Prevention and early detection of breast cancer
Dr. med. Teelke Beck
October 19, 2023
8 min
Dr Teelke Beck, what preventive measures do you recommend to women to reduce the risk of breast cancer?
The terms screening and early detection are often used interchangeably and are understood to mean the same thing. However, they have different meanings and it makes sense to distinguish between them.
The purpose of early detection is to recognise diseases as early as possible so that they can then be treated more effectively. In the early detection of breast cancer, this includes mammography and breast ultrasound. From the age of 50 (up to the age of 70), mammography is recommended every two years for early detection. Ultrasound is used if the breast density is high and/or the mammogram shows unclear findings. Some cantons have an early detection programme in which women are automatically invited for an examination and the costs are covered. However, the canton of Zurich does not offer such a programme. Even without a cantonal screening programme, we recommend that women - even those at no particular risk - have a mammogram every two years. Breast cancer is the most common cancer in women and statistically one in eight women is affected from the age of 50.
Prevention, on the other hand, is about preventing disease as far as possible. In the case of breast cancer, lifestyle - something that we can control and influence ourselves - plays a particularly important role in prevention. Diet, exercise and relaxation are key pillars in the prevention of diseases, not just breast cancer. By avoiding obesity, not smoking and consuming only moderate amounts of alcohol, women can significantly reduce their risk of breast cancer. These risk factors are far more important than the often criticised hormones.
Can breast cancer also occur in younger women and what special aspects should they consider in terms of prevention?
Yes, unfortunately younger women under the age of 40 are also affected by breast cancer, but much less frequently. In terms of prevention, the options mentioned above apply regardless of age. However, there are a few special features with regard to treatment.
Younger women are often at a completely different stage in life and may not yet have finalised their desire to have children. This is then no longer possible under the anti-hormone therapy that is often necessary for the treatment of breast cancer. It is therefore important to discuss fertility preservation options with women or couples and to arrange a referral to a centre for reproductive medicine. Furthermore, genetic defects are more common in younger women, so genetic counselling and testing is advisable.
What role do genetics play in breast cancer and how can I have my genetic risk assessed?
Since Angelina Jolie made her BRCA mutation public 10 years ago, the topic of genetics in relation to breast cancer has become widely known. Many women worry whether they could also be affected. Since then, genetic counselling has increased considerably. However, only five to ten per cent of all breast cancers are genetic. Up to 30 per cent of breast cancer cases occur more frequently in certain families (due to environmental factors, unknown genes, etc.), which means that 70 per cent of cases are due to random factors. The highest risk for breast cancer is being a woman and getting older.
If a woman is concerned about having an increased risk of breast cancer, she can seek advice from a geneticist or a specialised professional. If there are indications of a risk of more than ten per cent for positive genetics, a genetic test can be carried out after approval of the costs by the health insurance company. Women with a positive genetic test will receive counselling on what this means for them and their family. Women with a BRCA mutation have a 70 per cent risk of developing breast cancer in their lifetime and most women then opt for prophylactic surgery, the route that Angelina Jolie also took. The family on the father's side also plays an important role in terms of heredity. Although the consequences for men are less serious, they can pass on the defective gene to their children, with each child always having a 50 per cent risk of inheriting the gene.
Are there any specific dietary recommendations to prevent breast cancer?
There is no "anti-cancer diet", even though this is sometimes propagated. However, there are dietary recommendations that can have a positive impact on health, including breast health. We have evidence that chronic underlying inflammation in the body favours disease, including cancer. For this reason, it makes sense to favour an anti-inflammatory diet. A seasonal, organic, low-meat diet with plenty of vegetables, moderate fruit consumption and an adequate intake of omega-3 fatty acids and fibre is recommended for this purpose. The role of vitamin D is very important both in the prevention of breast cancer and after diagnosis. In our latitudes, we cannot absorb vitamin D in winter. It therefore makes sense to supplement vitamin D, preferably after a laboratory test, which is unfortunately no longer covered by health insurance.
Being overweight, but also underweight, should be avoided. Regular exercise should be part of your daily routine. Studies have shown that just 150 minutes of moderate physical activity per week, such as running, cycling or swimming, reduces the risk of recurrence in women with breast cancer. It is not necessary to run a marathon straight away; it is enough to get off the bus one stop earlier or take the stairs instead of the lift, for example.
What does integrative medicine mean for breast cancer?
The term integrative medicine describes the combined application of conventional and complementary medical approaches. Complementary medicine comprises diagnostic and therapeutic methods that are used in addition to conventional medicine in order to enhance it.
In integrative medicine, we bring together the best of both worlds, and complementary medical methods can be integrated into conventional medical treatment from the very beginning. Probably one of the best-known and best-researched therapies in complementary medicine is mistletoe therapy. A broad scientific basis shows that this therapy is safe and effective. Mistletoe therapy is now also listed in the general recommendations and guidelines and is recommended. It can help to alleviate side effects and consequences, such as fatigue syndrome, particularly when used alongside chemotherapy. In addition, methods from traditional Chinese medicine, anthroposophic medicine, phytotherapy and homeopathy are recognised by law and are good methods for alleviating side effects and supporting recovery. Mind-body medicine such as mindfulness, yoga, tai chi and other practices have great potential to support conventional therapy and make the path easier for patients.
Personally, I can no longer imagine my clinical routine as a gynaecologist working in surgery without complementary medicine. We need both the external doctor with conventional medicine to remove disease-related changes and the internal doctor who promotes and supports the body's own strengths and resources. For me, they form a whole.
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