Image of 1 in 8 women will have Breast Cancer

Breast microbiome and Cancer Risk Assessment tool

SUMMARY:  Recent studies challenge dogma and find that healthy breast tissue is NOT sterilafter-all. The breast seems to have its own microbiome of bacteria and such seems protective; dysbiosis (REDUCED richness and/or certain species) was associated with breast cancer.   Furthermore, healthy breast tissue had bacteria  Sphingomonas yanoikuyae (Proteobacteria), which is better known to degrade pollutants in the environment. In the cancer samples, there was little to none of S. yanoikuyae; this bacteria is able to use estradiols including 17-β estradiol, which are believed to be associated with breast cancer. The authors could not determine causality due to lack of S. yanoikuyae. Learn in this post microbiome implications for breast cancer, free online breast cancer risk assessment tools, ongoing studies personalizing cancer risk for mammogram frequency to reduce false positives, and look over a decent listing for cutting your risk for breast cancer in the first place from Prevention. Included specifically on that list is carotenoid loads which I preach about, including the need to consume carotenoids with the correct healthy fat so as to absorb them. LOWFAT DOES NOT ABSORB THOSE CAROTENOIDS.

The Pearl:  In 5 years, based on WISDOM study findings, all American women could be screened according to their own personal risk of breast cancer instead of one-size-fits-all recommendations.

Implications of the breast microbiome finding:

This research is contravening two longstanding bedrock assumptions that have underscored all modern attempts to find a cancer cause.

The first has been the almost universal belief that nearly all cancers are due to isolated genetic mutations that spontaneously occur in certain individuals. It has been assumed that breast cancers begin in single cells as isolated genetic mutations that occur more frequently in some individuals than others based on risk factors that may included diet, age or certain genetic variants that are known to run in families. The second concurrent presumption was that that all tissues in the body are sterile in the normal individual, and naturally, this includes breast tissue. -Physicians News Digest, What history is teaching us about breast cancer

Breast Microbiome & Cancer Risk

While you probably aren’t having your breast tissue microbiome 16S rRNA sequenced for cancer, how about those  mammography guidelines?  Totally confusing and wrought with controversy… from the large numbers of false positives, to when to begin screening and frequency.  Who do you trust and believe? If you are in the Athena Breast Health Network, a collaboration of five University of California medical centers, you may be eligible for the WISDOM study which offers assessment based on personalized risk factors (details below). Otherwise, THREE FREE tools you can use online calculates your breast cancer risk.  Talk to your doctor about your findings:

  1. Breast Cancer Surveillance Consortium Risk Calculator,
  2. National Cancer Institute Breast Cancer Risk Assessment, and
  3. BC Screening Mammography Decision Aid
Criticisms of mammography screening

An abnormal mammography is a women’s, and their loved ones, greatest fear. This is why many friends do mammography screening together; being alone and told such a finding is devastating. Criticisms of mammography screening includes over-diagnosis and over-treatment. False positives involves painful and time-consuming testing that too often finds there never was cancer in the first place

“Having a false positive was associated with a relative increase of 40% (for those who underwent additional imaging) to 75% (for those who underwent a biopsy), the absolute risk over a 5 or 10 year period was not large. After five years, about 2% of women who had a false positive were diagnosed with cancer, compared to about 1% of women who had negative mammograms.” –See,

False positives may provide clue to future breast cancer risk

From Susan G. Komen:  One downside of mammograms is false positive results. These occur when a mammogram finds something that looks like cancer, but turns out to be benign (not cancer). The more mammograms a woman has, the more likely she will have a false positive result that will require follow-up tests (breast MRI, biopsy). The chance of having a false positive result after 10 yearly mammograms is about 50 to 60 percent [21-23].

There is also the risk that a mammogram could catch a very small breast cancer that will go way on its own, or never progress to the point that it harms the woman. In other words, a mammogram could catch a tumor that isn’t really worth catching. To further understand the mammography pro/con issues, read this Nov, 2015 article, Annual Mammograms Won’t Lower Your Risk Of Dying From Breast Cancer. Here’s What Will.

