Almost two years ago, I wrote about Angelina’s decision to remove her breasts related to her genetic risk for breast cancer. Now, with Angelina’s announcement to also remove her ovaries, media is exploding in headlines on the subject of nature verses nurture in cancer outcomes as well as exalting or condemning
Angelina’s personal choice.
Below are some examples that highlight this polarization and the epigenetic potential of modulating cancer risk by lifestyle choices:
1. Is risk overestimated?
Green Med Info reports:
With Angelina Jolie’s recent announcement that she had her ovaries and fallopian tubes removed because of both a BRCA ‘gene defect’ and a history of breast and ovarian cancer in her family, the idea that genes play a dominant role in determining biological destiny and cancer risk is proliferating in the mainstream media and popular consciousness uncontrollably like a cancer.
The reality is that the average woman’s lifetime risk of ovarian cancer is exceedingly small, with the overall risk of developing ovarian cancer by 65 years of age being 0.8 percent and the lifetime risk 1.8 percent. For those with a first-degree relative developing ovarian cancer, as is the case for Jolie, the risk estimates show increases to 4.4 and 9.4 percent, respectively. (1)
2. Breast Cancer & Epigenetics
Epigenetics is a term to describe how the environment influences gene expression. Below are some examples of epigenetic factors related to breast cancer risk:
A 2010 article reported on a connection between physical activity and breast cancer. This cohort nationwide study included 725 BRCA1/2 mutation carriers. 218 of the women were diagnosed with breast cancer 10 years prior to the questionnaire. The authors found an inverse association between hours of activity in active sports before age 30 and after age 30 and breast cancer risk. They concluded, “Our results indicate that sports activity may reduce the risk of breast cancer in BRCA1/2 mutation carriers.”(2)
b. Food as Medicine
It has been suggested that gene-environment interaction is related to the risk of cancer. To evaluate departure from multiplicative effects between BRCA mutations and diet diversity in breast cancer (BC), a case-only study was carried out in a French-Canadian population including 738 patients with incident primary BC comprising 38 BRCA mutation carriers…
The results of this study suggest that the combination of BRCA mutations and vegetable and fruit diversity may be associated with a reduced risk of BC. (3)
c. Body Weight
A matched case-control study was conducted in 1,073 pairs of women carrying a deleterious mutation in either BRCA1 (n = 797 pairs) or BRCA2 (n = 276 pairs). ..
The results from this study suggest that weight loss in early adult life (age 18 to 30) protects against early-onset BRCA-associated breast cancers. Weight gain should also be avoided, particularly among BRCA1 mutation carriers who elect to have at least two pregnancies. (4)
d. Blood Sugar
Diabetes is associated with more advanced stage breast cancer, according to a new study that confirms a strong link between diabetes and later stage breast cancer at diagnosis. “Our findings suggest that women with diabetes may be predisposed to more advanced stage breast cancer, which may be a contributor to their higher cancer mortality,” said one scientist. (5)
Summary: Revisiting BRCA
The emerging field of study known as epigenetics clearly shows us that our genes are not our destiny. We can, in fact, influence how our genes behave. Women who are BRCA-positive have a mutation in that cell repair gene. There is no way to fix that. It means that this BRCA repair gene will not be able to repair defective (cancerous) cells. However, this is not the only cell repair gene that we have. Epigenetic research shows us that we can shore up the other cell repair genes to help compensate for the defective BRCA gene. (6)
(1) Ji, S. Beware of Organ Removal for “Cancer Prevention”: Jolie’s Precautionary Tale. Green Med Info.
March 24, 2015. http://www.greenmedinfo.com/blog/beware-organ-removal-cancer-prevention-jolies-precautionary-tale-2
(2) Pijpe A, Manders P, Brohet RM, Collée JM, Verhoef S, Vasen HF, Hoogerbrugge N, van Asperen CJ, Dommering C, Ausems MG, Aalfs CM, Gomez-Garcia EB; HEBON, Van’t Veer LJ, van Leeuwen FE, Rookus MA. Physical activity and the risk of breast cancer in BRCA1/2 mutation carriers. Breast Cancer Res Treat. 2010 Feb;120(1):235-44. doi: 10.1007/s10549-009-0476-0. Epub 2009 Aug 13.
(3) Ghadirian P, Narod S, Fafard E, Costa M, Robidoux A, Nkondjock A. Breast cancer risk in relation to the joint effect of BRCA mutations and diet diversity. Breast Cancer Res Treat. 2009 Sep;117(2):417-22. doi: 10.1007/s10549-008-0292-y. Epub 2009 Jan 23.
(4) Kotsopoulos J, Olopado OI, Ghadirian P, Lubinski J, Lynch HT, Isaacs C, Weber B, Kim-Sing C, Ainsworth P, Foulkes WD, Eisen A, Sun P, Narod SA. Changes in body weight and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res. 2005;7(5):R833-43. Epub 2005 Aug 19. doi:10.1186/bcr1293.
(5) Women’s College Hospital. Women with diabetes more likely to be diagnosed with advanced stage breast cancer. ScienceDaily. March 24, 2015. www.sciencedaily.com/releases/2015/03/150324120912.htm.
(6) Gazella K. Some Clarification For Angelina Jolie Pitt’s Followers: Jolie Pitt missed a few great opportunities to talk about risk reduction. Psychology Today. March 28, 2015. https://www.psychologytoday.com/blog/the-healing-factor/201503/some-clarification-angelina-jolie-pitts-followers