk to your doctor about going through breast cancer screening and tests such as clinical breast exams and mammograms. Become familiar with your breasts through breast self-exam for breast awareness. During a breast self-exam if there is a new change, lumps or other unusual signs in your breasts, talk to your doctor promptly. [4]

Drink alcohol in moderation if at all. Try to get at least 30 minutes of exercise every day. Maintain a healthy weight and body fat %. Choose a healthier diet filled with plant-based foods can reduce the risk of breast cancer. [4]

If your doctor tells you that you have a high risk of breast cancer due to family history and other factors. You want to make sure and ask about estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors. These medications have been shown to greatly reduce the risk of breast cancer in women with a higher risk. The downside is that there is a chance of side effects so you definitely want to talk to your doctor about these medications.  Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed. [4]

Pricing Strategy

Stage of disease at diagnosis is an important predictor of treatment costs. Treatment for more advanced disease is often more intensive or invasive than treatment for the earlier stages. As a result, a more advanced stage tends to be associated with a higher cost in addition to poorer health outcomes. Another reason to make sure you go through breast cancer screening [8]

Treatment costs by stage at diagnosis are important in quantifying the gains from early detection. If early treatment lowers costs, this will help offset the cost of interventions for earlier diagnosis and treatment. In addition, treatment costs by stage would be valuable to inform the cost-effectiveness studies for treatment or preventative interventions of breast cancer. [8]

The cost difference based on the stage at diagnosis was largely driven by the cost of chemotherapy and noncancer treatments. Earlier detection of breast cancer by routine screening leads not only to reduced morbidity and mortality but also to lower costs for cancer treatment. Research has also found that the costs of treating breast cancer could be meaningfully reduced by earlier diagnosis and treatment. [9]



Conclusion

In conclusion, Breast Cancer is a disease that affects mostly women but is not exclusive to women. Lifestyle and family history/gene mutations both heavily impact your risk of getting Breast Cancer. The three main screening tests are clinical breast examinations, mammograms and ultrasounds. The earlier the stage of Breast Cancer at diagnosis the less treatment costs and better health outcomes.

References

  1. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html [1]

  2. Sun, Y. S., Zhao, Z., Yang, Z. N., Xu, F., Lu, H. J., Zhu, Z. Y., Shi, W., Jiang, J., Yao, P. P., & Zhu, H. P. (2017). Risk Factors and Preventions of Breast Cancer. International journal of biological sciences, 13(11), 1387–1397. https://doi.org/10.7150/ijbs.21635 [2]

  3. https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html [3]

  4. https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470 [4]

  5. https://itsalwayssomething.blog/2017/06/12/do-genetics-play-a-part/  (pie chart) [5]

  6. Omidiji, O. A., Campbell, P. C., Irurhe, N. K., Atalabi, O. M., & Toyobo, O. O. (2017). Breast cancer screening in a resource poor country: Ultrasound versus mammography. Ghana medical journal, 51(1), 6–12. https://doi.org/10.4314/gmj.v51i1.2 [6]

  7. https://www.breastcancerhub.org/news-2/self-breast-exam-card [7]

  8. Sun, L., Legood, R., Dos-Santos-Silva, I., Gaiha, S. M., & Sadique, Z. (2018). Global treatment costs of breast cancer by stage: A systematic review. PloS one, 13(11), e0207993. https://doi.org/10.1371/journal.pone.0207993 [8]

  9. Blumen, H., Fitch, K., & Polkus, V. (2016). Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service. American health & drug benefits, 9(1), 23–32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/#:~:text=The%20average%20costs%20allowed%20per,of%20chemotherapy%20and%20noncancer%20treatments.[9]

 
Lopamudra Das Roy