OTHER COUNTRIES TAKE ON MAMMOGRAPHY:  In 2013, the Swiss Medical Board recommended stopping mammograms using a phase out approach. The Swiss Medical Board’s report was made public on February 2, 2014 (www.medical-board.ch).  A participant on this board explained in this New England Journal of Medicine article:  Systematic mammography screening might prevent about one death attributed to breast cancer for every 1000 women screened, even though there was no evidence to suggest that overall mortality was affected. At the same time, it emphasized the harm — in particular, false positive test results and the risk of overdiagnosis. For every breast-cancer death prevented in U.S. women over a 10-year course of annual screening beginning at 50 years of age, 490 to 670 women are likely to have a false positive mammogram with repeat examination; 70 to 100, an unnecessary biopsy; and 3 to 14, an overdiagnosed breast cancer that would never have become clinically apparent.5  The relative risk reduction of approximately 20% in breast-cancer mortality associated with mammography that is currently described by most expert panels 2 came at the price of a considerable diagnostic cascade, with repeat mammography, subsequent biopsies, and overdiagnosis of breast cancers — cancers that would never have become clinically apparent.-Abolishing Mammography Screening Programs? A View from the Swiss Medical Board, New England Journal of Medicine.

The Breast Cancer Risk CALCULATORS: the Breast Cancer Surveillance Consortium Risk Calculator, and the National Cancer Institutes Breast Cancer Risk Assessment Tool. and the BC Cancer Agency Screening Mammography Decision Aid

These calculators are FREE interactive online tools YOU CAN USE to calculate your risk of breast cancer.  

The Breast Cancer Surveillance Consortium (BCSC) Risk Calculator, asks six questions and estimates both your five-year and ten-year risk of developing invasive breast cancerin 2015, the calculator was further updated to include benign breast disease diagnoses. Physicians participating in the Breast Cancer Surveillance Consortium use the BCSC risk calculator. It was developed and validated in 1.1 million women undergoing mammography across the US, among whom 18,000 were diagnosed with invasive breast cancer. It was externally validated in the Mayo Mammography Health Study. 

The National Cancer Institute Breast Cancer Risk Assessment Tool asks eight questions and estimates your five-year risk for developing invasive breast. It was developed and designed by scientists at the National Cancer Institute (NCI) and the National Surgical Adjuvant Breast and Bowel Project (NSABP). See here for an explanation of those questions.

The BC Cancer Agency Screening Mammography Decision Aid asks six questions one of which is “new” in that it asks the time between mammograms as input into the risk assessment. That seems smart as the risk of over-diagnosis increases with the number of mammograms taken, and this is true even though actual cancer diagnoses increase due to aging —From Susan G. KomenThe chance of having a false positive result after 10 yearly mammograms is about 50 to 60 percent [21-23].  Note that the assessment is based on British Columbia data which may not necessarily be the same as your country’s false positive and actual cancer diagnosis data. This is the home page for BC breast cancer screeningThe final report indicates the number of women, out of 1000 women screened with a history similar to yours, that would have a false positive. The report specifies both the number of women called back for further testing and the number that undergo biopsy, both of which will turn out to be normal after testing. The false positive numbers are much greater compared to the number of women that would have breast cancer detected.

embellishment7You can Find the Breast Cancer Surveillance Consortium (BCSC) Risk Calculator here.

Have you assessed your risk for breast cancer using the The BCSC Risk Calculator?

You can Find the National Cancer Institute(NCI) Breast Cancer Risk Assessment Tool calculator here.

Have you assessed your risk for breast cancer using the NCI Breast Cancer Risk Assessment Tool calculator??

You can find the BC Cancer Agency Screening Mammography Decision Aid here.

Have you assessed your risk for breast cancer using the BC Cancer Agency Screening Mammography Decision Aid??embellishment7

The questions asked for the BCSC Risk Calculator, the NCI Breast Cancer Risk Assessment Tool, and the BC Cancer Agency Screening Mammography Decision Aid calculator are:

caution sign3I was surprised that the questions did not address more of the factors known to increase risk of breast cancer which are summarized in the 2014 paper, The breast cancer epidemic: 10 facts (a great read by the way). One easy factor for example missing, that many are not aware of, is the oral contraceptive link not just for breast cancer, but for cervical and liver cancer as well (WHO in 2005 classified them in the same category as arsenic, asbestos, and tobacco smoke):

In 2005, WHO raised the International Agency for Research on Cancer (IARC) classification for combined oral contraceptives (COCs) from “possibly” carcinogenic (IARC 1999) to a Group 1, or highest carcinogenic risk category. Furthermore, this agency extended the same Group 1 classification for combined oestrogen-progestagen hormone therapy. The Working Group did not find evidence sufficient to infer a protective effect at any site (Cogliano et al. 2005). The 2005 WHO statement concluded that in addition to being etiogenic for breast cancer, COCs are also Group 1 carcinogens for cervical and liver cancer (Cogliano et al. 2005). Other WHO-IARC Group 1 carcinogenic agents include arsenic, asbestos, and tobacco smoke.  

