Breast Cancer in Washington Heights- Avon Foundation
What Is a Risk Factor?
A risk factor is anything that affects someone’s chance of getting a disease. Different diseases have different risk factors. A diet high in saturated fats will increase someone’s risk for developing heart disease. Similarly, smoking will increase someone’s risk for developing lung cancer. However, risk factors are correlational not necessarily causal. A correlation describes a relationship between two variables. This relationship does not necessarily cause the other event from occurring. Thus, someone who eats fast-food and donuts every day may never develop heart disease. Likewise, someone who eats a diet high in fruits and vegetables may still develop heart disease. The cause of disease is usually complex and depends on many factors. Still, risk factors are an important component of medical screening. They provide useful information for predicting disease and mortality.
Like heart disease and lung cancer, breast cancer has its very own set of risk factors. Some of the risk factors are “modifiable” meaning actions can be taken to change them. These modifiable risk factors include physical activity, smoking, alcohol intake, and body mass index (BMI). The other risk factors are considered “non-modifiable” meaning these factors cannot be changed. Some of these include age, gender, race and ethnicity, age at 1st period, age at 1st birth, family history, and genetic mutations.
What Increases My Risk for Breast Cancer?
Your risk of developing breast cancer increases as you age. Two out of three most aggressive breast cancers are found in women 55 years and older.
Race and Ethnicity:
White women are at an increased risk compared to African American, Hispanic, and Asian women. However, more African-American women die of breast cancer.
1st Degree Family History:
Having a sister, mother, or daughter diagnosed with breast cancer doubles your risk for developing breast cancer.
The most common cause of hereditary breast cancer is an inherited alteration in the BRCA1 and BRCA2 genes. On average, carriers of the BRCA1/2 gene have a 50% risk of developing breast cancer.
Age at 1st Period:
Women who had their first menstrual period before age 12 have a higher risk of breast cancer later in life.
Age at 1st Birth:
Women who have their first child after age 30 have a higher risk compared to women who give birth before age 30.
Women who are overweight and obese (defined as having a BMI higher than 25) are at an increased risk.
Exercising at moderate or intense levels for as little as 1 hour and 15 minutes per week can lower your risk.
Long-term, heavy smoking is linked to a higher risk.
Women who drink three or more alcoholic drinks per week have an increased risk of developing breast cancer. Each additional drink increases the risk even more.
Prevalence of Breast Cancer Risk Factors in Upper Manhattan:
Researchers at Columbia University interviewed over 2600 women to learn more about breast cancer risk factors. Most of the women included in the study reside in Upper Manhattan, specifically in the Washington Heights/Inwood community. The researchers surveyed women at a breast imaging center. Women with and without breast cancer were included in the study.
Women at Breast Imaging Center:
50 yrs and older 77.8%
Native American 0.1%
1st Degree Family History:
0 Relatives 85.7%
1 Relatives 12.2%
>1 Relatives 1.4%
Don’t Know 0.7%
Negative for BRCA1/BRCA2 0.6%
BRCA1 Positive 0.04%
BRCA2 Positive 0.0%
Don’t Know 0.1%
Never Had Genetic Testing 99.2%
Age at 1st Period:
7 to 11 yrs 19.3%
12 to 13 yrs 41.0%
14 yrs and older 36.1%
Don’t Know 3.6%
Age at 1st Birth:
No Children 10.4%
Less than 30 yrs 74.3%
30 yrs and older 13.9%
Don’t Know 1.33%
1-2 hrs/week 6.9%
More than 2 hrs/week 12.9%
3 or more servings/week 5.2%
So What Do These Numbers Mean?
The data reveal that the majority of women surveyed at the breast imaging center were 50 years and older. Although women 55 years and older are at an increased risk for developing aggressive breast cancer, new guidelines recommend that women get screened starting at age 45. Therefore, there is still a large percentage of women in this community who are not getting screened early enough.
The data collected on race/ethnicity reflect the general demographics of the Washington Heights community. About 77% identified as Hispanic, while 10% identified as non-Hispanic White and 10% as non-Hispanic Black. Thus, only 20% are considered “high risk” based on their ethnicity alone.
Of the women surveyed, 13.6% had at least one family member with the breast cancer, putting them at an increased risk for developing the disease. Almost everyone surveyed never received genetic testing for the “breast cancer gene.” However, this number is not particularly alarming because genetic testing is only advised for a subset of women who meet certain criteria. Genetic testing is recommended for those with Ashkenazi Jewish heritage, a known BRCA1/2 gene mutation in the family, family history of breast cancer at age 50 or younger, cancer in both breasts in the same woman, both breast and ovarian cancers in either the same woman or same family, or male breast cancer in the family. Therefore, a family history of breast cancer does not necessarily mean you should undergo genetic testing.
Almost 20% of the women included in the study got their first period between age 7 and 11, putting them at a slightly increased risk of developing breast cancer. However, the majority of the women had a child before age 30, which has been linked to a decreased risk of developing breast cancer. The relationship between first menstrual period, first birth, and breast cancer is thought to be related to a woman’s exposure to the hormone estrogen.
Over 70% of the women included in the study were overweight or obese. Interestingly, before menopause being overweight or obese modestly decreases one’s risk of breast cancer while being overweight or obese after menopause increases one’s risk. However, the majority of these women are at an increased risk of breast cancer since 78% were over 50 years. On that same note, almost 74% never exercised. Like body weight, exercise is a modifiable factor that can not only decrease the risk of breast cancer, but many other diseases as well. Walking as little as an hour and 15 minutes a week can reduce your risk up to 18%!
Although the evidence is not clear, there appears to be a relationship between smoking and breast cancer. Among the women surveyed, almost 28% admitted to smoking at some point in their lives.
Drinking alcohol can increase one’s risk of developing breast cancer. And the more someone drinks, the higher the risk. Drinking more than 3 servings of alcohol per week has shown to increase one’s chances of breast cancer by 15%. However, only 5% admitted to drinking more than 3 servings of alcohol per week.
Breast Cancer Resources in Washington Heights/Inwood Community:
To schedule a breast imaging study contact:
Avon Breast Imaging Center
1130 St. Nicholas Ave
New York, NY 10032
To schedule a prevention consultation at NewYork-Presbyterian Hospital/Columbia University Medical Center contact:
(212) 305-5098 for a breast specialist
(212) 305-6731 for genetic counseling
Online Breast Cancer Resources:
Women at Risk: www.nyp.org
Avon Foundation for Women: www.avonfoundation.org
American Cancer Society: http://www.cancer.org/cancer/breastcancer/index