Breasts

The National Institutes of Health (NIH), American Cancer Society (ACS), National Cancer Institute (NCI), and the US Food and Drug Administration (FDA) report that no conclusive evidence links the use of underarm antiperspirants or deodorants to the development of breast cancer. On the flipside, some argue that we see a lower prevalence of breast cancer in developing countries where women don’t use these products. But in Europe, where antiperspirants are not widely used, the rate of breast cancer is higher than in the United States,24 so it seems that factors much more influential than sweat-stopping antiperspirants and odor-eating deodorants are at play.

While we’re talking chemicals, let’s move on to hair relaxers, particularly those feared to cause cancer in African American women. No doubt about it: cancer-causing compounds abound in hair products, but luckily for African American women who sport straight and silky hair, hair relaxers don’t make a cancer connection. Hair relaxers or straighteners, in the form of lotions or creams, chemically straighten curly hair by altering the hair’s internal structure. Product ingredients can enter the body through scalp burns or open cuts and sores. Since millions of African Americans use relaxers to reduce curl—one study found that 94 percent of African American women surveyed under age forty-five had used them at some point in their lives—these products have become the subject of much scrutiny, particularly as they may or may not relate to causing breast cancer.25 Funded by the National Cancer Institute (NCI), researchers followed over 48,000 African American women for six years in the Black Women’s Health study.26 A number of parameters were evaluated with respect to health and habits. Participants included women who had used hair straighteners seven or more times a year for twenty years or longer. When analyzing the 574 new cases of breast cancer that occurred during the study, researchers could not find any association between breast cancer risk and the duration of hair relaxer use, frequency of use, age at first use, number of burns experienced during use, or type of hair relaxer used.

Perhaps what we should be focusing on isn’t straighteners specifically, but the fact that there are numerous and potentially cumulative health hazards hiding in our self-care products—particularly in African American communities. Specifically, hair products, including shampoos, conditioners, oils, dyes, relaxers, and root stimulators, containing estrogens and placental extracts can mimic estrogen in our bodies so much that use of these hair products in early life has been considered a major contributor as to why the proportion of girls at age eight who experience early puberty (precocious puberty) is nearly four times greater for African Americans than for whites (48.3 percent and 14.7 percent, respectively).27 Check hair product labels and avoid using ones that contain estrogens, other hormones, and placenta, particularly for young children or while pregnant.28

PIERCINGS AND TATS

If you’re worried about the nipple piercings and body tattoos you got during your punk phase in college, let me put your mind at ease. Nipple piercings don’t cause breast cancer. Studies show that nipple piercings can cause breast infections, or theoretically create difficulties with breastfeeding, but they don’t cause breast cancer.29

Tattoos also can cause infection and allergic reactions; sterile needles and uncontaminated ink minimize that risk. Unlike piercings, tattoos fall under the “not sure, probably fine” cancer category. Studies show that skin cancers do not occur any more frequently than would be expected at the location of a tattoo,30 which should reassure breast cancer patients recreating a 3-D–appearing nipple and areola on mastectomy skin, or tattooing makeup in anticipation of chemotherapy-induced eyebrow and eyelash loss. On the other hand, when I remove lymph nodes during a cancer operation on someone with upper body art, the pathologist usually identifies tattoo pigment trapped within a node or two because the skin lymphatics drain ink to that location. No reports find that tattoos increase breast cancer risk, or that nodes with ink are more likely to contain metastatic breast cancer; however, ink does contain phthalates, hydrocarbons, and a number of other potential carcinogens and endocrine disruptors,31 which, as part of a larger whole, possibly impact breast cancer risk (see chapter 5). For mastectomy patients who worry about FDA warnings to “think before you ink,” pretty real-looking silicone reusable nipple prostheses come in a shade that matches skin tone; they just stick in place. An option: pinklotus.com/adhesivenipple.

RADIATION REBUKES

In our increasingly tech-reliant world, a lot of patients worry about radiation affecting breast cancer risk—specifically from mobile (cell) phones and power lines. Based on the studies available, this doesn’t appear to be a concern. Phew.

In 2018, the number of mobile phone subscriptions (6.8 billion) approached the number of people on Earth (7.5 billion). Since these devices emit radio-frequency (RF) signals and electromagnetic fields (EMF), their ubiquity has generated public concern over possible adverse health effects. The real controversy centers on cell phone use and the risk for brain cancer, but breasts have a way of getting attention too.