The Breast Cancer Surveillance Consortium (BCSC) study

The BCSC study results from the work of Dr. Laura Esserman, MD, MBA, a breast cancer surgeon, a professor of surgery, director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center, and a vocal proponent of the idea that breast cancer screening brings with it over-diagnosis and over-treatment.  Her study challenges the status quo and will compare the outcomes for women who get annual mammograms with outcomes for those who get personalized, risk-based screening. No one in the trial will receive screening that is less aggressive than the task force guidelines. “We’ll stay within the bounds,” Esserman said, “but over time the goal is to learn what risk factors are the most important and how we can adapt screening accordingly.”

The study is a 5 year trial known as the WISDOM study (Women Informed to Screen Depending on Measures of Risk) and involves some 100,000 participants who will be drawn from the Athena Breast Health Network, a collaboration of the five University of California medical centers.  WISDOM tests participants for genetic markers and other factors that point to a risk of breast cancer.  Women in the personalized group are assessed by weighing factors like age, race, family history of breast cancer, personal history of breast biopsies, breast density, genetic mutations, and inherited genes. The study screens those at risk more frequently than the current federal task force guidelines. Those deemed at less risk receive fewer mammograms. A control group will receive annual mammograms.  See more herehere, and here.

lightbulb2In 5 years, based on WISDOM study findings, all American women could be screened according to their own personal risk of breast cancer instead of one-size-fits-all recommendations.
Ductal carcinoma in situ and less aggressive treatment???

Diagnoses of ductal carcinoma in situ (D.C.I.S.), involving abnormal cells confined to the milk ducts of the breast, have soared in recent decades. They now account for as much as a quarter of women cancer diagnoses as radiologists find smaller and smaller lesions.

While it is still undecided on best treatment for D.C.I.S., the article, A Breast Cancer Surgeon Who Keeps Challenging the Status Quo explains:  This long-term study published in JAMA Oncology (an analysis of 20 years of patient data) made the case for a less aggressive approach to treating a condition known as D.C.I.S.; the current practice is nearly always surgery and often radiation. The results suggest that the form of treatment may make no difference in outcomes.

Dr. Esserman, an advocate for less aggressive treatment. may instead treat this condition using active surveillance which includes blood work and hormonal testing, instead of quickly performing biopsies, lumpectomies or mastectomies.  Why?  The side effects of aggressive treatment includes disfigurement for pre-malignant conditions that are unlikely to develop into life-threatening cancers.

Why other doctors aggressively treat D.C.I.S.:

D.C.I.S. can be a precursor to invasive cancer in some patients;  invasive cancer is commingled with D.C.I.S. about 10% of the time according to Dr. Elisa Port, chief of breast surgery at Mount Sinai Hospital in New York… When we watch and wait, we don’t know if it is only D.C.I.S.

“We know we are overtreating DCIS,” says Eileen Rakovitch, a radiation oncologist at Sunnybrook Health Sciences Centre’s Odette Cancer Centre in Toronto. “In most women, it will not become an invasive breast cancer and it will not be life-threatening. But for some, DCIS is the first step to invasive cancer—and we don’t know who these women are.”

The short sight of WISDOM: WISDOM needs to catch up and include gut and breast microbiome. 

Perhaps I am overly optimistic wishing WISDOM included gut microbiome given that the gut microbiome association to disease publications only began surfacing in 2013ish. Heck, the breast tissue microbiome association to cancer was only realized in 2014 using 16S pyrosequencing; specifically, when dysbiosis occurs in breast tissue, a REDUCTION in the overall number of bacteria and/or the abundance of specific species… may lead to decreased bacterial-dependent immune cell stimulation, ultimately resulting in a permissive environment for breast tumorigenesis.  See  Microbial Dysbiosis Is Associated with Human Breast Cancer study details below.  

