Real Pink – EP268 – Anna Horvat – Full
[00:00:00] Adam Walker: From Susan G Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
[00:00:17] Your breast health journey starts with knowledge. Whether you’re concerned about your risk of breast cancer, have a history of breast cancer or other cancers in your family, or are curious about genetic testing, the first step is learning more about risk. Everyone is at risk of breast cancer and some of us are at higher risk than others.
[00:00:37] Today we’re going to do some myth busting around breast cancer risk And shed light on factors that are and are not scientifically proven to increase your breast cancer risk so you can feel empowered to make important breast care decisions to take care of your health. Joining us on the show today is Anna Horvat, a specialist on Komen’s Breast Care Helpline.
[00:01:00] Anna, welcome to the show.
[00:01:02] Anna Horvat: Hi, thank you so much for having me today.
[00:01:04] Adam Walker: Well listen first off you’re like Breast care helpline person. I love all y’all like y’all are just wonderful amazing people So thank you first for the work that you’re doing there. And with that in mind, let’s dive in. So so the question.
[00:01:21] Yeah. So so when we talk about breast cancer risk, there’s a lot of information out there and it can be kind of difficult to keep track of. And so today I’d like to approach this in thinking about buckets, starting first with like, what are the most common risk factors that we know have been linked to increased risk of breast cancer?
[00:01:40] And can you help us understand what those are?
[00:01:43] Anna Horvat: Yeah, so you’re absolutely correct that there is a cumbersome amount of information out there and it can be really daunting. There are a number of things that can lead to increased risk. I’m only going to touch on, like you said, those main few. First and foremost, you know, being born female.
[00:02:02] Is going to increase that risk while any individual can develop breast cancer, you know Those that are born female are naturally going to be at higher risk than right other individuals Another common factor that we kind of look at when we look at risk is race and ethnicity There are studies that show that there is higher rates of breast cancer incidence So breast cancer occurrence, in non hispanic white women and black women there’s a lot of difference Reasoning behind why that might be, but those are kind of some big risk factors that unfortunately we just happen to have happen to us.
[00:02:41] Another one is getting older, right? Everybody ages, and unfortunately, the older we get, research has shown that is going to increase one’s risk for breast cancer occurrence. Some that are a little bit less common as far as things people might think of would be the start of your menstrual cycle.
[00:03:05] So for women who start their menstrual cycle at a younger age, specifically those that start before 11 research has shown that there is about a 15 to 20 percent higher risk in that situation. Then counterparts who may have started 15 or later on the flip side. So you’ve got your menstrual cycle starting, your menstrual cycle ending can also play a role in terms of risk for breast cancer.
[00:03:35] So in that instance, women who start their menopause, a. Later range so kind of that 55 and older have been shown to have a higher risk of breast cancer in some studies Than their counterparts who maybe start 45 or younger Okay, so, you know that kind of all encompasses genetics and reproductive cycles when you Look at risk factors.
[00:04:05] There’s also you know lifestyle That can play a role in terms of increasing risk in some ways as well as environmental factors. So those again can be cumbersome in terms of what those are, but those are kind of the big pockets and areas. I would say things that we get asked about, which are in fact risk factors, tend to be Related to medication.
[00:04:33] So we will get some calls about hormonal birth control and there are Studies that show that birth control pills can increase risk for breast cancer If you think about it, you know birth control pills tend to have estrogen in them estrogen in your body can create risk for developing breast cancer. So studies have shown that those that take breast control pills or have recently taken breast control pills have about a 20 30 percent higher risk than their counterparts that maybe have never taken them.
[00:05:06] The same has been found for menopausal hormone therapies. So women who are, you know, in menopause and using menopausal hormone therapies that have estrogen and progestin in them have also been shown to increase risk. And then, you know, you kind of mentioned this when you were giving us an introduction to today’s topic, that if you have a family history or a personal history with cancer, whether that’s, you know, breast cancer, ovarian cancer, or prostate cancer that in and of itself can be a risk factor.
