Is Breast Density an Overrated Cancer Risk Factor?

Researchers evaluated thousands of mammogram reports in Croatia and found no substantial difference in breast density between 230 women diagnosed with breast cancer and those who weren’t.

Just a small number of the women with breast cancer had very dense breast tissue, the researchers found.

“We cannot conclude from our study that breast density is not a risk factor, but it might not be a strong factor,” said study researcher Dr. Natasa Katavic of Health Center Osijek in Croatia. “We have an impression that breast density is presented to the public as the most important risk factor, which our study does not support.”

However, two U.S. experts took exception to the study’s conclusions.

“The findings do not apply to U.S. women,” said Dr. Debra Monticciolo, chair of the American College of Radiology Commission on Breast Imaging. She said the study researchers grouped women into four categories of breast density, but “the percent of women in each category is markedly different from what we see in the U.S., so it makes it hard to apply to women in the U.S.”

Dr. Laura Kruper added that the number of screenings evaluated for the study—about 53,000 over five years—was relatively low.

It would have been better to follow the women for several years to be sure they did not develop cancer later, said Kruper. She is director of the Cooper Finkel Women’s Health Center and co-director of the breast cancer program at City of Hope Comprehensive Cancer Center in Duarte, Calif.

Because of the relatively low numbers and the study’s design, she added, “I don’t think you can draw any conclusion.”

Women with dense breasts have a slightly higher risk of breast cancer compared to those with less dense breasts, the American Cancer Society says, although it’s not clear why. Also, when breasts are very dense, it makes it difficult to detect cancers in the breast tissue.

Dense breasts have a lot of fibrous or glandular tissue and not much fatty tissue, according to the cancer society. Density is common. With age, breasts often become less dense.

Some U.S. states require mammography results to include a report on breast density, and some doctors recommend women with dense breasts to undergo additional testing, according to background information with the study.

The women screened for this study were between ages 50 and 69 and seen at five facilities in Croatia. The researchers found that about half of the 230 women diagnosed with cancer were from the group with the least dense breasts. Slightly less than 3 percent were in the highest density group.

The findings were scheduled for presentation Wednesday at the annual meeting of the Radiological Society of North America, in Chicago. Studies presented at medical meetings are usually viewed as preliminary until they undergo rigorous peer review for publication in a medical journal.

In the United States, said Monticciolo, about 50 percent of women have breasts categorized as dense or very dense. In the new study, no more than 17 percent did.

Both U.S. experts said it’s important to keep breast density as a risk factor in perspective. It’s one of many risk factors, and, like age, it’s one that women have no control over. Family history is a stronger risk factor for breast cancer than density, Monticciolo said.

Women should continue to get annual mammograms, whatever their breast density, Monticciolo said, citing the American College of Radiology guidelines. Other organizations recommend mammograms every other year and have different starting ages.

At this time, the American Cancer Society does not recommend that women with dense breast tissue have MRIs in addition to mammograms.

Too Much TV in Your 20s Could Hurt Your Brain Later On

We found that low physical activity and high TV watching in young adulthood were associated with worse cognitive [mental] function” in middle-age, said Tina Hoang, a staff research associate with the Northern California Institute for Research and Education at the Veterans Affairs Medical Center in San Francisco.

And that finding was “particularly surprising,” added Hoang, given that the current study pointed to a negative impact on mental function in people who were mostly in their 50s. Seniors have been the focus of most prior investigations, she explained.

But, “this is really a preliminary study,” she cautioned. Hoang also acknowledged that while TV time and physical inactivity seem to be associated with diminished mental ability, the study couldn’t show whether or not such lifestyle factors actually cause mental decline. “More work is needed to really understand this relationship,” she added.

The study findings were published in the Dec. 2 online edition of JAMA Psychiatry.

To gauge the long-range mental health impact of TV and physical activity habits, investigators enlisted more than 3,200 men and women. Study participants were an average of about 25 years old when the study began. Most (55 percent) were white and 57 percent were female. More than 90 percent of the study volunteers finished high school, the researchers said.

Over the 25-year study, all of the participants completed at least three detailed lifestyle questionnaires.

The study authors defined high TV-viewers as people who watched more than three hours of TV per day during the prior year (on at least two-thirds of the questionnaires they filled out).

The researchers calculated physical activity by exercise units. These units were measured using a combination of duration of exercise with intensity of exercise. Those who scored low on physical activity were below the baseline number of exercise units for their sex, the study said.

Mental capacity was assessed by testing that looked at verbal memory skills, and the ability and speed with which participants were able to plan, organize and perform mental tasks.

In the end, the investigators found that 11 percent of the study volunteers were high TV-watchers. At middle-age, high TV-watchers were more likely to fare poorly on most mental function testing compared with low TV-watchers, the study found. The one exception the researchers discovered was that high TV-watchers did not fare worse in terms of verbal memory.

