If I had to get a breast cancer diagnosis, I might want it to come from Dr Stephen Grobmyer — chair of the oncology unit, professor of surgery and director of breast cancer surgery at Cleveland Clinic Abu Dhabi.
There are few families untouched by breast cancer at this point. Almost all of us have supported family members and friends through scares, diagnosis and treatment. We’ve lost people to breast cancer, or know someone who has died from it.
And we are terrified of getting it. Unless you have a strong family history of breast cancer, it’s not until you get into your 30s – and definitely 40s – that the reality sinks in. Breast cancer is the number one cancer in women; one in eight of us will be diagnosed in her lifetime. It has to be one of life’s worst lotteries.
According to the Abu Dhabi department of health, breast cancer represents 20 percent of all invasive cancers in the UAE and 50 percent of all cancer in women.
But rather than cowering in fear, we can stare risks in the face, find out what we can do to reduce them, and then do it. This is where Dr Grobmyser comes in: he’s all about taking responsibility for our own breast health, every single aspect of it. And then even if our worst fears are confirmed, we have given ourselves every possible chance for the best outcome. Here’s what you can do:
Take charge of your lifestyle
The very good news? These days, 33 percent of breast cancer is preventable.
That means while there is no way to protect ourselves completely from breast cancer, at least one-third of the risks are things we can manage for ourselves.
“This is all about risk mitigation,” explains Dr Grobmyer. “Doing these things, you are not only going to help reduce your breast cancer risk, you’re going to help yourself in a lot of other areas too.”
In broad strokes, lifestyle covers diet, exercise, maintaining a healthy weight and minimizing alcohol consumption.
As for food, Dr Grobmyer concurs with what the science says so far. Keeping it simple, that means limiting red and processed meat (for now, even in the face of recent studies suggesting otherwise), sugar, unhealthy fats and adopting a Mediterranean-style diet supplemented with olive oil.
Research also shows upping intake of cruciferous vegetables (cauliflower and broccoli, for example) and foods containing lycopene, beta carotene and carotenoids (orange and red vegetables) dramatically cuts risk.
Physical activity reduces insulin and estrogen, improves immune system functioning, cuts inflammation and enhances quality of life, all of which are beneficial to fighting cancer, says Dr Grobmyer.
Alcohol consumption boosts our androgen and estrogen levels, increasing the susceptibility of breast tissue to cancer and the likelihood of cancer spreading.
“All things in moderation,” recommends Dr Grobmyer.
In one study of 1,000 women, 116 of those who drank no alcohol were diagnosed with breast cancer, while the figure rose to 186 in women who had six units daily.
Omega 3 is also important, he advises, with studies showing a 14 percent reduction in risk in those who ingest it.
“We are learning more and more about diet, lifestyle and environment and how they can affect the genes,” he says. “So it’s the whole picture together, not just the genes. This is the empowering part of the picture.”
Women need to be aware of what their own breasts look and feel like, so they can know for sure when they change and get help.
Regular self-examination of the entire breast, up to the collarbone, down to the rib cage and into the armpit is part of this work. Take a good long look at your breasts in the mirror, and do it regularly. Any redness, dimpling, discharge, lumps and other skin changes should all be investigated immediately.
“The earlier we know about the problem, the better,” says Dr Grobmyer, “There’s a lot we can do.”
Although the research and reports on when and how often mammograms are required varies from region to region, and changes over time, Dr Grobmyer believes women should get a mammogram annually – or at least every other year – after they turn 40. And they definitely should get them after turning 50, he says.
Cleveland Clinic Abu Dhabi will be getting a new “3D mammogram,” which moves and gives “a whole movie” of the breast. He explains that this gives radiologists a better window to the breast and can cut down on the kinds of scary callbacks that happen with traditional mammograms.
This doesn’t mean traditional mammograms and their followup, ultrasounds, are inferior, however.
“If you feel something, ultrasound is an easy, cheap way to detect if it’s a solid lump or a cyst,” he explains.
Know your family history
“If it’s possible, talk to family members to find out who had breast or ovarian cancer or any other kinds of cancer,” explains Dr Grobmyer. “Because when you come to the doctor, they take that history, we’re processing that and using that information to decide who might need a gene test.”
Because genes come in pairs, when one is genetically damaged from the outset, the bearer is more vulnerable if the other gene should be negatively affected by environmental toxins, explains Dr Grobmyer.
When it comes to family members, the age of diagnosis is important: doctors are looking for cases under the age of 50. Breast cancer in both breasts and male breast cancers can also be significant in a family history.
Depending on the history, doctors may recommend genetic testing for the BRCA gene mutation or some other abnormal genes.
“When you know that a patient has a BRCA mutation before they get cancer, there are things that we can do to reduce the risk of getting cancer,” he says.
Those interventions can include radical mastectomy, but enhanced surveillance and drug interventions are also options.
Even with all the information, Dr Grobmyer cautions: you can get breast cancer without a strong family history, and not get it with one.
Learn about breast density
In recent years the “dense breast” has emerged as an another important way to assess risk factor, explains Dr Grobmyer. Women with what’s referred to as “extreme breast density” are 4.5 times more likely to develop breast cancer, for biological reasons the medical community doesn’t yet fully understand. Another factor is that dense breasts can make it harder for radiologists to find tumours at an early stage.
“Can having density in and of itself increase your risk, or is it just a detection problem?” asks Dr Grobmyer. “It’s both.”
The main message, he emphasizes, is to “just know” and discuss it with your doctor.
Finding a medical center that works for you and sticking with it is not only convenient, it helps close gaps that can be created in your testing and care, says Dr M Jean Uy-Kroh, formerly of Cleveland Clinic Abu Dhabi. Her advice is based on her own personal experience. When you visit different doctors, she says, the average woman has “no idea what was done.” And if that doctor has mammography and ultrasound services close by, even better.
“Going back to the same place over and over, where they have the same records, is immensely helpful,” she says.
•This article was originally published on October 23, 2019.