Between lifestyle and genetics

October is the international month dedicated to breast cancer prevention. The WHO-supported initiative aims to raise awareness of breast cancer and promote access to timely diagnosis, screening and effective treatment.

Breast cancer in numbers

Breast cancer is the most common oncological disease in women worldwide. In Switzerland, about 6500 women are diagnosed with breast cancer every year. Although the prognosis is much better than it used to be, thanks to advances in diagnosis and treatment, breast cancer is still considered the most common cause of cancer mortality in women (about 18% of cases). These figures should not frighten us but only encourage us to think about the importance of prevention: a correct lifestyle and special precautions, as well as regular screenings, can help us prevent the disease and treat it with less burdensome therapy.

Risk factors for breast cancer: between lifestyle and genetics

Certain risk factors such as age – most breast cancers occur after the age of 50 – family history, high glandular density or a history of mammary tissue hyperplasia are considered non-modifiable risk factors. Our lifestyle has an impact on this individual and sometimes unpredictable substrate.

Limiting alcohol consumption and giving up cigarettes are important aspects of primary prevention that have also been demonstrated for breast cancer.

The role of diet also seems to be of central importance. Numerous studies have shown that some diets are protective, particularly against certain cancers, especially hormone-sensitive cancers, while others increase the risk.

A protective diet includes

• moderate portions, so that calorie intake is in line with actual needs,
• regular consumption of vegetables
• reduced consumption of fats and added sugars
• a wide range of carbohydrates, mainly from fibre-rich vegetables
• reduced consumption of meat.

These habits reduce the risk of obesity, diabetes and dyslipidaemia, as well as the so-called metabolic syndrome

Metabolic syndrome and breast cancer risk

Metabolic syndrome does not refer to a disease, but to a set of characteristics:

• • Obesity, especially if it is localised in the abdominal area
  • high blood pressure
  • high blood levels of cholesterol, triglycerides
  • disturbed glucose metabolism or insulin resistance

The metabolic syndrome leads to an increased risk of cardiovascular disease, diabetes mellitus and degenerative diseases, and may be an aetiological factor in the development, progression and mortality of certain cancers. In women, it mainly affects “hormone-sensitive” cancers such as endometrial carcinoma and breast carcinoma, especially after menopause

How do obesity and abdominal fat affect primary breast cancer risk and recurrence in previously treated women?

Visceral or abdominal fat, unlike subcutaneous fat, accumulates around the organs of the abdominal cavity. This fat is a true endocrine organ capable of producing hormones and is responsible for a chronic silent inflammatory state.

The increased production of insulin, increased growth factors such as IGF-1 and leptin modulate the hormone production of oestrogen and androgen. In addition, fat cells produce pro-inflammatory factors. It is known that chronic inflammation promotes cancer development.

Can the risk of breast cancer recurrence be influenced by lifestyle?

Diet and regular physical activity are an important aspect for our organism, both in terms of well-being and in serious diseases such as breast cancer.

The benefits of a healthy lifestyle in breast cancer can actually help to:

• maintain a normal weight
• alleviate cancer symptoms and the side effects of treatment; and
• Improve quality of life;
• strengthen the immune system;
• Reduce fatigue

Early detection of breast cancer

Early diagnosis can be crucial for treatment and successful cure of the disease.

Early symptoms not to be underestimated

As with many tumours, breast cancer usually does not cause pain in the early stages. As a rule, breast pain is not due to the presence of the tumour, but rather depends on hormonal changes, especially during the menstrual cycle.

What should cause the warning signals, on the other hand, are lumps that can be palpated. Other important signs are changes in the nipple, fluid leaking from the nipples, changes in the shape of the breast or its texture (e.g. thickening or retraction of the skin). However, most tumours are only visible through radiological examinations.

Detecting breast cancer at an early stage, when it is still small and not palpable, means a high probability of complete cure with minimal surgical and pharmacological treatment. Mammography and breast ultrasound are components of imaging for early detection of breast carcinoma. Therefore, it is important for every woman to have an annual screening with her gynaecologist who will recommend the most appropriate radiological examination if needed.