Dr. Marisa Weiss: ‘You can take steps to lower your risk of breast cancer’
02/09/14 by Juanita Teschner
EDITOR’S NOTE: The Center for the Environment at Catawba College will host a presentation Tuesday, April 22, by Dr. Marisa Weiss. A breast oncologist at Lankenau Medical Center in Wynnewood, Pa., she serves as director of Breast Radiation Oncology as well as director of Breast Health Outreach. She is also the president and founder of the nonprofit organization Breastcancer.org, an online breast health and breast cancer resource.
The presentation, “Think Pink, Live Green: Reducing the Environmental Risks of Breast Cancer,” is scheduled for 6:30 p.m. in the Center building on the Catawba campus. The event is free and open to the public but registration is required: Call 704.637.4727.
Juanita Teschner, director of communications at the Center for the Environment, talked with Weiss recently about her upcoming presentation. This is an edited version of that transcript.
Q: You, yourself, are a breast cancer survivor. How has that reality impacted your work as a breast oncologist and the driving force behind Breastcancer.org?
A: I have been committed to taking care of women with breast cancer for 25 years, and about 8-10 years ago I really increased my focus on prevention because once you take care of women with breast cancer for that many years, you say to yourself, “I wish I could just prevent it from happening.” There are so many ways we can help women lower their risk of ever getting it.
I was fully engaged in research and educational programs around prevention and then I get my own diagnosis. Despite my own personal career, it’s a whole other matter when you’re diagnosed yourself. You really understand the devastation of the illness, and you also understand how much you want to do as an individual to lower your risk of ever having a problem again beyond what the doctors tell you to do.
The whole point of the treatment is to give you a life afterwards, and yet you want to know what you can do in your everyday life to reduce your risk – how can you change what goes in, on and around you in a significant way to help lower that risk. That is where prevention comes in.
Q: That diagnosis has to affect your family, too. How does that play out?
A: I’m the mother of a great daughter. I worry about her. The fact is that for any woman who’s diagnosed they think about themselves for about two milliseconds and then quickly they think about what impact this has on their daughter. So for all the years I have been taking care of women with breast cancer, I have been helping them address not just their own diagnosis but the impact of their diagnosis on their family.
When it hit me, I also thought of my daughter and my nieces and everyone in my family, and I had an even better understanding of what it would mean for my patients’ families. You feel it at a much deeper level, and I would also add that when you do get people addressing your healthcare needs in a sensitive, smart, accessible, warm and compassionate way, you have great gratitude. I feel deep gratitude for the doctors and nurses and other professionals who helped me. I certainly know how grateful people are for the scientists and the doctors, nurses, philanthropists – everybody committed to finding out how to prevent it.
Q: How does our environment increase the risk of breast cancer?
A: Here’s the thing: Breast cancer used to be uncommon, and now it’s the most common cancer to affect women by a long shot. The reality is that only 10 percent of breast cancers are due to one of the single rare genes like BRCA1 or BRCA2, the genes that Angelina Jolie has. Most breast cancers are related to how you lead your life; that is, what you’re eating, what you’re drinking, what you’re breathing in, medicines you’re taking, personal products you’re using.
So today, more than ever before, there are large numbers of chemicals in our environment that can look like and act like and taste like an estrogen. Breast cells like to feed off of hormones – not just your own body’s hormones but also things that you encounter in your food, in your drink, what you breathe in. We are surrounded by a lot of these chemicals that didn’t used to be there.
Q: What are some examples?
A: A hundred years ago, when breast cancer was uncommon, there was no such thing as hormone replacement therapy or birth control pills. And now we have millions and millions of women who are taking these products that are hormonally active and could potentially make breast cells grow and maybe trigger a breast cancer.
In addition to that, bisphenol-A (BPA), a synthetic estrogen, never used to exist but it’s manufactured now. It’s used in plastics to keep them supple. For example, it is used in the No. 7 water bottle, the upside-down bottle on a water cooler. The other way BPA is used is in the lining of food cans to protect the food from the taste of metal. Another exposure in your everyday life would be cashier receipts. They use BPA to seal the ink on the page.
