By Dr. Sundus Morgan
Breast cancer. It’s a frightening thought, and all too many people, including – and perhaps especially – men assume it won’t happen to them, meaning vital screenings often go missed. October, though, is Breast Cancer Awareness month, and its mission is to urge both men and women to get checked out as clinicians stress that early detection and treatment is key. Make October the month you talk to your health practitioner.
How common is breast cancer?
Worldwide, breast cancer is the most common cancer diagnosed in women and is the second leading cause of cancer-related death in women, after lung cancer. In the US, about one in every eight women will develop breast cancer during their lifetime. Male breast cancer accounts for 1% of total cases.
What are the risk factors?
Family History: Having a first-degree relative (mother, sister, daughter) with breast cancer doubles or triples the risk of developing the cancer. Having two or more first-degree relatives with breast cancer increases the risk to five to six times higher.
Breast Cancer Gene: Mutations in two genes, BRCA1 and BRCA2, are associated with a higher risk of developing breast cancer, but only 5% of breast cancer is attributable to these mutations. If relatives of such a woman also carry the gene, they have a 50-85% lifetime risk of developing breast cancer.
Gynecologic History: Women with early menarche, late menopause, or women who have never borne a child or had their first pregnancy after 30 years of age are at higher risk.
Use of Oral Contraceptives: Oral contraceptive use slightly increases the risk of breast cancer (by about five more cases per 100,000 women). Risk is highest during the years of contraceptive use and reduces during the 10 years after stopping. Women who began to use contraceptives before age 20 years are at particular risk.
Hormonal Replacement Therapy (HRT): Use of HRT with estrogen alone is associated with little or no increased risk of breast cancer. However, HRT treatment with estrogen and progesterone appears to increase risk modestly. The risk increases with the duration of HRT use and decreases once HRT is stopped.
Radiation Therapy: Exposure to radiation therapy to the chest area before the age of 30 increases risk.
Diet and Lifestyle: A Western diet, obesity and alcohol may contribute to development or growth of breast cancers.
What are the methods of treating breast cancer?
Once breast cancer is confirmed, additional tests are undertaken to evaluate the type and stage of breast cancer diagnosed. This information allows clinicians to determine the best treatment plan, which will usually involve surgery and radiation therapy, with or without adjuvant chemotherapy, hormonal and targeted therapy, taking into account patient preference.
What are the top five preventative actions to take to reduce the risk of breast cancer?
Screening: National screening programs are offered in many countries and have been shown to reduce mortality rates. Screening programs vary from country to country, but usually begin from the age of 47-50 years on an annual basis until the age of 50, reducing to two yearly, thereafter, in some countries.
Genetic Counseling: If you have a first-degree relative with breast cancer or ovarian cancer, then counseling at a genetic cancer clinic may be advised to evaluate your risk and discuss the advantages and limitations of genetic testing. Genetic cancer clinics can give advice on the relative risk of developing breast cancer and can test for the gene mutations.
Clinical Breast Examination (CBE): An annual CBE by a health practitioner for women aged 35 years and above should be performed. This augments rather than replaces screening mammography. It can identify suspicious changes and allow for earlier investigation, detecting between 7-10% of cancers that cannot be seen in a screening mammography.
Breast Self-Examination (BSE): Learning to examine your own breasts allows women to identify suspicious changes and seek medical attention early. Women can learn BSE from their health practitioner and should do this on a monthly basis. Changes can include lumps, skin changes, nipple changes such as redness, scaling, inversion or nipple discharge other than breast milk.
Lifestyle Changes and Diet: Limiting alcohol consumption, eating a well-balanced diet, not smoking and maintaining a normal weight can minimize the risk of developing breast cancer.
Early detection of breast cancer can save lives and improve survival rates. It is therefore important to raise awareness about breast cancer so that women can start with monthly breast self-examination and a screening program. Preventative care should be emphasized, focusing on lifestyle changes to help reduce the risk of breast cancer.