Women Performing Night Shift Work Have Higher Rates of Breast & Ovarian Cancer, Study Finds
Women themselves have expressed an interest and preference for screening surveillance strategies vis a vis ovarian cancer.
January 11, 2017
Dr. Karen Belkic MD is a clinical scientist with a PhD in neuroscience and physician specialist in internal medicine. On Sunday, December 8th, 2017, she delivered the Gloria Freedman memorial lecture on ovarian cancer to Temple Beth Shalom Sisterhood. Gloria Freedman was her mother.
Among women worldwide, Breast Cancer is the most frequently diagnosed cancer
A critical factor impacting survival is the stage at which Breast Cancer is diagnosed. Survival after diagnosis is related to when it is detected," Belkic said, which is hardly revolutionary. But what was new was the attempt to encourage screening through attention to ethnic and cultural differences.
In Europe, it is considered impolite or even illegal to ask a person's racial, national or ethnic origin. This is due to the World War II experience. "There are many countries outside Sweden that have no population based programs," Belkic said.
In many European countries there are many population based Breast Cancer mammography screening programs with very high recovery rates. But not all segments of the population in Sweden have benefited equally from the mammography screening program. Women born outside Sweden significantly less likely than Swedish born women to attend invitational mammography screening.
"The Swedish cultural file is what we call rather reserved. Send them one letter and they come. This doesn't work for Latinas, women from Africa, has to be personalized. We have screening methods that are effective, but they're not perfect."
In Europe, we have become aware of the vital importance of screening for women with high breast cancer risk, for whom there is a greater likelihood of more aggressive tumors presenting at a younger age, she said.
Lower Breast Cancer screening rates with late stage diagnosis frequently found in women from ethnic minority groups. Worldwide women from ethnic minority backgrounds are far less likely to go to screening. This is a problem, particularly among economically deprived immigrants or refugees," she said.
The concern about breast cancer is really universal. In the US, African American hispanic and American Indian women are more likely to be diagnosed at a more advanced stage of cancer. We know that there are tremendous disparities some from Africa have a poorer prognosis because they have late detection.
In Israel, Russian immigrant women often say "I have no time for potential troubles, I have real troubles." which is a cultural barrier. In Israel, all women aged 50 to 74 invited to screening mammography every 2 years free of charge. 90% cure rate in Israel for Breast Cancer. 80.6% is the screening percentage overall Jewish women in Israel for Breast Cancer. 71% among recent Jewish women
74% among ultra orthodox jewish women. Previously lower (66.8%) among Arab women in Israel. After concerted efforts in Israel, this statistic has improved, she said.
The total Jewish population of Europe: 1,407,200 and not a single study.
Imaging modalities for Breast Cancer screening include Mammography and MRS, an alternative technology. Systematic early detection through screening with mammography followed by appropriate diagnosis and management, significantly reduces mortality from Breast Cancer.
Dr. Belkic discussed the various technologies for Breast and Ovarian cancer screenings.
"Mammorgraphy is the mainstay of Breast Cancer screening, but has relatively poor specificity. False positives are a problem, because of the angst they quite understandably create."
The main problem with MRI is specificity is poorer than mammography. MRI has higher call back and biopsy rates, with fewer than 50% of these biopsies showing cancer.
Magnetic Resonance Spectroscopy (MRS) used modalities can aid in early Breast Cancer detection, without exposing the breast, a radiosensitive tissue, to ionizing radiation. With optimized data analysis, it is a powerful tool.
Ultrasound is a good ancillary method, but can't stand on it's own. Diffusion weighted imaging, or Diffusion tensor imaging is a good ancillary method.
Dr. Belkic's group studied data on 2411 women. Self reported mammogram within the last year or 2 years-61%. Barriers to cancer screening identified in ovarian cancer study groups of Orthodox jewish women. One barrier is "keeping miracles." Competing priorities, concern about pain, about having a male examiner, fear of the results, ovarian cancerial cohesion among observant women.
"Quality of life can be harmed by false positives," says Dr. Belkic. "Subsequent to such ovarian cancer occurrences, women are often disinclined to continue with intensive surveillance. Being called back is agonizing!" she says.
When performing a Breast Cancer Risk Assessment, Dr. Belkic's group focuses on the following Modifiable risk factors for which there is empirical evidence of potential impact on Breast Cancer risk: Obesity, Alcohol Consumption, and Smoking are well known to increase risk of all forms of cancer.
While it isn't known exactly why Night Shift Work leads to higher risk of breast and ovarian cancer, anyone with a high risk should avoid night shift work, said Dr. Belkic. Similarly, Prolonged exposure to artificial light at night is a risk factor.
Sedentary life style - exercise is protective, she said.
Use of hormone replacement therapy - this is revolutionary avoid it.
Other factors that seem to lead to a lower breast and ovarian cancer risk include Gynecologically related protective factors, early fixed full term pregnancy, More full term pregnancies, Breast feeding
This talk is about hope!" Dr. Belkic concluded. "A proactive approach combines lifestyle measures with screening can lower Breast Cancer risk."
Dr. Karen Belkic MD is a clinical scientist with a PhD in neuroscience and physician specialist in internal medicine. She is adjunct professor of preventive medicine at the University of Southern California School of Medicine, Institute for Health Promotion and Disease Prevention Research and at the Claremont Graduate University School of Community and Global Health. She is also affiliated to the Oncology and Pathology Department of the Karolinska Institute, where she holds a scientific tenure position. She earned her M.D. degree at University of Southern California School of Medicine.