[00:05:42] And so it’s really kind of important to know when you’re thinking about risk if you have the information kind of what your family has experienced and your own, you know, personal health history.
[00:05:53] Adam Walker: Yeah, that’s great. That’s great. And so, so that’s great information, I should say. So, so, so that’s what we know contributes to risk.
[00:06:03] Let’s look at the other side. What are the factors that are we know are linked to a decreased risk of breast cancer?
[00:06:10] Anna Horvat: Yeah, so again, there’s many, but to kind of hit the high points one of the main things that has been studied is kind of making overall healthy lifestyle choices. Individuals who are regularly exercising and maintaining a healthy weight have lower risk and that, you know, engaging in healthy lifestyle practice, such as exercise.
[00:06:34] And maintaining that stable weight decreases a woman’s risk from about 10 to 20 percent compared to those who do not. And again, keep in mind, you know, all of these things, there’s different levels, right? Like you, you don’t have to be exercising every single day all the time for that to be you. And you know, it’s not a foolproof situation, unfortunately.
[00:06:57] But something that also comes up is eating healthy fruits and vegetables. Which seems You know, a little bit kind of redundant when you think about healthy lifestyle choices and healthy living but there are. Certain pigmentation in fruits and vegetables that have been shown in studies to decrease risk of breast cancer.
[00:07:21] Really? Okay. Yeah, so I found that kind of interesting when I dived into the breast cancer world. I personally am a vegetarian and was like, Oh, well, I would have never thought. That this was, you know out there and actually
[00:07:34] Adam Walker: what are the what are the pigmentations we should be looking for?
[00:07:38] Anna Horvat: Yeah, so there’s a certain they’re called carotenoids That’s kind of a cumbersome term.
[00:07:43] But they’re essentially naturally orange red pigmentation in fruits and vegetables Okay. Yeah, so there’s a lot of When you think about orange foods like melons, carrots, sweet potatoes, things that kind of have that naturally orange y red Pigmentation have been shown to kind of decrease. Yeah, okay So there’s a lot of information if you wanted to kind of dive into that more about it on Komen’s website Because it can be pretty interesting at least to me That’s fascinating.
[00:08:17] Yeah. And then another one that is known and is out there is engaging in breastfeeding practice for those individuals that can do that. Individuals who have breastfed before menopause tend to have lower risk of breast cancer than those who do not. Okay. And then, you know, earlier you mentioned individuals who are high risk.
[00:08:42] And I think it’s important to note that if you do have a higher risk there are things that you can do to reduce that risk, such as medications that can be taken to help lower that risk and preventative surgeries. So, you know, even if you do have that higher risk, Those things are in place to help you decrease so that you’re kind of, you know, Looking at yourself in terms of the general population and risk reduction.
[00:09:08] Adam Walker: Okay. Wow. All right, That’s more you listed more things than I was expecting. Yeah And the only thing popping through my mind right now are red peppers and orange peppers for some reason. Yeah, so All right. So so now let’s talk about the factors that we just don’t know about. What are the factors like that are currently understudy, maybe for example?
[00:09:28] Anna Horvat: Yeah. So for those that don’t know what understudy means, just to kind of clarify that. Yeah. Typically that is where research has been done, but the findings are inconclusive or there’s just not enough to. Point in any one direction. So right now some of those kind of major things that are being looked at Are things like medication use such as the use of antidepressants or you know, daily aspirin intake Another is breast size.
[00:10:01] So there have been some studies around, you know If the size of a woman’s breast or breast tissue can increase that risk. Another major one is the use of fertility drugs, which, you know, if you think about medications and things that you’re putting in your body, it makes sense that would be a topic that would want to be looked at.
[00:10:20] Right. Some others include stress. You know, we all, I think, are, I’d like to say we all experience stress in some way, shape, or form. So, that’s another major one. As well as paraben, which are chemicals that can be found in beauty products or personal care products. Okay. And there’s, you know, those are kind of the main ones this time, but there’s several others out there too.