Another example would be pesticides like atrazine and Roundup. They are used to grow our most common crops today – corn and soy. It gets in the water and goes everywhere. One more example: People who raise beef and dairy cattle in the United States are allowed to use hormones to increase the hoof weight for beef cattle and the milk production by dairy cattle. Whatever goes into the cow can come out of the cow so it can be in the cow’s milk.
Q: You mentioned before that genetics typically causes about 10 percent of breast cancer. So that’s not a huge impact, but if you’re one of those 10 percent, it would matter to you a lot. Tell us about that.
A: Even though it’s a rare gene, quite a number of women have it, but getting the gene doesn’t mean you’re going to get the disease. It’s not like Huntington’s chorea where if you get the gene, you get the disease. With the breast cancer gene, if you get the gene, you get the risk.
Q: It seems that there are a lot of risks to getting breast cancer. How do you approach this?
A: We usually divide the risks into well established risk factors and emerging environmental concerns.
So we talked about some of the environmental concerns. That actually covers anything that happens beyond the genes you are born with. There’s a whole list of established risk factors. A bunch of them are related to your environment. They are
- obesity (The extra fat makes extra hormones.)
- lack of physical activity
- significant alcohol use (over five drinks a week on a regular basis)
- taking extra hormones, like birth control pills and hormone replacement therapy after menopause
- radiation exposure as a young woman
- early onset of puberty and menopause
- never having a full-term pregnancy
- not breast feeding.
These are all related to lifestyle. While it sounds like an overwhelming list, the good news is that at least it gives you more steps you can take to lower your risk. It’s one thing when you discover something and you feel that there’s nothing you can do about it. In this case, there is something you can do about it.
Q: How common is breast cancer compared to other types of cancer?
A: Every year the Center for Disease Control makes a list of cancer statistics and it shows basically that about 30 percent of all cancers that occur in a woman start in the breast. Compare that to ovarian cancer, which is only 3 percent. Then about 14 percent is lung and 9 percent is colorectal. Most lung cancers are related to smoking with half the amount of incidence as breast cancer, so the fact is that there’s something about the breast that is different from all the other organs in the body, making it so disproportionately vulnerable to the development of cancer.
The environment inside your body varies a little bit from one part to another, but generally it is pretty much the same. So there are other inherent biological differences that help explain why one is so much more common than the other.
Q: What are they?
A: One is that whenever you’re building an organ in the body – during pregnancy when the baby is being built – it’s clearly a very delicate, sensitive, vulnerable process. If something gets messed up, it can have a permanent effect that can lead to a general abnormality.
So during the first three months of pregnancy all the other organs are built and they begin to work. The heart is beating, the kidneys are peeing. Everything built is already running. But for the breasts, during pregnancy only the nipple and the areola are made, and the teeny breast bud is planted under the surface like a seed. Then during adolescence between the ages of 8 and 18 the breast tissue is built out – 10 years of a delicate process occurring. Even when the breast has been formed, the cells on the inside are still immature and incapable of doing their job, which is to make milk.
The only thing that makes the breast cells grow up and mature and get a job is a full-term pregnancy and breast feeding. That’s the only time they can make milk.
Q: So why is that important?
A: When a breast cell is immature and is waiting, waiting, waiting to do its job, it can get into trouble. The cells in the breast are very sensitive to any kind of hormonally active substance. It could be a natural estrogen or it could be chemicals in the environment. Those cells can respond to those chemicals that are all around us.
The reality is that given that biological vulnerability, modern life is dangerous because adolescence is happening drastically younger than ever before and that means all these girls are getting breasts earlier so they are available earlier to respond to chemicals out there, and then many fewer women are getting pregnant and breast feeding. So the period of time that they have immature breasts that are vulnerable is greater.
Q: So let’s encapsulate the message you will offer during your presentation.
A: The idea is there’s a long list of established risk factors and emerging environmental risk factors beyond inherited genes that alone and together combine to explain why breast cancer used to be uncommon and now is the most common cancer to affect women – and it’s projected to double its incidence worldwide in the next 30 years.
The good news is there are lots of steps you can take today that will immediately help to lower your risk, and I will be reviewing those steps with people and giving a presentation on what they can do in their everyday lives not just for themselves but for their families as well.