Steps You Can Take To Reduce Your Breast Cancer Risk

We talked with Coral O. Omene, MD, PhD, about risk factors, prevention and increasing awareness of clinical trials

New Jersey has the fifth highest age-adjusted cancer incidence rate in the U.S. Cancer is also the second leading cause of death in NJ — nearly 6,000 residents are killed by preventable cancers each year. But for many cancers, screening can detect cancers at an early stage when treatments are far more effective.

Women are being diagnosed with breast cancer more frequently and earlier than ever before in part due to increased screening over the years. Thanks to improvements in genetic testing, screening, and treatment and an increased awareness for self-advocacy, breast cancer has become more treatable with higher survival rates. There are a number of risk factors to be aware of and things you can do to keep yourself healthy.

We asked Coral O. Omene, MD, PhD, Program Director of Breast Cancer Disparities Research and medical oncologist at Rutgers Cancer Institute of New Jersey, about risk factors, prevention and the important work being done to increase awareness of clinical trials, particularly among Black women who are at a higher risk of the aggressive triple-negative breast cancer.

New Jersey Family: First, what are the risk factors for breast cancer?

Dr. Coral O. Omene: There are many things that increase your chances of developing breast cancer, especially when a person has a combination multiple of the following personal risk factors:

  • Being female assigned sex at birth (only 1% of breast cancer is found in cis-gender males)
  • Having one or more genetic mutations (BRCA1, BRCA2, CHEK2, PALB2)
  • Having a family history of breast cancer and other cancers
  • Having your period start early in life (around age 9-10) or having menopause start later in life (mid-50s or later)
  • Having periods regularly throughout your life without significant interruptions (e.g., pregnancies, breastfeeding)
  • Current or past use of alcohol and tobacco products
  • Being overweight or obese
  • Having certain racial and ethnic ancestry (g. people with Ashkenazi Jewish ancestry have a higher frequency of BRCA1 or BRCA2 gene mutations; African Americans have a higher probability of developing triple-negative breast cancers)
  • Use of certain oral contraception or hormone replacement therapies

NJF: Can you explain what we know about the genes that increase breast cancer risk?

Dr. Omene: The BRCA gene is the breast cancer gene. People who have genetic mutations like BRCA1 and BRCA2 have an extremely high risk of breast cancer over their lifetime – upwards of 85% for BRCA1 and 60% for BRCA2. BRCA is a tumor suppressor gene whose protein plays a key role in binding and interacting with a number of different proteins that are important in DNA repair. When that cell loses it, it cannot repair its DNA properly and has a chance to become cancerous.

If you have BRCA1 or BRCA2, in addition to having a higher risk of developing breast and ovarian cancers, you can also have a higher risk of pancreatic cancer, melanoma, and prostate cancers. BRCA mutations are determined after genetic counseling and testing. If you think you may have a family history of cancer, it’s important to consider genetic testing so you and your doctor can determine what screening and other actions are best for you.

NJF: What are the different types of breast cancer?

Dr. Omene: There are three main types of breast cancer – and anyone can be at risk for each type, but the risk varies depending on your personal and family risk factors as noted above.

First, there is a hormone receptor-positive breast cancer, which means that the tumor likes to grow in the presence of estrogen or progesterone. The receptors are binding to the hormones and making it grow.

A second type is called HER2, named after a protein that makes breast tissue grow – when there is too much of it made in cells, they can grow aggressively and become cancerous.

The third type is an aggressive form of breast cancer called triple negative breast cancer. These tumors don’t grow because of any of the three growth triggers mentioned above (estrogen, progesterone, or HER2 protein) so one, two, three: triple negative.

NJF: Is there a certain age that either teens or women should start examining themselves at home?

Dr. Omene: Anyone with breast tissue should be self-aware of their breasts and any changes. There is no designated age where we think it will lead to the prevention of breast cancer. However, I believe that women should do a self-exam at least once a month or when taking a shower. If you know about the texture of your own breasts and what feels “normal,” then when, for instance, you feel a lump that’s hard and firm and you think, “Oh, this is different,” that will spark you to seek medical attention.

Some signs to watch out for include:

  • New lumps (may not be associated with pain)
  • Texture changes, e.g., dimpling
  • Changes in the skin
  • Redness and tenderness
  • Discharge from the nipple, especially if bloody
  • Peeling, crusting of the nipple
  • A usually protruding nipple that is now inverted
  • Lumps or swelling under the armpit

ScreenNJ is a statewide service the provides education about cancer prevention and detection to the community and for professionals. ScreenNJ supports NJ residents to obtain cancer screening through navigation and mobile health services regardless of ability to pay. For more information about ScreenNJ visit screennj.org.

NJF: Is there an age you recommend having your first mammogram and do you recommend also doing an ultrasound?

Dr. Omene: We typically follow the American Cancer Society guidelines, which is age 40, but we do see women in their 20s and their 30s with breast cancer, and especially Black women who present younger and with late stage disease.

