Linda Brookes, Graham A. Colditz,December 08, 2014
Dr Colditz emphasized that breast cancer prevention efforts will have the greatest effects when they are initiated early in life.
Breast Cancer Screening Is Not Prevention
Medscape: What are the main factors in early prevention of breast cancer that physicians need to convey to their patients?
Growing scientific evidence indicates that childhood and adolescent lifestyle is clearly driving the risk for breast cancer. How we structure diet, level of activity, and alcohol intake in childhood and adolescence, and typically up to age 30, establishes a woman's lifetime risk for breast cancer. It is time that we acknowledge that breast cancer is the number-one cancer diagnosed in women in the world and start doing something serious about preventing it.
Dr Colditz: There is clear and growing evidence that diet composition in childhood and adolescence, physical activity, and alcohol intake before birth of the first child are all importantly related to the risk for premalignant breast lesions and invasive breast cancer. Part of the motive in our trying to get this message out is the fact that 21% of breast cancers are diagnosed in premenopausal women, and yet most of our discussion about prevention of breast cancer really starts with screening. That is detection, not prevention.
Medscape: Organizations representing other medical specialties, such as diabetes, are also campaigning vigorously for a healthier lifestyle in children and adolescents to prevent disease in early adulthood. How does education about breast cancer prevention differ from this?
Dr Colditz: The recommendation of a healthy, plant-based diet is clearly consistent with diabetes prevention, but it is probably even stronger for breast cancer.Regarding physical activity and avoiding weight gain, I think the message is the same for both breast cancer and diabetes. These factors tie in to a healthy childhood and adolescence.
Alcohol and Obesity: Not a Good Mix
Medscape: You recently published an infographic that showed that about half of breast cancers could be prevented, of which 5% could be avoided by alcohol restriction.
Dr Colditz: Correct. Alcohol consumption is that big of a contributor to breast cancer, and yet we largely ignore it.
Medscape: According to your estimates, 32% of breast cancer cases could be prevented by avoidance of weight gain.
Dr Colditz: That may still be an underestimate, but yes—it is amazing how strong that association is.