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Risk factors can be difficult to navigate

Despite the many advances in breast cancer research, the risk factors that make up an individual's likelihood for contracting the disease remain complex and not fully understood.

At Northwest Hospital's Herman & Walter Samuelson Breast Care Center open house on Oct. 12, clinicians provided free risk assessment screenings to every guest. The screenings take into account many of the different factors that make up the risk of breast cancer including age, family history and even biological details such as the age of the patient's first menstruation. After tallying up these separate factors, the clinicians designated the guests either low, moderate or high risk.

Herman & Walter Samuelson Breast Care Center

The Herman & Walter Samuelson Breast Care Center is a full-comprehensive center in Randallstown featuring breast care screenings, a dedicated breast surgeon, consultation, genetic counseling and other services for breast cancer patients. At its open house, women from the community were invited into the center for a tour, cake, free assessment screenings and an opportunity to schedule mammograms and other appointments. Susan Katz, imaging manager of the center said the open house was a way for people to see the spa-like atmosphere of the center as well as spread the word about the important risk factors that determine a person's chances of getting breast cancer.

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Age as a risk factor

Dr. Robert Paley, radiologist at the center, said the most important factor in determining risk is age.

"Age trumps all. Your age increases your risk by a factor of 30, density is a factor of five, and if your mother had it, it's a factor of two," Paley said. "Yet, the average woman thinks that family history is the most important factor."

Though the risk for contracting the disease increases with age, the cancer can be more deadly when it develops in a younger person. Deb Kirkland, nurse navigator at Samuelson Breast Care Center, was diagnosed with breast cancer in 2001 when she was 32. Now she helps newly diagnosed breast cancer patients with support education and resources. She says that the cancer is more aggressive in younger women.

"Older women tend to be getting mammograms, so typically it's caught earlier and is easier to treat. Their survival rate is greater," Kirkland said. "We see more younger women than we used to. We don't know if it's because of awareness and we're detecting more, or if more women are actually developing the disease younger."

In women younger than 40, the tumor has a higher likelihood of being estrogen receptor negative, meaning it cannot be treated hormonally and can potentially be more dangerous. Kirkland said it can be difficult to find the disease in younger women.

"We don't really have effective screening tools for women under 40 because their breasts are more dense," Kirkland said. "It doesn't always show up in a mammogram. It's like looking for a polar bear in a snow storm."

Understanding density

Breast density is a factor that is not yet completely understood. Breast density refers to the ratio between breast tissue and fat. A greater amount of tissue results in a higher risk for breast cancer. Though the correlation between density and risk is widely accepted, the connection between the two is not yet understood.

"We used to think that it was an issue with finding the cancer," Paley said, "but the reality is that it's an independent factor on its own. A woman with high density is five times as likely to develop the disease."

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Race and breast cancer

Another factor that is still not fully understood is the connection between race and cancer. White women older than 40 are more likely to develop breast cancer than women of color; however, in women younger than 40, black women are more likely than white women to contract the disease. Though they have a lower incidence rate on the whole, black women are 38 percent more likely to die from breast cancer.

Other factors

Dr. Dawn Leonard, medical director at the center, said that across all women, socioeconomic status is still one of the most important determiners for breast cancer survival.

"Poorer women do more poorly across the board," Leonard said. "They don't have the access to those vital screenings or treatments."

Leonard emphasized that one of the most important controllable risk factors is personal health and obesity.

"Diet and exercise lower your chances of contracting breast cancer by 50 percent," Leonard said. "We don't know why it works. All we know is that it works."

Leonard said that a healthy diet and exercise stabilizes the body's metabolism and provides it with the building blocks that are needed to support DNA repair.

Kirkman said that exercise is equally important for breast cancer survivors as it is for those looking to stave off the disease.

"Exercise is key not only to prevent it, but to keep it from ever coming back. There's a study that says if you're estrogen receptor positive and exercise three to four hours a week, you can decrease your chances of it coming back by 50 percent," Kirkman said. "I think the fear of recurrence is probably worse than the physical elements. Most people, as long as they keep healthy, go on to live normal, happy, healthy lives."

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