[00:10:43] Adam Walker: Okay. All right. So so now we’ve covered, you know, what we know contributes to risk, what we know takes away from risk, what we don’t know now it’s time to do some myth busting. And there’s a lot of them out there. So. Let’s talk about those. I’m just going to go through a handful and then you tell me, give me your responses and then we can, you can add to them along the way.
[00:11:06] So the first one I’ve got is breast self exams are just as effective as mammograms.
[00:11:12] Anna Horvat: Yeah. So this is actually not the case. Breast self exams alone are not enough to reduce the risk of breast cancer death. There’s a lot of studies out there demonstrating this. I think it’s incredibly important to kind of know your normal, and Komen likes to educate on breast self awareness.
[00:11:33] So just doing those breast self exams is not always going to catch, you know, things that we need to catch, and mammography can help to catch things early when the chance of survival is the greatest. You know, practicing breast self awareness includes knowing your risks, so what we’re discussing today.
[00:11:53] Getting those screenings, those mammograms, and then knowing that normal.
[00:11:58] Adam Walker: All right, myth number two, kind of related to self awareness or risk factors there, you said. If I don’t have any symptoms of breast cancer or family history, don’t need a mammogram, right?
[00:12:08] Anna Horvat: Yeah, that is also not the case. Only about five to seven percent of the individuals who are diagnosed with breast cancer have family history, family linkage.
[00:12:19] or genetic complications that could cause, you know, breast cancer risk. And so it’s recommended that women individuals get mammograms every year, every one to two years, and there’s. ways to do that as well as practicing that breast self awareness and knowing you’re normal because it’s not always just a lump.
[00:12:39] There’s other signs and symptoms that can trigger, you know, maybe something is going on. And if you’re not getting those annual screenings and you’re not, you know, kind of monitoring your own breast health, then some of those things might go missed.
[00:12:52] Adam Walker: All right. So speaking of lump, myth number three, if you find a lump in your breast, you definitely have cancer, right?
[00:12:59] Anna Horvat: That is also not true most lumps actually are not felt and there’s a lot of benign breath conditions such as cysts or fibroadenomas that individuals can experience where maybe you do have a lump, but it is not, in fact, a malignant cancerous situation. Individuals can also experience lumps as it relates to hormone fluctuations with menstrual cycles.
[00:13:27] Yeah. So, you know, again, I might sound like a broken record, but knowing that breast self awareness is important because, you know, if you’re, if you do notice a lump or you notice a change, And it’s there and it’s not going away. It’s really important to consult a healthcare provider because it may not be cancer, but you just want to make sure that you’re monitoring and getting it checked out
[00:13:49] Adam Walker: That’s right.
[00:13:50] That’s right. All right myth four mammograms are too expensive
[00:13:54] Anna Horvat: So, also not true. There are commercial, state, federal insurance plans such as Medicare and Medicaid that are going to cover preventative screening mammograms typically every year or two years for women who are 40 and older. There’s also a lot of programs out there to assist with making screenings affordable.
[00:14:17] If individuals are uninsured or even if they’re underinsured, that’s something that on the helpline, I think we handle every day, is looking at locating affordable screening services for individuals just to make sure that, you know, we are helping kind of level the playing field and make sure that everyone has equal access to, to healthcare and to screening.
[00:14:38] And if you or someone that you know needs more information or help, you know, please know that the helpline is there to help.
[00:14:45] Adam Walker: That’s why the helpline is there, or at least that’s one of the many reasons that the helpline is there, right? Yeah! Alright myth number five. A mammogram will expose you to unsafe levels of radiation.
[00:14:57] Anna Horvat: So that is also false. Mammograms are conducted with very low levels of radiation. And it’s generally the benefit of the mammogram and the exposure to that low level of radiation is going to outweigh any potential risk. There have been studies and statistics put out by American Cancer Society that share that the level of radiation used in a mammogram is the same as typical daily exposure over a three month time span.
[00:15:26] So hopefully that will bring some ease to people that is an area of concern for them. Yeah.
