What We Could Learn From George Burns About Breast Cancer Risk

Making sense of one’s personal risk for developing a disease is complicated. In fact, it’s virtually impossible.

We all know of lifetime smokers who never get lung cancer and nonsmokers who do. While there is a strong probability that smoking causes lung cancer, the smoking-lung cancer equation is not definitive for all individuals. There is a clear and documented relationship, however, between smoking and negative health outcomes. In general people who smoke do have an increased risk of developing lung cancer compared to those who do not. Likewise, people who are not exposed to cigarette smoke generally have a decreased risk for lung cancer compared to those who do. According to the Surgeon General, smoking is the “single greatest cause of avoidable morbidity and mortality in the United States.” This probability lends support to public health policies that prohibit smoking in public places as well as public programs aimed at deterring smoking habits. It does not explain why beloved comedian George Burns—rarely seen without his trademark cigar—never developed lung cancer and lived to the ripe age of 100.

I imagine that many people with the best of intentions tried to convince old George to quit smoking, and this health researcher would have agreed wholeheartedly that doing so would probably be a good idea. No doubt, it would be unwise to change public health protocols on smoking based on one or a few outlying cases. Yet something protected this man from lung cancer and he surpassed the national average for men’s life expectancy by about 25 years despite years of smoking. Examples like Burns point to the strengths and limitations of using population level data to understand individual outcomes.

Probabilities tell us how things work in the aggregate for entire populations. Such knowledge can help societies to develop overarching strategies for dealing with public health. They also lend insight into what individuals within those societies might do to avoid certain illnesses or gain desired levels of healthiness. As the smoking scenario suggests, however, health outcomes are more than simple cause and effect. Even with well-documented causal relationships, some characteristics and exposures (i.e., risk factors) contribute to the development of particular diseases whereas other factors protect people from them. The accumulation of both risk factors and protective factors over time eventually adds up to the conditions of health and/or illness. Identifying these factors gives individuals and societies needed information to create health-promoting, illness-avoiding conditions both for themselves and for their communities. This brings me to breast cancer.

Though all women are at some degree of risk for developing breast cancer in their lifetimes, there are factors that increase a woman’s risk. Those we know about include: older age (i.e., the greatest percentage of diagnosed women are between the ages of 50 and 59); genetic factors (i.e., 5-10% of diagnosed women have inherited a mutation in the known breast cancer genes, BRCA1 and BRCA2); increased breast density and use of hormone therapy; family history of breast or ovarian cancer; long menstrual history and, relatedly, having no children or having a first full-term pregnancy after the age of 30; postmenopausal obesity, ionizing radiation, and daily alcohol consumption. Taken together, the known risk factors only account for about 30 percent of total breast cancer cases.

Many of the known risk factors are characteristics that women cannot influence, such as being a woman, getting older, having a genetic mutation, or having a long menstrual history. Some of the risk factors are characteristics that women would not want to change even if they could, perhaps choosing to have children at a young age to lower one’s lifetime exposure to estrogen. Equally important to note is the reality that, according to the National Breast Cancer Coalition, “A woman could have all of the known risk factors, and still never get breast cancer during her lifetime. Another woman could have none of the known risk factors, yet she might develop breast cancer next year.” Although it is not very encouraging to know that the known risk factors for breast cancer account for less than one third of all cases, it is heartening that risk factors alone are not responsible for the development of breast cancer. Protective factors are at work too.

For example, studies show that alcohol consumption of 2 to 5 drinks per day contributes to a 40 percent increased risk for the development of breast cancer, compared to a woman who does not drink alcohol. This sounds like a big risk. In reality, if the average woman’s cumulative risk for breast cancer over a lifetime is only 1 in 8 (12.5%), then an increase of 40% due to daily alcohol consumption raises this risk to 17.5%, which is still not that high. In addition, studies show that high intake of folic acid found in legumes, asparagus, broccoli, spinach and other greens, and multivitamins mitigate the excess risk of breast cancer due to alcohol consumption. According to Dr. Susan Love, if you enjoy having a drink then “increase your green leafy vegetables and take a multivitamin.”

Dr. Love is not being flippant in giving this advice. She knows it would be impossible to identify all the factors that alone, or in combination, would enhance or inhibit a person’s chances for developing a disease. Yet, focused attention to key risk and protective factors can help people to avoid disease in the first place. George Burns seemed to know something about this when he glibly told Cigar Aficionado, “If I’d taken my doctor’s advice and quit smoking when he advised me to, I wouldn’t have lived to go to his funeral.” Outliving his doctor after smoking cigars every day since the age of 14 is not necessarily proof that smoking contributes to longevity, but it does give one pause. Something protected Burns from lung cancer. Maybe he ate broccoli everyday, too.

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1 comment to What We Could Learn From George Burns About Breast Cancer Risk

  • ann

    George Burns was one lucky person to live that long and smoke cigars for the amount of years he did. Smoking is HAZARDOUS TO ONES HEALTH, and is no JOKING matter. George made light of his smoking, but I’m glad that Sulik reiterated several times that many factors can be protective of one’s health. This IS heartening!

"women urged to get screened because it might save their lives. But that’s only 1 possible outcome, and it’s the least likely one" @cragcrest cutt.ly/jei8WJr

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