Those whose physical activity levels were ranked as low (about 16 percent of participants) were significantly more likely than those ranked high to fare poorly in terms of the ability to think quickly and perform mental tasks, the study found.

And participants who were both high TV-viewers and low exercisers had up to double the risk for poor mental performance by middle-age, compared with those who had been both low TV consumers and more physically active during young adulthood, the findings showed.

Could other “couch-potato” factors apart from TV viewing—such as poor nutrition or reading less—decrease mental performance down the road?

“We did try to control for some confounding factors, such as education, body mass index, smoking and alcohol use,” Hoang said. “But there may be others that we were not able to account for.”

Susan Albers is a psychologist in the department of psychiatry and psychology with the Cleveland Clinic in Wooster, Ohio. Albers cautioned that, ultimately, “there are too many variables and confounding factors to say that the behaviors of TV watching and a sedentary lifestyle is a direct ticket to cognitive deficits.”

Yet, she added, “there is no surprise that there is an association.” And the findings clearly highlight that “what you do in your teens and early adulthood matters,” Albers said.

“Young adults often don’t make the connection between what they do now and what happens 25 years from now,” she pointed out. “This study helps connect the dots.”

Could There Be a ‘Quit-Smoking’ Gene?

Researchers analyzed genetic differences cited in 22 studies involving nearly 9,500 white smokers. Of particular interest were variations in genes involved in processing dopamine, a neurotransmitter that helps to regulate the brain’s reward and pleasure centers.

Experts believe that the nicotine found in tobacco boosts dopamine in the brain, leading to addiction.

The researchers wondered if variants in genes that regulate dopamine might be associated with the ability to put out the butts for good.

In the end, the scientists focused on a DNA sequence called Taq1A. They found that smokers who carried a variation of that sequence—called A2/A2—appeared to have an easier time quitting smoking than those who carried other variations of the Taq1A sequence.

“This variant has been studied for years, but this study provided more convincing evidence on the role of this genetic variant in smoking cessation by analyzing a significant large number of smoke samples,” said study co-author Ming Li, a professor in the department of psychiatry and neurobehavioral sciences at the University of Virginia.

The findings were published Dec. 1 online in Translational Psychiatry.

Li, working with researchers from Zhejiang University School of Medicine in Hangzhou, China, noted that roughly 6 million people die worldwide every year because of smoking.

The studies included in the current analysis were conducted between 1994 and 2014, and numbered from fewer than 100 participants to more than 2,000.

Quitting success varied widely, ranging from less than 10 percent to nearly 67 percent, the researchers reported.

Ultimately, the team found there was a “significant association”—but no definitive proof—between having the A2/A2 DNA variant and an increased ability to successfully quit.

The authors said the finding should encourage more research into the genetics behind efforts to quit smoking. Such research could eventually lead to the development of personalized treatments that target each smoker’s inherited predispositions, they suggested.

However, Li’s team cautioned that “research on this problem remains in its infancy.”

And Li further highlighted the complexity of the science by noting that “there are many genetic factors involved in smoking addiction. The variant studied in this report is just one of those.”

Meanwhile, Dr. Norman Edelman, senior medical consultant for the American Lung Association, expressed little surprise at the idea that genetics has a role to play.

“There’s a huge variability in the ability to quit smoking,” said Edelman, a professor of medicine and preventive medicine at the State University of New York at Stony Brook. “Quitting cold turkey, for example, is only effective 5 percent of the time. But I have patients who got up one morning and decided to stop smoking and just stopped. And then I have patients who have tried 10 times and can’t do it.”

Genetics likely explain some, but not all, of these differences, Edelman added. “The next step, in terms of advancing the science of smoking cessation, is trying to figure out exactly what the gene does, what proteins it codes for, and to see if there’s some way to modify the way it works. That’s probably going to turn out to be very hard.”

Still, Edelman called the current research “a good finding.” As he sees it, “the more you know about smoking and the predilection to smoke and smoking cessation, the more you are going to be able to develop effective strategies to help patients.”

Coffee or Tea? An RD Weighs in on Which Is Healthier

A colleague recently came to me asking what’s better: coffee or tea? She told me that she (a coffee drinker) and her boyfriend (more of a tea guy) were debating which beverage is healthier, each believing their own personal preference was the more virtuous option.

It’s a good question because it seems like every day there’s news about the health benefits of one or the other, but you never see the two compared.

The truth: there isn’t a clear standout. Both of these uniquely healthy pick-me-ups have their own long list of health pros—and cons. Below, I go over the reasons to sip one or the other, along with tips for getting the most out of each one.