[00:15:31] Adam Walker: That’s right. All right. This next myth is I think probably the most common ones, the one that I’ve actually heard the most, which is that mammograms are painful.
[00:15:41] Anna Horvat: Yeah. So that is also false in terms of our myth busting.
[00:15:45] You are going to feel some pressure when you do engage in a mammogram, but it should not be painful. And I think it’s important to note that the technology has come a long way. We are leaps and bounds, you know, above where we used to be. And so you should just, you know, feel pressure. It might be a little bit of an uncomfortable situation to engage in, but you shouldn’t experience pain.
[00:16:08] And if you are, then you need to make sure you’re talking to the medical team about that.
[00:16:12] Adam Walker: Alright, and Last myth on my list, and then of course, you know, contribute as needed. If you had a normal mammogram last year, you don’t need another one this year, right?
[00:16:23] Anna Horvat: So that is also false. You know Going back to those recommended kind of screening guidelines.
[00:16:30] It’s recommended that starting yearly your screen or excuse me It’s recommended that at age 40 those screenings are happening yearly because Things can change, you know, and things can develop and so while you may have had a normal mammogram the previous year, the recommended screening guidelines say that you need to have that mammogram every year starting at 40.
[00:16:52] And for those that are 20 and older, clinical breast exams are recommended at least every 3 years. Just to make sure that you are monitoring and checking out breasts and making sure there’s no changes. If you are at higher risk, while we’re on the topic of risk, you know, your screening recommendations may be a little different.
[00:17:12] And I think it’s important to note that while you’re talking about what that risk might be, Ultimately, you and your provider are going to be the best ones to determine, you know, the frequency of screening for you. So, you know, while you’re looking at your own risks, make sure that you’re communicating that with your team because they may want you to have them, you know, more frequently or less frequently.
[00:17:33] Adam Walker: Yeah, that’s right. So important to understand what’s best for you and for your body. All right. So are there any other common questions you receive on the breast care helpline related to risks that we haven’t covered today that you think would be helpful for our listeners to know?
[00:17:49] Anna Horvat: Yeah, so a couple of things I think come to mind.
[00:17:53] First and foremost, we get a lot of questions about genetic testing and counseling. We didn’t necessarily hit on this earlier, but if you do have a family history of breast cancer. Sometimes there can be genetic mutations that are related to increasing one’s risk and getting genetic testing and counseling gives individuals the opportunity to know if maybe they are carriers of genetic mutations, which can help them, you know, plan for risk reduction.
[00:18:24] And there’s a lot of opportunity for that to be done. There’s financial resources to assist with that. There’s recommendations and guidelines. And so we field a lot of calls. I would say about, hey, you know what is right for me? Should I do this? And so, you know, that would be one that I would think comes up a lot, just in terms of how do I navigate it?
[00:18:47] What do I talk to my provider about? And luckily, Komen is a wealth of resources and knowledge and has what we call our questions to ask providers that kind of serve as a sample script to help patients walk through these conversations because I always like to say, what you don’t know, you don’t know.
[00:19:06] That’s right. And so having these outlines, I think, takes some of that pressure off the conversation for fusion. So that’s probably the biggest one. The National Comprehensive Cancer Network, they have a pretty cumbersome list of who should consider genetic testing and that’s on our website, and people can always access that or call us if they have questions Typically, I think kind of a buzzword that people hear is the BRCA gene.
[00:19:35] That’s pretty common in the breast cancer world, but there’s several others that can be risk factors and increased risk for individuals. And so, you know, then we start having conversations about what they call the extended panel of genetic tests. And. That is, I think, something that we field a lot of questions about.
[00:19:56] So, that’s one. I would say another one is related to kind of self advocacy and second opinion. So, some people will notice changes in their breasts and they’ll have a screening and everything will come back fine. Or everything will, you know, appear to be normal. But We are the best champions of our body.
[00:20:19] We know our body better than anybody else. And so people will know that something is not right. So we walk through a lot of self advocacy and patient rights and help people find access to second opinions. If they want to have additional screening services, just to ensure that nothing is missed and that.
