Breast cancer: debunking common myths

Despite more than twenty years of awareness campaigns each October, a month dedicated to breast cancer awareness, misconceptions about the disease persist. The Beiruter sat down with Dr Christina Khater, an American board-certified hematologist and oncologist, to help dispel some of them.

I don’t have a family history of breast cancer; therefore, I am protected against the disease

False. Breast cancer is hereditary in only 5% to 10% of cases. The main risk factors remain the woman’s age and the fact that she is a woman. According to figures from international scientific societies, one in eight women will develop breast cancer at some point in her life.

Specialists identify additional risk factors, mainly obesity, excessive alcohol consumption, as well as hormone replacement therapy during menopause or hormonal stimulation as part of an in vitro fertilization procedure.

Yet, in 80% of cases, breast cancer occurs in women with no identifiable risk factors.

Nevertheless, the risk increases for women who have a first-degree relative, a mother or a sister, diagnosed with breast cancer before the age of 50. In such cases, genetic testing is recommended. The other women in the family should begin screening ten to fifteen years earlier than the age at which their relative was diagnosed.

In Lebanon, the Ministry of Public Health (MOPH) recommends starting breast cancer screening at the age of 40. This includes an annual mammography and, depending on the case, a breast ultrasound.

Breast cancer is being diagnosed at an increasingly younger age

True. In Lebanon, the median age of diagnosis is 52, compared to 63 in France and 64 in the United States. The causes remain unclear but may be linked to environmental or genetic factors. That is why the MOPH recommends starting screening at the age of 40, rather than 50 as in many other countries.

This allows to detect the tumor at an early stage, increasing the ten-year survival and cure rates to 90%.

From the age of 75, breast cancer screening becomes optional. The decision is made jointly between the woman and her doctor, based on her preferences and overall health.

X-rays from mammograms increase the risk of breast cancer

The benefits of mammography outweigh the risks of radiation. Modern machines are highly advanced and emit very low doses of X-rays.

Moreover, the amount of radiation a woman receives during a mammogram is eight times lower than the terrestrial radiation to which humans are exposed over the course of a year.

Breast cancer means mastectomy

False. Most breast cancers detected through mammography can be treated with breast-conserving surgery. The tumor is removed along with a few lymph nodes in the axilla (the sentinel nodes). In most cases, radiotherapy is recommended following surgery. On the long term, the outcomes of breast-conserving surgery combined with radiotherapy are equivalent to those of a mastectomy in terms of ten-year survival and cure rates.

In some cases, however, mastectomy is advised, mainly for inflammatory breast cancer, large tumors in small breasts (breast size don’t have impact on the risk of developing breast cancer), and breast cancers associated with BRCA1 and BRCA2 genetic mutations. In the latter case, a double mastectomy is recommended.

There is only one form of breast cancer

False. There are several forms of breast cancers. The most common type is hormone dependent breast cancer. It is driven by sexual hormones, such as estrogen.

Another frequent form is HER2-positive breast cancer. In this type of the disease, HER2 receptors present on the surface of the cells multiply in an abnormal way.

In recent years, significant therapeutic advances have been noted in the treatment of both these types, including metastatic cases.

The triple negative breast cancer (TNBC) is the most aggressive and invasive one. In this form of the disease, cancer cells lack estrogen and progesterone receptors, and do not express the HER2 protein. A few years ago, immunotherapy was added to the therapeutic arsenal for TNBC. Combined with chemotherapy, this treatment improves outcomes and extends life expectancy. A drawback to note: this treatment remains expensive.

Sports help prevent breast cancer

True. Many studies have shown that physical activity is beneficial to treat and prevent breast cancer, in more ways than one.

Moderate physical activity helps patients better tolerate chemotherapy. It also reduces fatigue following treatment sessions. Sports help fight weight gain as well, which is common during chemotherapy or hormonal treatment.

On another hand, being overweight or obese is a known risk factor for breast cancer. Furthermore, excess weight can increase the cancer recurrence.

For all these reasons, regular physical activity is recommended to help prevent breast cancer, and during and after treatment.

Breast cancer is a female disease

False. Breast cancer is the most common tumor in women, accounting for 25% of all cancers diagnosed in women. However, around 1% of breast cancer cases occur in men. According to the National Cancer Registry, 3,309 breast cancer cases were registered in 2022, including 79 cases in men.

In cases of male breast cancer, genetic testing is recommended to check for BRCA1 or BRCA2 mutations.