From what we can tell, mobile phones can’t cause breast cancer, even if you tuck them in your bra, because they do not emit the right type of energy (or a high enough amount of energy) to damage the DNA inside breast cells. In order to communicate with service towers, cell phones emit EMF. Body tissues absorb some of this radiation during regular phone use; usually those nearby tissues would be your face and brain, not your breast, but in the quest to be hands-free, many women tuck that smart box into a bra or shirt pocket. Here’s the key concept: mobile phone EMF is nonionizing, and as such, the energy waves are too wimpy to break DNA and other biochemical bonds. Besides your phone, other nonionizing sources of radio-frequency signals include microwaves, television, radio, and infrared.32

In contrast to nonionizing EMF, X-rays, gamma rays, and ultraviolet (UV) radiation emit ionizing EMF. These do create enough energy to mutate DNA, which can potentially lead to cancer. Common ionizing sources include sun exposure (UV rays) and medical X-rays like CT scans and mammograms. For a cell phone’s energy to go from nonionizing to ionizing, it would have to get 480,000 times stronger than it currently is.33

Several notable studies have examined the cell phone/cancer connection as it relates to brain tumors.34 Only one of these authors observed an increase in brain tumors with the use of mobile phones, and all the other studies could not reproduce the correlation.35 No study has postulated that cell phones cause breast cancer. If you carry your phone in your bra, I’d be more concerned about accidentally texting a photo of your breast to your boss than causing cellular damage to your breast DNA.

Living near power lines can’t cause cancer either. Power lines emit both electric and magnetic energy that’s too muted to damage breast DNA. Additionally, walls, cars, and other objects shield and weaken the energy from power lines. When rates of female breast cancer on Long Island ranked among the highest in New York State, a 2003 study set out to explain possible environmental reasons why.36 One theory was that EMF caused the hike in cancer. Rather than using indirect measurements of EMF exposure (such as occupation or distance from power lines), investigators performed comprehensive in-home assessments of magnetic field exposure and only looked at women living in the same home for at least fifteen years. They compared these data between almost six hundred local women with and without breast cancer; in the end, they found no link between the disease and EMF emitted by power lines. A nationwide Finnish study and a Seattle-based study also concluded that typical residential EMF generated by high voltage power lines do not elevate overall cancer risk in adults.37

Similar to the EMF from cell phones, magnetic energy from power lines produces a low-frequency, nonionizing form of radiation that doesn’t mess with the breast. Maintaining that the weak EMF derived from power lines could have a catastrophic biologic effect sounds plausible to most of us because we don’t readily understand physics; but to a physicist, it’s a laughable proposition.38 Consider this factoid: the magnetic field from the earth itself is 150 to 250 times stronger than ones from power lines. If a power line’s small magnetic field could cause breast cancer, then just inhabiting Earth for a few years should lead to a total body cancer transformation.

HORMONE-RELATED HEALTH WORRIES

A lot of women express concern that certain health habits increase their risk—most of which circle the topic of affecting their estrogen levels, since estrogen feeds the majority of breast cancers. However, a bunch of these worries are, in fact, myths.

I’ve repeatedly heard the popular rumor that oral contraceptive pills (OCP)—birth control pills—cause breast cancer. But if you are at normal risk for breast cancer, an unexpected pregnancy will add a lot more worry to your life than OCPs. Strong evidence from fifty-four studies concludes that current OCP users have a tiny 24 percent increase in the risk of having breast cancer diagnosed while they are taking OCPs and then the risk becomes 16 percent one to four years after stopping, 7 percent five to nine years after stopping, and no risk ten years out.39 Why do I call that “tiny”? Let me make this brilliant point: if you are twenty, the probability of developing breast cancer by age thirty is 1 in 1,567, so it only takes one more breast cancer case (2 in 1,567) to suddenly proclaim that rates went up 100 percent. And since studies say it’s 24 percent, your new risk will actually be 1.24 in 1,567 on OCPs. Pretty tiny, right?

Depending on your personal risks, the bump in breast cancer might be offset by the fact that OCPs reduce colorectal cancer by 14 percent and endometrial (uterine) cancer by 43 percent.40 And if you’re a BRCA gene mutation carrier, there’s OCP good news for you too. After six years of use, OCPs reduce the risks of ovarian cancer by 50 percent for BRCA-1 and 60 percent for BRCA-2—with no increase in breast cancer.41 All premenopausal BRCA carriers with ovaries who are not trying to get pregnant should take OCPs to slash ovarian cancer risk.

