April 27, 2011
School of Medicine, Kochi
 

Dr. Marisa Weiss, Director of Radiation Oncology, Lankenau Hospital, Philadelphia is also the Founder-President of Breastcancer.org, the website committed to disseminating information on prevention and treatment of breast cancer.
 

Breastcancer.org is the number one website in the world not just for medical information but also because it supports an enormous online community online; it is not uncommon for 200,000 conversations to be ongoing 24×7 at its discussion boards.
 

With over twenty years of experience in treating breast cancers, Dr. Marisa is a leading radiation oncologist in the United States. She has dedicated her life for the prevention and treatment of the disease.
 

Dr. Marisa was recently at Amrita’s Health Sciences Campus, speaking about the disease and its prevention. Reproduced below are the excerpts from her talk.
 

The whole idea behind diagnosing and treating breast cancers is to give people life after breast cancer treatment and get them back to a life that is meaningful and comfortable. Breast cancer is curable but it can also be a very nasty disease. It is every woman’s greatest fear.
 

Think Pink Live Green is around the opportunity for prevention; really that means risk reduction. The logo shows the Yin-Yang of the breast. The breast is the pink representing the inside environment of the body, of the breast, and how it is interconnected with the external environment represented by the green leaf. This project of breast cancer prevention has been undertaken in partnership with the Harvard Medical School.
 

We started our research with the question, “Why is the breast so vulnerable to cancer than any other organ in a woman’s body?” This presentation is first looking at why breast cancer happens, what are the risk factors and then using those insights to help us understand the opportunity for prevention. We believe that the opportunity for prevention is particularly important in India because the incidence has been low but it is now rapidly climbing and the country is without the resources for early detection and treatment for every individual.
 

In the US, over decades, we have made great progress. We have better diagnostics, we have MRI scanning, we have PET scanning to help us find breast cancer, hopefully, early when it is most treatable. We also have special tests that come out of the laboratory that tell us what genes turn on the breast cancer cells and what genes turn them off. Of course, that information gives us insights into treatment. We have better therapies now than we did before. There are more opportunities for support.
 

But despite these advances, breast cancer remains the most common cancer to affect women and the incidence is expected to double in the next 30 years and most of that increase will happen in China and India. I will show you why the incidence increases and it is not just because people are living longer, because the longer you live the higher is the risk of breast cancer. There are other reasons. As a nation becomes developed and assumes “Western Lifestyles” the incidence increases and we are going to be seeing more breast cancers in younger women.
 

So far, there has not been a public health campaign to educate girls and women in a timely way about those well-established risk factors as well as emerging environmental factors which will increase the risk. Think about how successful other campaigns have been including campaigns on smoking and lung cancer, sun exposure melanoma, cervical cancers. They were successful before internet and social networking. People want medical information to come from an authority.
 

I think, everyone will agree that prevention is far better than diagnosis and treatment. The way we interpret prevention is in multiple ways. When we talk about prevention, it also means sparing the next generation because what a mother does can influence her daughter’s risk. For example if someone is obese and has diabetes during pregnancy that increases the daughter’s risk of breast cancer later in life, because the weight of the baby at birth is more to begin with. Birth weight is associated with a higher risk later on. What medicines the mother takes can also influence the way the breast is developed during the first trimester of pregnancy.
 

If we have a better understanding of what causes breast cancer then we can know much better how to prevent it or how to reduce the risk. In fact, the main reason why the incidence of breast cancer has increased is because the environments have changed; the environment outside the body as well as the environment inside the body. These two environments interact.
 

You look at families that do have a breast cancer gene abnormality and you look over four
generations since World War II, the gene is identical in all generations but the incidence is
higher in the current generation and it is happening at an earlier age. So something is happening.
 

The Biology
 

I want to show you a little bit of biology to help you understand what it is about the breast that makes it so uniquely sensitive to cancer. The reality is that breast cancer risk starts at conception. All the other organs are almost completely made during the first trimester of pregnancy. The time a baby is born, all those other organs are working. But the breast does not get fully made until adolescence. It takes ten years for the breast to develop. During those ten years, what you eat, what you drink, the medicines you take, the supplements you use, the household products you are exposed to, those are the foundation materials of the future breast health. What happens during adolescence can increase the risk of breast cancer later in life. Also what happens during pregnancy can also increase the risk of breast cancer later in life.
 

Once the breast has finished developing at the end of adolescence, the breast cells are still immature and highly proliferative until the first full-term pregnancy. Remember, all the other organs have been made and they are all working, doing a job. The breasts are not performing a job until they go through the full nine months of pregnancy and start making milk. That is the first time in the life of the breast that it is actually performing a job for which it has been directly intended. That is the first time actually the breast cells grow up, mature and are more stable.
 

Until that time the life of the breast is more sensitive than other organs. Breast feeding and
pregnancy both help the breast cells grow up and mature and both protect against breast cancer.
 

Why Breast Cancer is More Common Today
 

I would like to show you the new realities today that represent the whole interplay between the outside environment and the inside environment that can help us understand why breast cancer is more common.
 

Puberty and breast development are starting earlier and earlier. The sooner you have breasts, the earlier they could be exposed to toxins. The biggest reason is obesity but there are other reasons why puberty is starting earlier and earlier. Extra fat makes extra hormones which can drive extra breast cell growth.
 

Fewer women are having pregnancies and breast feeding. More women are delaying first full-term pregnancy and remember that the breast organ remains immature and proliferative until that first full-term pregnancy forces it to grow up. Fewer women are breastfeeding or they are breastfeeding for a lesser time. Modern lifestyle changes can contribute to breast cancer risks like alcohol consumption, smoking and physical inactivity.
 

More women are living longer. The ageing process increases the risk of mutation on a regular basis every day. As we grow older, the risk of new mutation is higher and the ability to repair those new mutations is less. More women are taking hormone medications after menopause to deal with menopausal symptoms. Women are taking hormone replacement therapy and birth control pills.
 

Women and girls are exposed to more pollutants which can turn on abnormal breast cells. The chemicals get into the water we drink, the food we eat, the air we breathe and the products we use. They go up the food chain and bio-accumulate.
 

All these things are worrisome and urge us to Think Pink and Live Green; to change our lifestyles to reduce risk. It is true that the lifestyle changes you make today could potentially reduce your risk of breast cancer tomorrow. Yes, we are all stuck with some risks. You cannot change the past. The past is a history and the future is just a promise. All you have is the present. You have to focus on the present. You cannot change your family or your genetic makeup but there are a lot of things that you can do because the fact is that our body has a tremendous capacity to heal, repair, rebound and be healthy. We have to treat our body in a way that will help it to become healthier.
 

This is a quote by Laurie David “If everyone does one thing, they are likely to do two things, then three things. Then they are likely to influence friends and family, and that’s how you build a movement.”
 

To prevent breast cancer for you and everyone that you care about is going to take a movement. We invite you to get involved. Together we can make a much bigger difference.