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CC May 2017 Modifiable Risk Factors for Breast Cancer

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echoecho's version from 2017-06-14 14:31

Section

Question Answer
What cancer is the second most commonly diagnosed cancer (after _____ cancer)?Breast cancer ; lung
The etiology of breast cancer is complex, likely caused by what?1) combination of genetic factors 2)endogenous hormonal stimuli 3) exogenous toxins
What does estrogen do regarding breast cancer?it acts as a carcinogen by stimulating malignant transformation of mammary cells
List the evidence for the above theory of estrogen causing breast cancer?data shows decreased breast cancer rates in those who take selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs), both which have estrogen antagonist activity
Many important factors can affect breast tissue, more significantly PRIOR to ____ full-term pregnancy when the terminal ducal-lobular units of the breast become fully differentiated?first
List the most important risk factors for breast cancer which are nonmodifiable?1) family hx 2) age of menarche 3) breast density 4) white race 5) tall stature 6) age at first birth
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COMBINED ORAL CONTRACEPTIVES (COC) AND BREAST CANCER
Question Answer
Regarding combined oral contraceptives (COCs) and breast cancer, what are they? What do they protect women from? 1) combined (estrogen and progesterone) 2) protect from endometrial CA, ovarian CA, and possibly colon CA
Why is COC use and breast cancer remaining controversial?1) older studies are limited because many studies included COCs with higher estrogen doses than are now used 2) the time lag from usual use of COCs and development of cancer may span decades and confounds outcome data with variable exposures and environmental influences
*** A recent meta-analysis from Jan 1, 2000 forward showed what conclusion?breast cancer incidence was slightly but significantly INCREASED in users. But there was no association with duration of use of COCs (from 1 to > 120 months) and increased risk of breast cancer
In light of these conflicting studies, how should a provider counsel his women patients?1) the evidence of association between COC use and breast cancer is mostly from lower quality retrospective data 2) there does not seem to be association between COC use and breast cancer mortality 3) provider should discuss the current uncertainties and potential risks, although they do not seem to be large
*** Does a family hx of breast cancer affect risk associated with COC use?no
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ALCOHOL AND BREAST CANCER
Question Answer
*** Is alcohol use associated with an increased risk of breast cancer?yes
There seems to be a dose-response relationship starting with alcohol intake as low as ______ drink per day?one
How does alcohol promote breast cancer?1) by increasing estrogen levels 2) influencing breast tissue response to estrogen 3) alcohol causes increase in aromatase activity and decreased metabolism of androgens in the liver and can also affect adrenal steroid production Increased estrogen acts on breast tissue either directly or through estrogen receptors
Give the findings of the Nurses' Health Study that followed a cohort of women for 28 years and measured alcohol intake at 9 points during that time?1) 7,690 cases of breast cancer were diagnosed 2) an association between higher alcohol intake and breast cancer incidence was seen 3) for 3-6 drinks consumed per week, the RR of developing breast cancer was 1.15 4) binge drinking was associated with increased risk when controlling for total lifetime alcohol intake
A meta-analysis of 110 studies showed what about light drinking of alcohol?light drinking (up to 1 drink per day) was associated with increased breast cancer risk in women
Evidence shows that even at low levels (average 1 drink a day), alcohol use slightly increases breast cancer risk. The effect is small, but real and based on good evidence. Is risk affected by the type of alcohol? Is wine protective for cardiovascular disease?1) no 2) yes
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SMOKING AND BREAST CANCER
Question Answer
Many early studies were confounded by concomitant _____ intake?alcohol
Tobacco smoke contains 20 chemicals that induce mammary cancer in rodents. Is there evidence of carcinogenicity in humans?limited evidence
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Smoking can decrease ____ levels, thereby potentially decreasing risk of cancers related to estrogen
Question Answer
What was the findings of a cohort study of 74,000 women?1) current smokers had an elevated risk of breast cancer compared to never smokers 2) former smokers had an elevated risk of breast cancer compared to never smokers
A large study in 2015 showed a ____% increased risk of breast cancer among smokers?35
Was there a higher risk of breast cancer if the person smoked before menarche and before the first full-term pregnancy?yes
Did exposure to secondhand smoke appear to be related to increased breast cancer risk?no
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BREASTFEEDING AND BREAST CANCER
Question Answer
List two ways that breastfeeding may affect breast cancer incidence?1) causes differentiation of breast tissue 2)reduces the number of lifetime ovulatory cycles
Breast milk itself contains components that ____ cancer risk?inhibit
A large, pooled analysis of epidemiologic data found that for every 12 months of lifetime breastfeeding, risk of developing breast cancer decreased by ____%?4.3%
A case-control study of 1,655 pairs of women with either BRCA1 or 2 mutations found a ____% reduction in breast cancer risk with 1 year of breastfeeding and even greater reduction with longer duration of breastfeeding?32
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BMI, NUTRITION AND BREAST CANCER
Explain the following statement "the effect of BMI on breast cancer depends on the menopause status"?: In premenopausal women, elevated BMI seems to be related to a decreased risk of breast cancer, while in postmenopausal women, elevated BMI is linked to elevated breast cancer risk
Question Answer
A large cohort study found a relationship between elevated BMI in postmenopausal women who had never used hormone replacement therapy (HRT) and hormone receptor _____ tumors?positive
For women who had taken HRT at baseline, the risk for both hormone receptor positive and negative tumors _____, with a stronger increase for positive tumors?increased
What is the mechanism of action in postmenopausal women?peripheral conversion of estrogen from excess adipose tissue
The same study found an ______ association of risk with BMI for hormone receptor positive (but not negative) tumors in premenopausal women?inverse
*** A large meta-analysis that included 15 cohort studies (> 2 million women) and 35 case-control studies (71,000 cases) found an ______ (but nonsignificant) relationship between BMI and breast cancer in premenopausal women?inverse
In postmenopausal women, this study found a significant effect on the incidence of breast cancer based on increasing ____ , although overall effect was small?BMI
What dietary pattern confers lower risk of breast cancer?a Mediterranean diet (higher intake of fruit and vegetables)
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PHYSICAL ACTIVITY
Question Answer
*** Independent of BMI, what appear to be protective for breast cancer?physical activity
What is the mechanism of exercise on breast cancer protection?the effect of exercise on serum estrogen, insulin and insulin-like growth factors
A large meta-analysis of 31 studies on 64,000 women with breast cancer found that exercise was associated with a _____ risk of breast cancer? The association was strongest for BMI < ____ and _____ (pre vs post menopausal women)?1) decreased 2) BMI < 25; 3) premenopausal
Was the above dose-related, explain?yes, greater reduction fro breast cancer was noted with longer, more vigorous exercise
The study found a ___% decrease in risk for every 10 metabolic-equivalent (MET)-hour/week increment in recreational activity (roughly equivalent to a ___ hour week of walking at 2 miles/hour or 1 hour /week of running at 6 miles/hour)?1) 3% 2) 4
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OTHER ASSOCIATED RISK FACTORS
Question Answer
Comment on why there is a significant increase in breast cancer among shift workers?it may be due to suppression of melatonin and altered or disrupted sleep cycles
Have studies showed an increase risk of breast cancer with caffeine intake, termination of pregnancy, tubal ligation or breast implants?no
*** SUMMARY = True or false? Use of combined oral contraceptives (COCs) confers slightly increased risk of breast cancer, but positive family history does not increase this risk further?true
*** SUMMARY = Alcohol intake is significantly associated with ____ risk for breast cancer?increased
*** SUMMARY = Does exercise confer protection independent of BMI?yes
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