How might the gut microbiome affect breast tissue?

To summarize: The gut microbiome can affect the enterohepatic circulation of estrogen and carcinogen metabolism, and the GI microbiota can also alter signaling pathways involved in breast cancer pathogenesis or metastasis, such as Rho GTPases, Cox-2 and MAPK.

2015, Investigation of the association between the fecal microbiota and breast cancer in postmenopausal women: a population-based case-control pilot study is a pilot study finding that 48 postmenopausal women with breast cancer patients have altered composition and estrogen-independent low diversity of their gut microbiota. Whether these affect breast cancer risk and prognosis is unknown.

Below is excerpted from Dr. Susan Love, Army of Women, who’s advisory committee reads like a who’s who in breast cancer research. The Army of Women has funded  RUSH University Medical Center,  Chicago, Illinois, researcher Ece Mutlu, MD, to look at gut microbiome and breast cancer (see below for study details):

  • Breast cancer incidence is rising and current genetic factors explain only 5% of the cases seen in clinical practice.
  • The GI microbiota is also affected by and may be responsible for the observed effects of environmental factors on breast cancer such as diets, phytoestrogens, alcohol, and obesity. It is also well known that GI microbiota can convert estrogens to their active or inactive forms depending on the bacterial groups present, and can affect the enterohepatic circulation of estrogen and carcinogen metabolism.
  • The GI microbiota can also alter signaling pathways involved in breast cancer pathogenesis or metastasis, such as Rho GTPases, Cox-2 and MAPK. Most recently, infection with an enteric organism that alters GI microbiota was shown to cause breast cancer in animal models.
  • Despite all of this evidence pointing toward a role for GI microbiota in breast cancer and the availability of new molecular biology tools which allow for a wide survey of the GI microbiota and alterations in its gene expression, this topic has not been studied. 

How might the breast microbiome affect breast cancer tissue? The breast microbiome of cancer tissue differs from that of healthy. Seems this testing should be incorporated into WISDOM for those samples biopsied.

Breast microbiomes are beginning to publish.

The breast microbiome for healthy Canadian and Irish varied.  See 2014, Microbiota of Human Breast Tissue with full text here.

While I don’t have a US breast microbiome to compare, the cancer incidence for breast, prostate, and total cancer (2008) can be seen on these images from Organisation for Economic Cooperation and Development (OECD). US, Ireland, and Canada rank high in cancer incidence:

Breast tissue is not sterile challenges the dogma, and Dysbiosis is associated with breast cancer

The first 16S pyrosequencing study of bacteria in breast cancer tissue published in 2014, Microbial Dysbiosis Is Associated with Human Breast Cancer.

For background:  Until two years ago, bacteria in the breast was studied in the context of infections and in healthy individuals, but no comprehensive study of bacteria in breast cancer was reported. Recall that traditional culture-based methods (aka petri dish) underestimates and bias’ the microbial diversity in a given sample since 99% of the bacteria present is anaerobic and can not be grown in air.  Consequently, the role of microbes in breast carcinogenesis has not been thoroughly explored. New technology, 16S pyrosequencing, changes that!

The study characterized and compared the breast microbiota in breast tumor to paired normal adjacent tissue for 20 individuals with estrogen receptor (ER)-positive breast cancer.  The same individual’s breast microbiome was used due to variability in the 20 patient’s breast microbiomes.  NOTE: This is a small study cohort; none the less… generally, cancer tissue had REDUCED microbiome richness and/or diversity (such as little to no S. yanoikuyae) compared to the healthy tissue.

The study findings:

  • Collectively, our data and previous reports support a model in which bacteria contribute to maintenance of healthy breast tissue by stimulating resident immune cells. When dysbiosis occurs, a reduction in the overall number of bacteria and/or the abundance of specific species such as S. yanoikuyae, may lead to decreased bacterial-dependent immune cell stimulation, ultimately resulting in a permissive environment for breast tumorigenesis.
  • Microbial DNA is present in the breast and that bacteria or their components may influence the local immune microenvironment.
  • The dramatic reduction in bacterial load found in breast tumor compared to healthy breast tissue warrants further study to determine if bacterial load could be an additional indicator of diagnosis or staging of breast cancer.
  • Dysbiosis was associated with breast cancer disease state and severity... the inverse correlation between bacterial load and tumor stage implies that bacterial load might be used in conjunction with current methods to monitor the progression of breast cancer and to facilitate staging of the disease.
  • Furthermore, it is tempting to speculate that a decrease in bacterial load in a healthy individual may be a signal of heightened breast cancer risk.
  • Based on our studies, further investigation into the role of microbes in breast cancer would be of interest. . Our findings suggest a previously unrecognized link between dysbiosis and breast cancer which has potential diagnostic and therapeutic implications.”
Reduced breast microbiome diversity and richness; could antibiotics play a role in breast tissue microbiome to skew?

While I am certain many factors affect the microbiome of breast tissue, one obvious (with some supporting studies) is antibiotic load.

  • Bacteria may play a protective role in breast cancer; in mice,  antibiotic treatment regimens led to increased risk of  mammary tumor development as well as higher rates of tumor growth [39 or full text Influence of Antibiotic Treatment on Breast Carcinoma Development in Proto-neu Transgenic Mice], 
  • A human study by Velicer et al. provides clinical data to support the idea that bacteria may play a role in preventing breast tumorigenesis [40]… increasing cumulative days of antibiotic usage correlated with increased risk of developing and succumbing to breast cancer.
  • Some epidemiologic studies have suggested a positive association between antibiotic use and risk of breast cancer ( 1, 2).  A Finnish population study found that premenopausal women who used antibiotics for urinary tract infections had an elevated risk of breast cancer compared with women who did not use antibiotics.  In a North American population study ( 2), cumulative days of antibiotic use were associated with increased risk of breast cancer, in women who underwent long-term (>1,001 days) antibiotic treatment.  [But there are conflicting studies.]  Other studies have found either no clear association between breast cancer and antibiotic use ( 3, 4) or a low association ( 5) between breast cancer and a specific antibiotic, such as flucloxacillin, which is commonly used to treat breast cancer abscess and mastitis ( 6). Thus, it remains unclear whether antibiotic use is causally related to breast cancer or whether there are common mediators of antibiotic exposure and breast cancer. Indeed, some women may have underlying immune or inflammatory disorders that predispose them to neoplasia, and antibiotic use would only be a marker for impaired immune function or for underlying infections. Influence of Antibiotic Treatment on Breast Carcinoma Development in Proto-neu Transgenic Mice
How to cut your risk of breast cancer in the first place:

“Everything we do from the moment we wake—from what we eat and drink to whether or not we exercise and avoid BPA, parabens, and other carcinogenic chemicals—is a factor that can turn on or off the genetic switches in our bodies, including ones that could lead to cancer. The risk of many cancers, including breast cancer, can be significantly reduced by living a healthy lifestyle.” -10 Ways To Keep Breast Cancer Out Of Your Future. 10 suggestions from this article are:

  1. If you have dense breasts: Dense breasts increases your cancer risk up to 6 times higher. Ask your doctor about adding MRI or ultrasound to your screening regimen, or switching from traditional mammography to digital, which is higher in contrast, making it easier to see abnormalities in dense breast tissue.
  2. Get moving. Women who’d gained 21 to 30 pounds since age 18 were 40% more likely to develop breast cancer than those who hadn’t gained more than 5 pounds. The reason: estrogen, which can stimulate cell overgrowth and breast cancer. Before menopause, most of a woman’s estrogen is produced by her ovaries; after menopause, when ovaries stop producing the hormone, most of the estrogen comes from fat tissue. The more fat in a woman’s body, the more estrogen. Exercise also alters estrogen metabolism lowering breast cancer risk. Brisk walking 1¼ to 2½ hours a week had 18% less risk of breast cancer than women who were inactive. To protect yourself from breast cancer—and all cancers—the ACS recommends aiming for 150 minutes of moderate-intensity exercise weekly, which breaks down to 30 minutes 5 days a week.
  3. Family history matters including Dads: 5 to 10% of breast cancer is hereditary. Look at first-degree relatives (parents, siblings, and children) and second- and third-degree relatives too (aunts, uncles, cousins, great-grandparents, grandchildren, nieces, and nephews).
  4. Minimize radiation exposure from screening tests ionizing radiation can cause DNA mutations in cells.
  5. Limit hormone therapy: The Women’s Health Initiative found that long-term use of combined estrogen plus progestin therapy increases a woman’s risk of breast cancer by 24%.
  6. Breastfeed for the first 6 months as this has a 10% reduced risk of death from cancer, compared with those who don’t.
  7. Diet: Women who had the highest carotenoid levels in their blood had a 19% lower risk of breast cancer than those with the lowest levels. Carotenoids are found in fruits and vegetables such as leafy greens, carrots, and red peppers. Women who consumed more carotenoids had an even lower risk of developing estrogen-receptor-negative breast cancer (which is often more aggressive).

