I was reading
the blog of Dr. Barry Boyd who has practiced oncology for a number of
decades. I thought what he, and others, had to say was practical,
informative and timely. Here is some of his response to Angelina
Jolie's radical mastectomy choice.
While he agrees
that women who carry the BRCA gene mutation limit their risk of
mortality from breast cancer by 85-95% when the breast surgery is
performed before age forty, he believes the public is woefully
under-informed when it comes to identifying the need for such surgery.
Dr. Boyd believes that many hold the misconception that the leading
risk factor for breast cancer is a gene mutation resulting in a
hereditary predisposition to cancer.
“This, in
part, reflects confusion about the difference between 'hereditary'
and 'genetics,' with regard to cancer risk. Hereditary risk factors
are changes in the genes you inherit from one or both parents, which
are present in all cells in your body. In families with a very high
cancer risk, some family member(s) might inherit that abnormal gene.
It is important to note that while virtually all cancers are
'genetic,' most cancers are not inherited but, rather, reflect the
genetic changes that occur within the DNA of that cell.”(We
actually know that DNA is not static, but can be changed by exogenous
or endogenous stress, exposure to chemicals, viruses, bacteria or
environmental changes.) “Over a period of years, a mutated cell
can give rise to generations of new cells that acquire additional
genetic changes, eventually resulting in an actual cancer. Thus,
stricktly speaking, all cancer is 'genetic' but not necessarily
inherited.”
Only 15% of
breast cancer in the US is related to a strong family history, and
only 8-10% of breast cancer has a defined inherited genetic
predisposition. The problem seems to be that women confuse the high
risk in individuals with the BRCA-1 gene mutation ( 85-95% risk of
breast cancer until age 70) with the general risk of getting breast
cancer. According to Dr. Boyd, the real risk is that women who have
no family history or genetic predisposition to breast cancer
underestimate their risk for cancer and are not taking adequate
preventative measures against this.
The problem I
see is that the medical community, in general, doesn't either see or
agree upon the importance of environmental factors and diet in breast
cancer. We have seen a dramatic growth in the incidence of breast
cancer in all women over the past twenty to thirty years. Something
has changed. We have seen that change cause an increase in the
lifetime breast cancer risk in carriers of an inherited BRCA-1 or 2
gene mutation from only 20% to up to a 85-95% risk. This is similar
to the marked increase in non-inherited breast cancer incidence during
this same time period. Dr. Boyd says that this is rarely discussed
and cannot be caused by an increase in frequency of these genetic
mutations...that would take hundreds-to-thousands of years for this
magnitude of change to take place. Scary, isn't it?
In her book,
Your Life in Your Hands,
Dr. Jane Plant discusses many of these issues, and, this book was
published over a decade ago! She, herself, had breast cancer a total
of five times and was told that the last episode of breast cancer
would end her life. She did extensive research on this topic and,
“cured” herself. It's a fascinating book and one I have
recommended to all women over the years. I highly do so, again, for
any and all of you interested in some answers as to why we have seen
such a significant increase in breast cancer since the 1980's and
what we can do to help protect ourselves.
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