Breast Cancer Prevention Starts in Childhood

Linda Brookes, MSc; Graham A. Colditz, MD, DrPH

Disclosures

December 08, 2014

The message about alcohol consumption is different. The incidence of heart disease in those who drink moderate amounts of alcohol is lower than in nondrinkers. People are going to get their heart disease at ages 50, 60, and 70 years, and it is what they are drinking at that age that modifies their platelet function, not what they drink at 18.

Alcohol is a known carcinogen[6] and yet we are not addressing that. The other factors do tie in to a healthy childhood and adolescence, and to me the question then becomes, how do we get mothers, grandmothers, aunts, fathers, and uncles to take this issue seriously? Obviously we have collectively avoided it to date and we now have a global epidemic of childhood obesity. Our campaign hasn't been effective, and the diet composition is continuing to move away from plant-based food.

Alcohol and Obesity: Not a Good Mix

Medscape: You recently published an infographic that showed that about half of breast cancers could be prevented, of which 5% could be avoided by alcohol restriction.[7]

Dr Colditz: Correct. Alcohol consumption is that big of a contributor to breast cancer, and yet we largely ignore it.

Medscape: According to your estimates, 32% of breast cancer cases could be prevented by avoidance of weight gain.

Dr Colditz: That may still be an underestimate, but yes—it is amazing how strong that association is.

Medscape: Isn't overweight/obesity usually regarded as a risk factor for postmenopausal breast cancer?

Dr Colditz: Evidence from the Nurses' Health Study,[8,9] and from women who have had bariatric surgery and major weight change,[10,11] show that weight loss after menopause lowers the risk for breast cancer. But obviously you are better off never having gained weight in the first place. There are continuing messages around weight, physical activity, and alcohol consumption that are all important after menopause.

But in premenopausal women, cancer is less responsive to treatment, and that is again where there has been a gap in the focus on prevention. There are data out of Europe showing that weight gain in premenopausal years actually increases premenopausal as well as postmenopausal breast cancer,[12,13] and that is why it is potentially an underestimate to say that 32% of breast cancer could be prevented by avoidance of weight gain. If the European data hold up in the United States, which I think they will, we will also be adding in some premenopausal breast cancer that is driven by weight gain through the 20s, 30s, and early 40s age groups.

Medscape: Do these factors affect women with and without inherited risk factors?

Dr Colditz: Yes. Lifestyle factors may work to the same collective benefit in women with BRCA 1 and 2 gene mutations and in women without mutations. Obviously, it is a more important focus in the women who have the genetic predisposition.

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