One of the most common cancers in the United States, breast cancer will affect about 1 in 8 women in their lifetimes, according to the Centers for Disease Control and Prevention.
Yet there are many misconceptions about breast cancer—and improving your knowledge of the disease is one way you can fight it.
Here are seven common misconceptions, and the facts from some of Mount Sinai’s leading breast cancer specialists.
Misconception: More than 50 percent of breast cancer patients have a family history of breast cancer.
The Facts: Many women think you can only get breast cancer if there is a genetic factor and, as a result, are not getting screened. In fact, 80 to 90 percent of all breast cancer patients have no family history. There are women who have genetic predispositions to breast cancer and genetic mutations that cause breast cancer. However, only 5 to 10 percent of all breast cancer patients actually have one of these genes, and a majority have no genetic predisposition or family history. In reality, your biggest risk factors are gender and age. If you are a woman who is 40 or older, even if you don’t have a close relative with breast or ovarian cancer, you should still follow the CDC’s recommended guidelines to begin getting screened annually.
Misconception: Screening recommendations are the same for everyone, regardless of a family history of breast cancer.
The Facts: The guidance for the general population is to start mammography screening at age 40 and continue on an annual basis thereafter. Those who may be at a higher risk, such as those with a family history or other personal factors, may need to be screened earlier. If you have a first-degree relative, such as a mother or sister, who was diagnosed at a certain age, you should start screening 10 years before that relative’s age at diagnosis. So, for example, if you were diagnosed at 45, your daughter should start screening at age 35. If you have a genetic predisposition, such as the breast cancer (BRCA) gene, you may need to begin screening as early as age 25.
Misconception: Only women get breast cancer.
The Facts: For most men, the risk of getting breast cancer is extremely low, approximately 1 percent. However, for men with the BRCA1 gene, the risk is about 1 to 2 percent, and for those with the BRCA2 mutation, the risk is 7 to 10 percent, about the same as the general female population. These men should be followed at a high-risk surveillance center.
Misconception: Consuming too much sugar directly increases your risk for breast cancer, and non-natural sugar is riskier than natural.
The Facts: There are no human studies that can absolutely defend or corroborate that theory. Your body maintains a more or less constant sugar level, and even if you consume a lot of sugar, it does not directly affect cancer cells. However, adopting healthy eating habits can reduce your risk for developing cancer and other chronic health conditions, especially if you have diabetes and are prone to have high blood sugars. You need to have a certain amount of fiber. You need to have foods that are natural whole foods, and minimize the amount of processed foods.
The U.S. government dietary guidelines recommend five to seven servings a day of fresh fruits and vegetables. We recommend increasing that to 7 to 10 servings a day. One serving is an amount that fits in the palm of your hand. Stay away from saturated fats, eat healthy oils, such as extra virgin olive oil, and lean meats that don’t have a lot of fat. You should eat a mostly plant-based diet. That doesn’t mean vegetarian or vegan. It means the majority of the foods you consume should be plants. Legumes, a type of vegetable that includes peas, beans, and lentils should be an essential part of it. Two servings a day of legumes are associated with decreased chronic disease, including cancer. You can still enjoy some sweets in moderation.
Concerning whether there are better types of sugar: Fruit, even though it is high in fructose, also contains fiber, which blunts the absorption of the fructose, so you don’t really get those peaks of high blood sugar. Honey and agave nectar don’t raise blood sugar as much as other sugars, because they are thicker, and they have some health benefits. Though artificial sweeteners are referred to as “sugar-free,” they contain ingredients that drive appetite and cause people to consume more calories throughout the day, and should be limited or avoided.
Misconception: Limiting alcohol consumption to several drinks per week can reduce your risk for developing breast cancer.
The Facts: Studies show there is no amount of alcohol that a human being can safely consume without any future risk for chronic disease. When people increase their alcohol intake, they also tend to eat less fruits and vegetables, which is linked to a number of cancers. This is because, unlike food, your body cannot burn off alcohol for energy. Instead, it converts alcohol to fatty acids in certain parts of the body that become fat depots and can lead to insulin resistance. This is how unhealthy diets can lead to cancer.
Misconception: If you tested negative for the BRCA gene 10 years ago, you do not need to get tested again because the test today is not much more advanced.
The Facts: If you haven’t been tested since 2013, you should get re-tested, because the testing today is based on much more comprehensive data. Aside from BRCA genes, we now test for a whole other panel of genes that predispose for developing breast cancer, including PALB2, CHEK2, and the ATM gene. The risk these carry is affected by family history. If there’s a lot of family history of breast or ovarian cancer, and you also have that gene, then you are in the highest range of the risk model of that gene.
Misconception: It is not necessary for everyone to get tested for the BRCA gene because only some ethnicities are affected.
The Facts: Genetic testing is vastly underutilized. The American Society of Breast Surgeons recently changed its guidelines and recommended testing every woman diagnosed with breast cancer regardless of family history or background. However, there are certain ethnic groups that are at higher risk for having a BRCA gene. For example, in the general population, about 1 in 500 to 1 in 1,000 will have a BRCA gene—far less than one percent. Among the Ashkenazi Jewish population (Jewish people of European descent), the rate is 1 in 40, or 2 percent of the Ashkenazi Jewish population. Many clinicians feel that population-based testing should be done in these selected groups where the yield is higher. But no ethnic group is without risk. For example, there’s an Icelandic version of BRCA. There’s a Hispanic version of BRCA. We see BRCA in Black women. There is a version of BRCA across all ethnic backgrounds, and it’s just a question of picking populations where the yield is the highest. We implemented a program so every woman can get genetic testing regardless of ability to pay. The maximum out-of-pocket expense is $99, which will be waived if you can prove financial need.
This Q&A is based on questions and answers from the annual Dubin Breast Center Fact vs. Fiction Luncheon and Symposium held in June. The panel discussion was moderated by Elisa Port, MD, FACS, and featured a panel of experts, including David Anderson, MD, FACS; Anna Barbieri, MD; Jeffrey Mechanick, MD; Cardinale Smith, MD, PhD; and Joseph Sparano, MD, FACP. Watch the video here.