[00:20:38] you know, if there is something there, they’re catching it as early as possible.
[00:20:42] Adam Walker: Yeah. So important. That’s so important. So last question, do you have any recommended resources to our listeners where they can go to learn more about their personal breast cancer risk? And what they should do if they have any concerns?
[00:20:56] Anna Horvat: Yeah. So I think anytime there’s a concern, we always immediately jump to you need to talk to your medical provider or a healthcare professional. That’s going to be kind of our number one, let’s start there just because we want to make sure things are being looked at. If you’re unsure what to do, you don’t even know where to begin.
[00:21:14] You don’t have a healthcare provider by chance. You can always call the helpline. Myself, all the other helpline navigators are more than happy to kind of assist you through steps and coach you through, you know, what you might need to say or what questions to ask. Again, I may sound like a broken record, but Komen has a wealth of knowledge on the website regarding risk.
[00:21:35] That’s right. Risk factors, genetic testing and counseling. And so there’s information on those topics we didn’t hit. So things that have been known to show increased risk, as well as those that are still under study, because we only mentioned a couple and there’s a ton out there. I think in terms of understanding one’s own risk, some tools that I commonly refer people to there’s two of them, one of which is a link on the Komen website to a tool based on the Gale model, which is a breast cancer risk assessment tool, and it allows patients to input factors that pertain to them, and it’s going to calculate an estimated risk for them.
[00:22:17] Oh wow, that’s cool. Yeah, that is kind of super helpful, especially if you’re looking at where you fall, kind of where the dominoes lay. Right, yeah. A second one that I think can be particularly helpful for those that either know their health history or don’t is a family health history tool because it’s going to prompt you to put in some information or it’ll prompt you to ask questions if you’re able to get those answers from family members that will help determine potential risk factors for you based on that family history component.
[00:22:49] Yeah, and then I’ve mentioned the questions to act on, ask the providers about genetic testing and counseling, but there’s actually several. Pretty much about any breast care topic that you would want to know, but specific to this conversation some about assessing risks getting assistance and just knowing what questions to ask are out there too.
[00:23:12] And then not to plug the helpline, but that’s, you know, that’s what we’re here for is to provide that health education to help serve, you know, kind of as an advocate or a bridge for those that just need a little bit more support in understanding what’s going on with them or where to turn when they have questions.
[00:23:29] Adam Walker: And just to be clear, the helpline is a free resource, right?
[00:23:32] Anna Horvat: The helpline is a free resource. Yep, it is completely free to anyone that calls or emails. It can be accessed via calling. It is 877 465 6636. So that’s basically 1 877 GO KOMEN. Or emailing. Some people prefer that. It’s easier, busy working crazy lives.
[00:23:55] So emailing helpline at Komen. org is also going to be a good way to reach out to us. And then we are open Monday through Thursday from nine to seven and Friday from nine to six. So anyone can access us pretty much at any time. And you know, we will get back to them as quickly as we can if we don’t catch ’em, you know, right in that minute.
[00:24:16] Wow. That’s fantastic. Yeah. I also, I forgot to mention we serve in English and Spanish. We do have several. bilingual helpline specialists. So if there is fear or concern about calling, because maybe you feel like you’re not going to be able to access someone that understands that is something we can do as well.
[00:24:34] Adam Walker: I love that. I love that. Well, Anna, again, thank you for the amazing work that you’re doing. Thank you for joining us on the show today for debunking some myths and talking us through all these different factors. I really appreciate you.
[00:24:46] Anna Horvat: Oh, thanks. Of course. It was happy to be here. And thanks for having me.
[00:24:54] Adam Walker: Thanks for listening to Real Pink, a weekly podcast by Susan G Komen. For more episodes, visit realpink. komen. org and for more on breast cancer, visit Komen. org. Make sure to check out at Susan G Komen on social media. I’m your host, Adam. You can find me on Twitter @ajwalker, or on my blog, adamjwalker.
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