Breast Cancer: The Myths and Truths.

Women should look to their overall health patterns, including diet and exercise, and regular checkups to reduce the risk of breast cancer.

Like many women with large breasts, Barbar C. believed the size, as well as the recurrent benign breast cysts that she experienced, represented a risk for breast cancer. In truth, neither is a precursor to a disease that affects nearly 200,000 women annually in the United States.

Several myths surround breast cancer, some erroneously believed by physicians as well, according to Kathy Helzlsouer, M.D., assistant professor of oncology and epidemiology at Johns Hopkins School of Medicine in Baltimore. "Many physicians believe that the father's side of the family isn't important, but an inherited tendency can come from both the mother's and father's side," Helzlsouer said. "So both should be reported."

Other common myths and their possible causes include:

Myth: Large-breasted women are more susceptible to breast cancer.

Truth: Breast size has no direct relationship to breast cancer. The myth may have originated because excessive body fat may, indeed, be linked to cancer of the breast, since body fat produces hormones. "To have any kind of cancer we need initiators and causers. Initiators cause it, and causers promote it. It's still an area of ongoing research, but estrogen may be a promoter. We have found that women who have high body fat have higher levels of estrogen, which may be linked to breast cancer in some instances. Also, overweight women tend to have more breast tissue, so that may have helped to cause the myth," Lynne Carpenter, Ph.D., R.N., of the Breast Care Center, University of Michigan, said.

Myth: Trauma to the breast, such as a hit or bruise, can cause a malignant tumor.

Truth: "What is more likely is the cancer was there, but after bumping something, the woman became aware of it and went to see a doctor. It's a myth that has been passed down over the ages, and it's simply not true," Carpenter said.

Myth: Caffeine consumption can cause cancer of the breast.

Truth: A relationship exists between coffee and benign cysts or lumpy breasts, but not malignant lumps or cysts. "The methylxanthine in caffeine, and evident in chocolate, coffee, and tea, may cause lumps, which are experienced by most women, but there is no relation to these cysts or lumps and breast cancer," Carpenter said.

What may be linked to cancer is dietary fat, according to Helzlsouer. "Some controversy still exists concerning dietary fat intake and breast cancer, but there are lots of good reasons to lower it now, chiefly heart disease," she said.

However, ongoing studies indicate that alcohol consumption may be linked to an increased risk of breast cancer. University of Buffalo researchers have found that premenopausal women with a fast-acting form of an alcohol-metabolizing enzyme who have at least two drinks a day appear to have three times the risk of developing breast cancer compared to lighter drinkers with the fast-acting form of enzyme, or those with the slow-acting form.

Myth: Heavy exercise, such as lifting weights or running, contribute to breast cancer.

Truth: Exercise may actually help reduce the incidence of breast cancer. "Studies show that a woman can get peak benefit from exercise with four hours per week. It's believed that exercise alters hormones in a beneficial way for women. It's not just estrogen, but a whole profile of hormones that affect a woman's body," Helzlsouer said, "and ongoing studies will shed more light on how exercise works as a preventive measure."

"Women who train heavily may experience some breast pain from breaking tiny ligaments that support the breast, so when breast pain occurs, it isn't breast cancer. In these situations, some women may then do a breast exam, because they are aware of the pain. Because they are doing an exam when normally they wouldn't have, they may find a lump," Carpenter said.

Myth: Mammograms take the place of breast self-exams.

Truth: Twenty percent of breast cancers are not visible with a mammogram, even though it can detect small growths that may be signs of early-stage breast cancer. "That's the beauty of a mammogram," Carpenter said, "but it cannot stand alone. Through regular breast self-examination we get to know what is normal for our breast. When we feel something different, it can provide a clue that something is happening."

Helzlsouer said women over 40 should do a self-exam once a month, and a mammogram yearly, along with a physician's examination of the breast.

Myth: Breast cancer is the leading cause of death in women.

Truth: No, heart disease is the leading cause of death in women, followed by lung cancer. Eric Louie, M.D., president of the American Heart Association of Metropolitan Chicago, emphasized at a Chicago Women and Heart Disease Conference that "500,000 women a year will die of cardiovascular diseases, which is almost twice the number of women who will die of cancer in that same year [all cancers], and which exceeds the total number of women who will die of cancer, lung disease, and diabetes combined."