    You know to ABSORB carotenoids you must consume them with healthy fats.  See posts:lightbulb2TYPE OF FAT CONSUMED AND BREAST CANCER DIAGNOSIS FOR MEDITERRANEAN DIET

    MEET THE FATS & BEST SALAD DRESSING OIL, PART1, and

    SOYBEAN OIL, CORN OIL, DIABETES, AND METABOLIC SYNDROME.  Note that vegetable oil includes these oils and their association to toxin compromise: Significantly affect the expression of many genes that metabolize drugs and other foreign compounds that enter the body, suggesting that a soybean oil-enriched diet could affect one’s response to drugs and environmental toxicants. The single most highly represented family of dysregulated genes was that of the [key liver detox] cytochrome P450 (Cyp) genes (30 genes total).  – 2015, Soybean Oil Is More Obesogenic and Diabetogenic than Coconut Oil and Fructose in Mouse: Potential Role for the Liver


    Other phytonutrients may also protect against breast cancer, including sulforaphane (found in cruciferous vegetables) and lycopene (the chemical that gives tomatoes their red color). The ACS recommends eating five or more servings of fruits and veggies a day, limiting processed (I’d say eliminate processed) and red meats, and choosing whole grains (I would add if you tolerate them) to help reduce risks of all types of cancer. I believe they are totally missing the increase Omega-3 load and decrease the Omega-6 loads. They also have not included dairy if you tolerate such, as well as adding live ferments. See below slides for better understanding.  Finally, limit alcohol to no more than one drink per day—any more than that increases your breast cancer risk to 1½ times that of someone who doesn’t drink at all.

  8. Early detection: The 5-year survival rate for breast cancer that’s found early and confined to the breast is 99%, says the American Cancer Society (ACS).  Follow guidelines, they vary:
  9. “Previvor” strategies: various ranging from mastectomy to close monitoring with rotating MRI with mammogram every 6 months, to tamoxifen and lifestyle changes.
  10. Have a survivor strategy to minimize change of recurrence.
So, what are mammograms good for
  1. Mammograms are excellent at finding cancers that may never actually need to be treated at all—that might even go away on their own, as up to 20% of cancers are thought to do. Mammograms detect calcifications, growths that most often turn out not to be anything whatsoever. Annual Mammograms Won’t Lower Your Risk Of Dying From Breast Cancer. Here’s What Will
  2. Mammograms are excellent at finding cancers that are so slow-growing a woman would eventually have noticed a lump while dressing or showering and ultimately had the exact same prognosis and treatment as if it had been discovered. Annual Mammograms Won’t Lower Your Risk Of Dying From Breast Cancer. Here’s What Will
  3. From Susan G. Komen:  Mammography is good at finding breast cancer, especially in women ages 50 and older. Overall, the sensitivity of mammography is about 84 percent [8]. One downside of missing so few cancers is false positive results. These occur when a mammogram finds something that looks like cancer, but turns out to be benign (not cancer). The more mammograms a woman has, the more likely she will have a false positive result that will require follow-up tests (breast MRI, biopsy). The chance of having a false positive result after 10 yearly mammograms is about 50 to 60 percent [21-23].
  4.  A participant on the Swiss Medical Board explains their recommendation of abolishing mammograms in this New England Journal of Medicine article:  Systematic mammography screening might prevent about one death attributed to breast cancer for every 1000 women screened, even though there was no evidence to suggest that overall mortality was affected…. The relative risk reduction of approximately 20% in breast-cancer mortality associated with mammography that is currently described by most expert panels 2 came at the price of a considerable diagnostic cascade, with repeat mammography, subsequent biopsies, and overdiagnosis of breast cancers — cancers that would never have become clinically apparent.-Abolishing Mammography Screening Programs? A View from the Swiss Medical Board, New England Journal of Medicine. Clearly relative risk differs in quantification though I am not a stat wiz.
Beyond the WISDOM trial and Regarding the question: What age to begin mammography?