RELATED: 29 Gifts For People Who Can’t Live Without Coffee

Tea

The pros: Tea boasts a long list of health benefits. The rich antioxidants in tea fight inflammation, and have been shown to help prevent blood vessels from hardening. Tea drinkers have a significantly lower risk of strokeand heart disease, and tea is known to boost brain health. One study, for example, found that compared with older adults who drank less than three cups a week, those who drank more than two cups of green tea a day had a significantly lower risk of age-related declines in memory.

Regular tea drinkers also have higher bone density levels and slower rates of bone loss.

Overall it’s associated with anti-aging: research shows that the cells of regular tea drinkers have a younger biological age than non-drinkers. Pretty potent stuff!

The cons: The first one is purely cosmetic—stained teeth.

Another is the potential impact on your iron levels due to tanins, a type of antioxidant that interferes with the absorption of non-heme, or plant-based iron from foods like greens and beans. In one classic 1982 studydrinking tea with a meal resulted in a 62% reduction in iron absorption compared to 35% for coffee.

Finally, if you’re sensitive to it, the caffeine in tea may also be a con, although the levels are lower than coffee. One cup or eight ounces of black tea contains 14-70 mg of caffeine, and green tea 24-45 mg, compared to 95-200 mg in the same sized portion of coffee.

RELATED: 10 Must-Have Gifts for Anyone Who Loves Tea

Healthy prep tips

The most important tip for tea is to limit or avoid adding sweetener. Enjoy it hot or iced, and if you need a little sweetness add a splash of 100% fruit juice. You can also add flavor with a bit of natural seasoning, like fresh grated ginger, or fresh mint. Each of these also boosts the antioxidant potency in your mug.

As for the iron issue, if you’re an omnivore this is less of a concern since tannins do not impact the uptake of animal-based heme iron found in meat, fish, and poultry. But if you are vegetarian or vegan the best way to offset the impact is to consume your iron-rich plant foods with a source of vitamin C. In the same study, OJ upped iron absorption by 85%. Other top vitamin C sources include bell peppers, broccoli, cauliflower, Brussels sprouts, kiwi, and strawberries.

Coffee

Pros: The good news about coffee just keeps on coming. A brand new Harvard study found that those who drink about three to five cups of coffee a day may be less likely to die prematurely from some diseases than those who drink less or no coffee. A rich source of antioxidants, regular coffee consumption has also been linked to protection against type 2 diabetes, Parkinson’s, and certain cancers.

RELATED: 12 Surprising Sources of Caffeine

Cons: Natural substances in unfiltered coffee (meaning boiled or espresso) have been shown to raise cholesterollevels slightly. Also coffee is more acidic than tea, so if you have stomach or digestive issues you may tolerate tea better.

Coffee has long had a reputation for bone issues, but it remains unclear how significant the effects are. One study found that a high intake of coffee—four or more cups a day—reduced bone density by 2-4%, but the effect didn’t translate to an increased risk of fracture. However, if you already have low bone density coffee consumption is something you should discuss with your physician.

The remaining cons of coffee are primarily tied to its caffeine content, which again is higher than in tea. Caffeine is a stimulant, so if you’re sensitive to it coffee may leave you feeling overly stimulated, jittery, and anxious. If you have high blood pressure, you should limit your caffeine intake because caffeine can cause a short, but dramatic spike in blood pressure.

Also two or more cups of coffee a day can up the risk of heart disease in people with a fairly common genetic mutation, which slows the breakdown of caffeine in the body. Unfortunately the testing for this is limited, and not typically offered by doctor’s offices. One company, affiliated with the University of Toronto, offers a test through registered dietitians, but it will likely be an out of pocket expense.

RELATED: 10 Coffee Drinks Worse Than a Candy Bar

Finally, coffee is a known diuretic, meaning it flushes water from the body. Research shows that your body can adjust to a regular habit, but if you only have it once in a while, or you have more than usual, it could leave you dehydrated.

Healthy prep tips

Again, sugar and other coffee “adds” are a big issue. Fancy coffees doctored up with syrups, milk, and whipped cream can easily add up to more calories than a meal should provide: 540 for a Starbucks grande peppermint white chocolate mocha made with 2% milk and whipped cream. That’s 140 more than a salad from Chipotlemade with romaine, black beans, fajita veggies, salsa, and guacamole. I’m not in favor of using artificial sweeteners due to their potential impact on appetite and blood sugar regulation, as well as gut health.

I advise my coffee loving clients to add a little plant-based milk, a minimal amount or no added sugar, and a sprinkling of an antioxidant-rich spice like cinnamon.

The bottom line

Stick with what you’re partial to, take the cons into account, and be sure you aren’t using the caffeine in either tea or coffee as a crutch, to mask fatigue from too little sleep. While you may get a benefit from using caffeine pre-exercise it’s best to cut off caffeine completely at least six hours before bed for optimal sleep. And if either beverage leaves you feeling zapped of energy, either from the caffeine or what you’re adding to it, wean down your intake and up the H2O, the ultimate health-boosting beverage.