No medical professionals, though, minimize the increasing prevalence of breast cancer. In 1993, 108.3 women per 100,000 were diagnosed with breast cancer--up from 82.6 in 1973. These figures, however, could be related to better methods of detection and the changes women have undergone in the past few years, according to Benita S. Katzenellenbogen, Ph.D., professor of physiology and biophysics at the University of Illinois at Urbana.

"Women begin cycling earlier, are having children later, and menopause happens at a later age, which means women are having ovarian function for longer periods of time, which adds to an increased risk factor," Katzenellenbogen said.

Myth: Certain foods contribute to cancer.

Truth: It is not known for certain that any particular foods contribute to cancer. However, some foods may inhibit cancer. Soy products, since they contain phytoestrogens and other plant sources, may help to lower the risk of breast cancer, according to Helzlsouer. Phytoestrogens are also found in many vegetables (especially green leafy ones).

Many fruits and vegetables, including garlic, tomatoes, greens, onions, soybeans, and grapes, also contain phytochemicals, which serve as antioxidants, and prevent cellular damage.

Additionally, studies at the National Institute of Environmental Health Sciences in North Carolina show that vegetables high in vitamin A and B-carotene may have a protective effect on breast cancer.

Myth: Breast cancer causes pain, so women will know when they have it.

Truth: "Not all breast cancer is going to cause pain. Pain happens when something cuts or presses on nerve endings, and we have a fair amount of space where something can happen and not press on nerve endings. Also, pain can relate to breaking of ligaments, or cysts, that are fluid-filled sacs. Pain can be related to a number of different things," Carpenter said.

Myth: Everyone with breast cancer gets the same treatment.

Truth: Not all breast cancers get the same treatment.

"You want your situation figured out in terms of what is best for you," Carpenter said. "None of us knows why Nancy Reagan chose what she did for her treatment (mastectomy). She had a tiny, little cancer. She could have been a candidate for lumpectomy and radiation. But to do that, she would have needed to be escorted daily to radiation. Because of being a public person, it probably would have upset her role as first lady. So, in addition to decisions on the best way to treat a particular person, it also has to do with lifestyle. Also, there are differences that pertain to family history and overall health."

Myth: Wrong or bad attitudes can cause cancer.

Truth: Absolutely not, according to Carpenter. Maybe the immune system can be depressed and a cancer already there can grow, but initially there has to be an initiator and a promoter. Then if some of the other things are going on, such as stressful life events, or maybe not sleeping enough, and your body is just not in its peak of health, your immune system may not be up to capacity. Usually, when we have a cell that goes bad, our immune system takes care of it. But if we're, say, depressed, then it may let that little cancer cell slip by without being recognized. But the thing is, the emotional piece didn't cause the cancer that your immune system is distressed about."

Myth: We should have a cure for cancer by now.

Truth: There are about 100 kinds of cancer, each caused by many different factors, so no one treatment can cure it for everyone.

In 1972 the National Cancer Institute's budget for all cancer research was $379 million. Today it is $332 million alone for breast cancer research.

"We are working with the science we have available to us. We have made tremendous progress. We really do have women living out their full, natural lives when diagnosed in early stages," Carpenter said. And today 85 percent of patients live for five or more years after treatment.

Myth: Estrogen is risky to take in light of its effect on breast cancer.

Truth: Ongoing research, including the comprehensive Nurse's Health Study at Brigham and Women's Hospital in Boston, begun in 1976, indicates that while there is an increase in breast cancer for some women who take estrogen replacement therapy (ERT) longer than 10 years, the benefits to the heart for a majority of women are increased substantially. "The risk benefit ratio [comparing high risk for breast cancer and high risk for heart disease] is greatest for women who choose ERT," Katzenellenbogen said. In other words, women taking ERT showed the greatest reduction overall for mortality, because of the cardiovascular benefits.

ERT also appears to improve the effects of osteoporosis, a bone-thinning disease, and may have beneficial effects on Alzheimer's, since studies indicate that reduced estrogen levels play a role in the disease.

In the meantime, health professionals said women should look to their overall health patterns, including diet and exercise, and regular checkups to reduce the risk of breast cancer.

Rita Robinson writes from Big Bear City, California.