Women who have had or are considering in vitro fertilization (IVF) also shouldn’t fret that it causes breast cancer. Given the causative connection between hormones and breast cancer, fertility treatments have come under suspicion since they involve ten times the normal exposures of estrogen and progesterone each time the ovaries are stimulated.42 No evidence strongly connects fertility drugs with increased risk. A multitude of studies conclude that prospective moms using any of the ovarian stimulation medications associated with IVF, including clomiphene citrate (Clomid), gonadotropin-releasing hormone (GnRH antagonist, Lupron), human chorionic gonadotropin (hCG), follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone, do not have a higher risk of breast cancer.43 In fact, works published since 2012 on the matter not only suggest a lack of interaction, but even a protective role of ovarian stimulation, as emphasized in two meta-analysis studies that pool the results of over 1.5 million infertile women who underwent IVF.44 And for those of you who have endured over seven cycles of IVF, I have reassuring news: the largest, most comprehensive study to date followed over 25,000 infertile Dutch women for twenty-one years, and guess what? Your tenacity paid off (I hope with a baby too): breast cancer risk was significantly lower in women undergoing seven or more cycles compared to those receiving one to two cycles.45 For all the twenty-one years they were followed, breast cancer risk among IVF-treated women was no different from that in the general Dutch population. There are exceptions, naturally, but they’re few. For example, one notable study from Australia did find an increased rate in women starting IVF under the age of twenty-four, but that’s an unusually young group to undergo IVF, and the study otherwise showed no overall increase in risk.46

Abortions and stillbirths don’t cause breast cancer either, though a link has often been suspected due to the estrogen surges that occur with pregnancy. I want all of you affected personally by any type of terminated pregnancy to read on and know this good news applies to you! When most women hear the word abortion, they commonly consider that word to mean an induced abortion, a medical procedure performed to voluntarily end a pregnancy. But there’s also the natural event of a spontaneous abortion, usually referred to as a miscarriage, which means the loss of a fetus before five months (twenty weeks) into the pregnancy. These generally result from genetic issues with the fetus that are incompatible with life, or from problems with the environment in which the unborn child is growing. And then there’s a stillborn birth, which refers to the death of a fetus after five months’ gestation while still in the uterus. While the cause is usually unknown, common identifiable reasons include nicotine, alcohol, or drugs taken by the mother, physical trauma, umbilical cord problems, Rh disease, and radiation poisoning.

Research examining whether abortions cause breast cancer should relieve any concerns you have. Data from fifty-five studies spanning sixteen countries and including 83,000 women with breast cancer show no connection between breast cancer and spontaneous or induced abortions.47 A panel of over one hundred leading world experts convened by the National Cancer Institute (NCI) in 2003 performed a rigorous review of the scientific evidence regarding abortions and breast cancer risk.48 They concluded that no correlation exists between breast cancer and abortion, either spontaneous or induced. They deemed the level of scientific evidence for these findings as “well established,” which is the highest level achievable.

With such an important and charged issue as abortion, we must be right when declaring a connection or not. We must rely upon data that is free from responder bias. We deserve and have the highest level of evidence from which to draw conclusions. Hence the consensus statements of both the 2003 NCI report and the concurrent American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice report rely upon only the most rigorously conducted research. Ethical and political disputes aside, let’s hear this good news clearly: “the totality of worldwide epidemiological evidence indicates that pregnancies ending as either spontaneous or induced abortions do not have adverse effects on women’s subsequent risk of developing breast cancer.”49

DOES CHANGING YOUR ANATOMY CAUSE CANCER?

Making changes to your natural anatomy doesn’t cause breast cancer, though you might worry it would based on misinformation that trauma (accidental or surgical) upsets the natural state of things.

Let’s first talk breast implants: if you have them, should you have regrets too? Whether saline or silicone, above or below your chest muscle, decades old or brand new, textured or smooth, round or shaped, implants do not cause breast cancer.50 In fact, a study of 3,139 women who got an augmentation between 1953 and 1980 shows that, after an average of 15.5 years, these women have 31 percent less breast cancer than would be expected.51 And this isn’t the only such study. A meta-analysis of seventeen studies also showed a significant decrease in cancer incidence among those with cosmetic implants by one-third.52 Before you rush out to protect your breasts with implants, the decrease in risk likely corresponds to the facts that women with implants generally have a lower body mass index (BMI) than those without implants, and have their children prior to age thirty, two known factors that decrease breast cancer.53 That being said, implants can complicate the detection of an existing breast cancer, so I do recommend more rigorous screening for those who have them. Generally speaking, women with breast implants in whom breast cancer develops are diagnosed at similar stages and have equivalent survival rates as compared with breast cancer patients without implants.54

