Dr. Afghahi Joins the Latest Mind the Brain EpisodeMay 12, 2021
Breast cancer in the United States: where are we today?
In 2020, an estimated 276,000 new cases of invasive breast cancer were diagnosed in the United States. Most of those diagnoses were Stages 1-3, with very good prognoses and likely to be cured by current treatment protocols. An additional 50,000 cases were diagnosed at Stage 0, or Ductal Carcinoma in Situ (DCIS).
Of those diagnosed with breast cancer, black women have the highest mortality rate of any racial or ethnic group. While this may be explained in part by their higher predilection toward a triple-negative breast cancer subtype, it is also clear manifestation of the system-wide health disparities, barriers to access, and inequitable treatment that affect BIPOC Americans every day.
The causes of breast cancer and appropriate use cases for hormone replacement therapy
Dr. Epperson asks Dr. Afghahi to set the record straight about what really causes breast cancer, given a common fear of estrogen use and hormone replacement therapies. Dr. Afghahi breaks it down for us:
Genetics: 10-15% of women with breast cancer have a genetic predisposition, which is often the cause of their cancer.
Hormone Use: Breast cancer due to hormone replacement is most common among women with prolonged use (several years) of hormone replacement therapy following a natural menopause. Prolonged use of hormone replacement therapy poses a greater risk in women who have already gone through a natural and timely menopause, as their bodies expect lower estrogen levels once menopause is complete.
Women who go through menopause at a young age (i.e. women in their 30s or early 40s who have a genetic predisposition such as the BRCA 1 or BRCA2 gene mutation and undergo an oophorectomy) often should consider using hormone replacement therapies, as the brain and body of a woman in her 30s is used to being—and expects to be—exposed estrogen. As Dr. Epperson notes, epidemiological studies have shown that going through menopause at an early age puts women at a greater risk for adverse effects to brain health (such as depression, anxiety, cognitive changes, vasomotor symptoms) for this very reason. Dr. Afghahi adds other adverse risks of early menopause to the list, including bone weakening, increased risk of heart disease and stroke, and sexual wellness.
Each patient and each case are different, however, and each will require different protocols, treatments, and healing modalities.
Dr. Afghahi’s patient Kristi Wilson, joins the conversation to share her own journey of healing. Kristi was diagnosed with Stage 3C breast cancer in 2018 and was matched with Dr. Afghahi shortly thereafter. Kristi’s treatment included chemotherapy, a mastectomy and axillary dissection, and 32 rounds of radiation —but there was much more to her recovery than what happened in the hospital and clinic.
Brain health and breast cancer: how tending to her mind changed Kristi’s life
In the early stages of her treatment, Kristi turned to regular meditation and prayer after being told that women who meditated and had faith not only were less likely to experience side effects from chemotherapy, but had higher statistics of survival.
Kristi continues to use prayer and meditation in her survivorship, saying that it’s become more a lifestyle than just a tool or good habit. Cancer treatments cause pain syndromes in many people, and Kristi has noticed that she now experiences physical pain when she’s stressed—which she uses meditation to help treat. She tells Dr. Epperson, “It’s pretty amazing and mind-blowing to me that you can use your brain to alleviate physical pain. It’s just incredible.”
Kristi shares that the relationship to meditation and prayer she’s developed through her treatment and survivorship are of so much value to her, that she now looks back on her cancer with gratitude. She even goes as far as to say that if she could give the cancer back, she doesn’t think that she would.
In addition to prayer and meditation, Kristi—who has suffered from anxiety from the age of 13—turned to a therapist for support, attending 18 months of weekly sessions. She tells Dr. Epperson, “I knew that there were things that I needed to deal with from my past, but I didn’t know what they were. I could meditate all day, but I still didn’t know what those things were that were causing my trapped emotions and trapped stress.”
“It’s a lot of brain work that I’ve done over time.”