Esserman explains:  ...We didn’t have the right data to figure out what intelligent screening would look like. “The data that informs our approach to screening was collected in the 1980s.,” We now know so much more about the different forms the disease can take and the way risk can manifest—for instance, with the BRCA1 and BRCA2 genes—and yet the studies published today analyze stats collected at a time when our understanding of the disease, and its risk factors, was more basic.

She has in mind a highly personalized approach to breast cancer screening, in which women with the lowest risk are screened far less often than women with the highest risk. It’s a method driven by science, not fear. It would mean downgrading DCIS to a noncancer status deserving of the same no-sweat attitude we have toward something like an abnormal Pap test: You’re aware of it, you keep an eye on it, you make some lifestyle tweaks to be as healthy as you can. That’s it. “DCIS is not an emergency,” she says. “People don’t die in days or months. You have time to absorb the information, understand the diagnosis, and think about treatment options.”

Future work must involve: Gut and breast microbiome analysis (see above for details). And Esserman says, A nationwide database of breast cancer incidence, false positives, and D.C.I.S. diagnoses, to continue to refine the personalized screening model and to perfect breast cancer care. If we do this right, we will nab more of the lethal cancers earlier while sidestepping life-altering false positives and the epidemic of overreacting to precancers.

RUSH’s Breast Cancer Microbiota Collection Study
Clinical Trial Title: Study of the gastrointestinal microbiota (colon bacteria) in patients with and without breast cancer
Clinical Trial Protocol ID: 08110504
Clinical Trial Investigator: Ece Mutlu, MD, Rush University Medical Center, Chicago, Illinois

Summary: 800 subjects will be recruited at Rush University Medical Center, in the Midwest states and in southern California. Subjects will complete questionnaires and provide a blood draw and two stool collections. This study will analyze the DNA and RNA from stool and blood cells. These tests are meant to understand how our cells and microbial cells interact with each other and with their environment.

Clinical Trial Eligibility Criteria in order to participate:
  • Have no personal history of breast cancer and had an abnormal mammogram.

Exclusion criteria is meeting any of the following criteria:

  • Are not between the ages of 30 and 80.
  • Have gastrointestinal diseases.
  • Have been on antibiotics, immunosuppressants or hormone therapy drugs within past three months.

RUSH microbiome/breast cancer study, excerpted from CURRENT RESEARCH PROJECTS, Dr. Susan Love, Army of Women, who’s advisory committee reads like a who’s who in breast cancer research:

Study Abstract We intend to study the role of the gastrointestinal (GI) microbiota in the pathogenesis of breast cancer (BC) in women. Humans are super organisms that represent a fusion of eukaryotic cells of their own, as well as bacteria and archaea that reside in and over the body, primarily in the GI tract. Little is known about the GI microbiota, which represents the most dense and least diverse ecosystem known on earth. It is believed that GI microbiota is passed on from the mother to her infants and remains fairly stable through life.

  • Bacterial cells in the GI tract outnumber human cells in the body by about 10 fold and carry thousands of additional genes which can rapidly evolve under the pressure of changing environmental factors.
  • The GI tract microbiota approximately weighs about 1 kg in a human being and is estimated to have a metabolic activity comparable to the human liver.
  • A recent metagenomic survey of this activity shows that the bacterial genes for xenobiotics (important in carcinogen and hormone metabolism) are enhanced in the human GI tract.

I find breast cancer screening such a difficult issue to address as so much more needs yet to be understood about breast cancer and the breast microbiome. My prayers go to all fighting, surviving, or having lost a loved one to a breast cancer diagnosis.

 
Last updated: March 22, 2016 at 21:08 pm

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4 thoughts on “Breast microbiome and Cancer Risk Assessment tool”

  1. When to Have Mammograms: No Consensus, http://www.berkeleywellness.com/self-care/preventive-care/article/when-have-mammograms-no-consensus?ap=400 July 2017.
    Gudelines vary:

    -The U.S. Preventive Services Task Force: between ages 50-74, mamograms every 2 year. Women in their 40s can choose every two years depending on risk factors and prefernece.