When you hear about a cluster of types of cancers that we know are associated with breast cancer mutations, and you know the patient and their family may have the genetic mutation, it helps to counsel all of the other members who are not yet of age. They should get their screening mammograms and MRIs at least 10 years earlier than the family member who was diagnosed with cancer so that it can help to detect breast cancer earlier and they can discuss other considerations with their medical team and family (e.g., timing of children).

A 3D mammogram is best for routine screening. The mammogram may also have an ultrasound ordered with it as recommended by your medical provider. There is increased risk for breast cancer for women with dense breasts  because it’s hard to examine very clearly on the mammogram and it may be missed. So the guidelines are suggesting that we use an MRI as well, which we do.

NJF: Are there any reasons that contribute to why more women seem to be diagnosed with breast cancer at a younger age?

Dr. Omene: I think that it’s everything coming together over the past decade: including increased awareness, education, screening strategies and increasing access.

NJF: You are leading a project funded by the V Foundation for Cancer Research in partnership with ESPN to increase clinical trial awareness and enrollment of Black women with breast cancer. Why are you so passionate about this topic?

Dr. Omene: The V Foundation is interested in increasing diversity in clinical trials and so they put out a request for proposals and our project was accepted. Rutgers Cancer Institute is an NCI-designated Comprehensive Cancer Center, and so our mission is always to provide clinical trials to our patients, the highest level of care, and options in terms of newer treatment options and technologies. Clinical trials are one of the ways in which we do that.

In terms of racial and ethnic risk factors, it’s well-known that women of African descent or Black women, have a higher chance of presenting with the aggressive triple-negative breast cancer. Interestingly enough, for this population, some of the known risk factors for breast cancer in general can be the opposite: instead of having no children, having an increased number of children actually is a risk factor for triple-negative breast cancer. Not breastfeeding, which tends to be one of the risk factors for Black women, poses increased risk. Obesity, as I mentioned previously is a well-known risk factor for breast cancer, and Black women are disproportionately affected by obesity for a multitude of reasons.

The crisis, quite frankly, is the fact that Black women with breast cancer have a 41% higher mortality death rate compared with white women. That is unheard of and just unacceptable.

In fact, they do worse than any racial or ethnic group. When you look at other groups, like Hispanics, South Asians, Asians, Asian Pacific Islanders, they all cluster together with or slightly below white women in terms of survival – but they’re all higher up on the curve than Black women. Black women do much, much more poorly in terms of survival.

Black women are extremely underrepresented in clinical trials for multiple reasons, including the historical reasons that lead to justified mistrust in the medical system. There is also lack of access, structural barriers to care, and other socioeconomic factors that all together prevent Black women from getting the best that we have to offer. Education is key. We have to educate Black women so they can overcome the distrust. We have to let them know why it’s important for them to participate, ask questions, and seek second opinions if necessary, because they need this care and the opportunities it represents.

We practice intentional targeting of this population for education regarding breast cancer clinical trials and identifying those that are eligible. The nurse navigators and research team follow up with patients and identify if there are barriers. Some people have issues because of their job, or they can’t dedicate the amount of time needed, or they need help with transportation. If we identify the barriers, we can assist with them and that will allow a woman to perhaps join a trial. That could be better for her and improve her survival.

We also make sure that when we run clinical trials on this topic, we offer them at healthcare sites in the community so that they are more accessible.

 So what can we do to reduce our risk of breast cancer and of needing a clinical trial for breast cancer treatment? First, know your family history and other risk factors, and then talk to your doctor about if genetic testing is right for you and when and how frequently you should get screened for breast cancer.

Interested in learning more or getting screened but not sure where to start? Contact ScreenNJ patient navigators for free help scheduling your cancer screening regardless of your income or health insurance status. Email patientnavigation@cinj.rutgers.edu or call (833) 727-3665 or text SCREEN to 43386.

Dr. Coral O. Omene is a medical oncologist with a passion for women’s health who is dedicated to the care of treating and managing a diverse pool of breast cancer patients. She completed her Internal Medicine residency at New York Presbyterian Hospital-Columbia University Medical Center and a fellowship at NYU School of Medicine, in the field of Hematology/Oncology, with a special interest in the area of breast cancer. At NYU, she was awarded the Dean’s Scholar-NYU Physician Scientist Training Program grant, and later subsequently was the first recipient to receive the Breast Cancer Research Fellowship at NYU Langone Medical Center. She is currently studying changes in response to neoadjuvant chemotherapy in African American women with Triple Negative Breast Cancer and the interplay with host factors such as obesity that impact on cancer disparities. The ultimate goal is the development of interventional strategies and clinical trials in these populations to help mitigate disparities.

Thinking about screening for yourself or someone you love? Start by talking to your primary care doctor about screening options or contact ScreenNJ, a cancer prevention, screening, and early detection program brought to you by Rutgers Cancer Institute of New Jersey, the NJ Department of Health, and healthcare and community organizations statewide. 

 

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