It’s important to note, however, that the World Health Organization has confirmed a probable association between breast implants and the rare development of anaplastic large cell lymphoma (ALCL), a cancer of the immune system, but that is not the breast, and ALCL is not breast cancer.55 Implant-associated ALCL occurs in approximately 1 per 5,000 women with textured implants (rarely with smooth implants) and presents with fluid forming around the implant an average of eight years after placement. Thankfully, just removing the implant and the capsule that forms around it completely cures 97.5 percent of women. If needed, those affected can receive a targeted antibody-drug called brentuximab; chemotherapy and radiation are rarely indicated.

We also know that while implants don’t cause cancer, augmentation and implants after mastectomy can present long-term complications, including changes in nipple or breast sensation, undesirable implant positioning, implant rupture, tight scar tissue around the implant (capsular contracture), or persistent pain.

On the other end of the spectrum, you should also know that no link exists between breast reduction surgery (reduction mammoplasty) and breast cancer. In fact, you may actually see a decrease in breast cancer risk. Medical literature supports the notion that breast reduction surgery decreases risk consistently around 30 to 40 percent, with even higher numbers reported when removing two cup sizes (over six hundred grams) of tissue per breast.56 By removing additional ducts and lobules that carry the potential to become cancerous, there aren’t as many around to cause trouble.57 Another prevailing theory as to why reductions help suggests that removing fat (i.e., adipose tissue) favorably changes the world where breast cells live, called the microenvironment.58

While we’re on the topic, you should know that breast size doesn’t directly affect risk either; small-breasted women don’t have less risk of breast cancer than large-breasted ones. However, there’s one connection between breast size and cancer when analyzing the composition of your breast tissue.59 Remember, the more ducts and lobules you have (as opposed to adipose tissue), the more cells you possess that can become cancerous. To demonstrate, a prospective study compared self-reported bra size and cancer risk among of 88,826 premenopausal women followed for eight years.60 They held a number of factors constant so as to isolate the effect of breast size. After stratification by body mass index (BMI), they found a significant trend for increasing bra cup size and greater breast cancer risk in one and only one group—the leaner women. Among overweight or obese women, no association between bra cup size and breast cancer was found.

In other words, leaner women with generous breasts have more breast cancer precisely because they have very little fat, and therefore, a lot more glandular tissue. More glandular tissue simply equals more breast cancer risk. In this group of 420 leaner women with breast cancer, 96 percent wore smaller than a D-cup, so the subgroup of large-breasted lean women at risk due to size alone is small. The vast majority of large breasts are large because of all the fat surrounding the glandular tissue (and as stated, this fat is very unlikely to become cancerous). Conversely, small breasts generally have less fat, and potentially have the same net volume of glandular tissue as many larger breasts. Therefore, in the final analysis, women should have a similar incidence of breast cancer risk irrespective of their breast volume. The majority of studies attempting to correlate size to risk conclude that no such association exists.61

ACHOO! CAN YOU “CATCH” BREAST CANCER?

Wondering if you can catch breast cancer or give it to someone else—whether it’s by breathing it through the air, or from exposure to bodily fluids such as breast milk, blood, and saliva, or from sharing utensils, kissing, or having sex—might at first seem ridiculous. But this is actually a real question I’m asked. So here’s your real answer.

When the DNA within a breast cell mutates, that cell starts to grow and divide and spread without control or order; that’s how cancer happens. And that’s the only way it starts. Exposure to someone else’s mutated breast cell doesn’t do anything to your own cells’ DNA. Yet several studies have shown that many people believe breast cancer to be contagious; these findings suggest a pressing need to develop breast cancer educational programs.62

What’s encouraging is that in 1964, 20 percent of residents interviewed in Perth, Australia, believed that cancer is contagious; however, when that same interview was repeated forty years later, only 3 percent expressed that same belief.63 In other words, improved education about health issues can impact beliefs. We need effective community-based interventions that target the demographics most vulnerable to these faulty myths, which tend to be recent immigrants and those of lower socioeconomic status. Busting myths can change behavior and, in turn, improve cancer outcomes.

SEND ME YOUR BREAST MYTHS!

Heard of another myth and you just can’t figure out the truth? I want to hear about it! Head on over to pinklotus.com/breastmyths and tell me more. I choose the best myth submissions and debunk them for you on our Pink Lotus Power Up blog.

PART 2

REDUCING CANCER RISK

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