    -The American Cancer Society (ACS): Ages 40-45, annual optional. Ages 45-54 every 2 years. Biennial for ages 55 and over. Have mamograms as long as life expectancy is at least 10 yrs.

    -The American College of Obstetricians and Gynecologists (ACOG): 2017 New guidelines https://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Breast-Cancer-Risk-Assessment-and-Screening-in-Average-Risk- Mamogram, annual or biennial is optional in 40s. Mamograms should occur at the latest at age 50 and it can be annual or biennial. At age 55, mamograms should be biennial. Screening can continue to age 75,

    Pearls: Begin talking with physician about age 40. Keep in mind that when it comes to cancer screening, more isn’t always better. Excessive screening greatly increases the risk of over­diagnosis and overtreatment without—from a public health perspective—saving enough extra lives to compensate for these harms. The guidelines of the Task Force and ACS are reasonable, but women need to work with their doctors to come up with the most suitable screening schedule for them, based on their values, preferences, and risk factors.

  2. Study links consumption of an energy-dense diet to increased breast
    cancer risk, Oct 2016, http://asn-cdn-remembers.s3.amazonaws.com/005b60439a37fb704ee015245f311a74.pdf (see study PDF at: http://files.constantcontact.com/d133df39001/5ddce057-f40b-452f-94db-1860539009db.pdf )

    Hartman TJ, Gapstur SM, Gaudet MM, Shah R, Flanders WD, Wang Y,
    McCullough ML. Dietary energy density and postmenopausal breast
    cancer incidence in the Cancer Prevention Study II nutrition
    cohort. Journal of Nutrition 2016;146:2045-50.

    Cohort is 57,000 breast-cancer-free postmenopausal women with an average age of 68 years: Their findings suggest that, after controlling for a list of important confounding factors, women who consume diets with the highest levels of energy density (calories per gram of food) may be more likely than those who eat diets with the low energy densities to be diagnosed with breast cancer

    Those eating the least-energydense diets, women consuming diets with the highest energy densities were 20% more likely to be diagnosed with breast cancer during the study. This relationship did not seem to be modified by body mass index (an indicator of obesity), age, or physical activity level. The scientists posit that their findings support the importance of fruits and vegetables and other low-energy-dense foods that simultaneously support both a healthy body weight and reduce the risk of breast cancer.

  3. Dietary Fiber Intake in Young Adults and Breast Cancer Risk, http://pediatrics.aappublications.org/content/early/2016/01/28/peds.2015-1226 March 2016

    Women who ate a lot of fiber during adolescence had a 24% reduced risk of developing breast cancer before menopause, compared to women who had eaten a low quantity of fiber. For every extra 10 grams of fiber the women ate every day, their breast cancer risk declined by 13%. And the effect was particularly strong for those who ate more fruits and vegetables… We also observed a significant inverse association between fiber intake and premenopausal BC incidence.

    Adolescence women in the highest quintile of fiber intake had a 25% lower proliferative BBD risk than women in the lowest quintile,28 suggesting the importance of investigating dietary factors during this period of life.

    A recently published meta-analysis of 16 prospective studies had a 5% lower BC risk was seen for each 10 g/day increment of fiber intake. Our results are consistent, although stronger, with a 13% lower BC risk per 10 g/day fiber increment during early adulthood and 14% lower BC risk per 10 g/day fiber increment during adolescence.

    Growing evidence that dietary fiber can reduce a person’s estrogen levels by escorting estrogen out of the body through the GI tract and by changing gut bacteria. A diet high in fiber has been hypothesized to reduce BC incidence by inhibiting reabsorption of estrogen, thus decreasing circulating levels.3–5 Fiber may reduce BC risk through improving insulin sensitivity51, and decreasing insulin-like growth factors.52 Furthermore, dietary fiber may decrease plasma levels of estrogen by inhibiting colonic β-D-glucuronidase activity, resulting in decreased deconjugation and reabsorption of estrogen and thereby increased fecal excretion.4,53,54

    Bacteria feed on fiber and make short-chain fatty acids, which get absorbed into the bloodstream and tamp down inflammation in the body. But when there isn’t enough fibrous food for those bugs, a host of things can go wrong…

Now I'd like to hear your thoughts... comments are always welcome!