Breast Cancer Prevention Starts in Childhood

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

Disclosures

December 08, 2014

Medscape: Young women can be very sensitive about weight gain, to the point of being underweight. Should weight advice take this into account to avoid too much emphasis on losing weight?

Dr Colditz: Dr Steven Gortmaker, at the Harvard School of Public Health, has done work in schools promoting increased physical activity and healthy diet. He studied the frequency of excess concern with weight and found that girls who underwent a program of increased activity had less concern about their weight than those who did not have activity intervention.[19,20]

While parents should certainly have a good idea of where their child falls in the weight range, when it comes to the children themselves, the focus should be on healthy eating and activity habits, rather than on weight per se.

I know the media see underweight as an issue. And concerns about body image are quite important, yet data show that only a small percentage of girls[21] and adult women[22] in the United States are underweight, while nearly two thirds of adult women are either overweight or obese. How do we make a healthy weight the norm without undue concern about underweight?

Figure 2. Strategies to prevent breast cancer.

Courtesy of Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Wanted: Nationwide Cancer Prevention Strategy

Medscape: In your publications you have implied that there isn't enough being done in the United States research and education about breast cancer prevention.

Dr Colditz: In the past there has been more emphasis on childhood and adolescent diet and physical activity to prevent diabetes and heart disease.[23] We have got to get cancer into that discussion as well. Cancer risk is accumulating from before the time a girl hits menarche. How quickly she grows impacts her lifetime risk for breast cancer, and if she drinks lots of milk she grows faster than if she doesn't drink lots of milk, and that raises her risk.[14,24] There is good evidence that an animal protein diet versus a vegetable protein diet results in earlier menarche and greater growth velocity.[25,26,27] If children eat a plant-based diet, they may still end up as tall as if they eat a diet high in animal protein; it just takes a little longer for them to get to full height, and that slower growth actually is beneficial for life.

Medscape: Do you think the National Institutes of Health or the Centers for Disease Control and Prevention should coordinate a campaign to raise awareness about breast cancer prevention?

Dr Colditz: We have got to build this in to a public health strategy. We need to better understand how to sustain the change to a healthier diet and activity level in childhood and adolescence, to have the benefit of lower risk for heart disease, diabetes, and cancer.

We do not do a good job of telling adolescents and women in their 20s about health trade-offs and the impact that their lifestyle behaviors will have on their current risk for diabetes and their future risk for cancer. The whole presentation and communication of wellness and long-term risk is not an area that has been studied.

Medscape: Is behavioral research needed as much as basic science or clinical research at the moment?

Dr Colditz: For the alcohol risk, if we actually knew how alcohol was damaging breast cells, eventually we could prevent that damage, even in adolescents and young women who are drinking. Maybe the damage is associated with folate intake.[28] Maybe the damage involves some pathway that you could inhibit, so that if a woman is going to drink, then she should be doing something that would counteract the negative effect of alcohol. At the moment, we don't know what the "something" is; there is clear potential for more study of mechanisms and pathways with the hope of prevention.

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