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Breast Cancer
Breast cancer is one of the most common female cancers that claim several thousand lives a year. The incidence is ever on the rise and the risk for our generation is more than doubled over the past four decades. Unlike the ovary the breast is an external organ. With proper information, and following some simple guidelines most of these cancers can be detected at an early stage. Why then do we bury our heads in the sand and pretend that it could never happen to us? By the way the lifetime risk of being diagnosed with breast cancer for a woman is 1 in 8. Can we still afford to be complacent? The best thing we can do is to stay alert and informed, about the changing landscapes and trust ourselves to make the best available choices.

October is dedicated to bring breast cancer awareness globally. More than 1.2 Billion new cases will be detected and more than 500,000 women are expected to die from this dreaded disease worldwide this year alone. This is my humble effort to bring information, to as many women as possible so that every woman can empower herself with the knowledge and not live in fear of the disease, but follow a few guidelines which would help her not to succumb to the disease. So with faith in God, hope in your future and a smile on your face read on.

What are the risk factors for breast cancer?

Gender– Breast cancer is more common among females. 1% of the cases occur in males.

Age– Risk increases with age. 77% of the cancers are diagnosed over the age of 50. 0.3% is diagnosed before the age of 30.

Genetic risk factors– Only 10% of the cancers run in families. Nevertheless it is important for women who have family history to know the risk they carry.

Mutation of BRCA1 and BRCA2.– Individuals with this gene mutation have a 60% chance of developing breast cancer before the age of 70
Mutation of p53gene (tumor suppressive gene) increases the risk of breast, ovarian, cervical and colon cancer. This is evident in some families when different members of the family suffer from different type of cancers.

Family History– Having one first- degree relative doubles the chance, 2 first-degree relatives increase the chance 5 fold.

Personal history of breast cancer- 4 fold increased risk of developing breast cancer in the other breast.

Race– More common in whites. Least common in Japanese women.

Previous breast biopsy– Women whose previous breast biopsies were reported as proliferative breast disease with no atypia are at higher risk. Women who had fibrocystic disease are at no additional risk. It is very important for all women to keep a copy of the histopathology report whenever such a test is performed.

Previous radiation. Women who might have received radiation to the chest for some other disease like leukemia, Hodgkin's etc. are at a higher risk.

Menstrual periods. Onset before the age of 12 and menopause after the age of 51 carries a higher risk.

Lifestyle related factors

Oral contraceptives– Slightly increased risk in current users. No risk 10 years after discontinuation.
Not having children or having children after the age of 30.

Breastfeeding– breastfeeding lowers the risk.

Use of HRT or ERT– The risk is 0.2 – 1.2% over 5-15 years of use. Each patient should individually evaluate her risks and benefits with her doctor and make an informed choice.

Alcohol– Regular consumption of alcohol even in small amounts increases the risk.

Smoking– Increases the chances of several cancers hence both active and passive smoking should be avoided.

Obesity and high fat diets- The relationship of obesity and breast cancer is complex.
Breast cancer is more common in women who gained weight in adulthood rather than in childhood. It is more common in obese women using HRT than in obese women not using HRT

What are the symptoms of breast cancer?
Breast lump noted during breast self-examination usually painless, firm and irregular.
A lump or mass in the armpit.
A change in the size and shape of the breast.

Nipple discharge
Bloody or clear to yellow.

Change in the colour or feel of the skin of the breast or nipple.
Dimpled or puckered.
Orange peel appearance.
Prominent veins on one breast surface.
Skin ulceration.

Change in the appearance or sensation of the nipple
Pulled in, enlarged or itching.
Breast discomfort on one side only.
Breast enlargement on one side only.
Bone pain.
Weight loss.
Swelling of arm.

What steps to take if you have above symptoms?
Visit your gynecologist
The doctor will examine you and may order one or more of the following investigations.
Breast ultrasound
Fine needle aspiration
Surgical Biopsy

Are there any lifestyle changes that reduce the risk?
1. Having babies at a younger age and breastfeeding the infants.
2. Diet should be low in animal fat – animal fats contribute to high estrogen levels in the body. Also animal foods normally contain estrogenic hormones given to animals to promote growth.
3. Soy products like Tofu and miso lower cancer risk.
4. Broccoli and cabbage are found to be beneficial.
5. Have a cup of green tea (normally used by Chinese and Japanese) it has been shown that women who drink 4-5 cups of green tea have very low incidence of breast cancer.
2 tablespoons of ground flax seed taken with serial or juice reduces the risk in high risk patients.
6. Regular moderate exercise 4 hours per week reduces the risk.
7. Strenuous exercise in childhood may provide lifelong protection.
8. Stop active or passive smoking.
9. Reduce consumption of alcohol.
10. Prevent exposure to organochlorine chemicals found in pesticides and industrial practices especially when you are pregnant, during prepubertal years of your daughters, and menopausal age.
11. Stop using plastic containers in the microwave.
12. Psychological factors like grief and depression, enhances the growth of cancer by suppressing immunity. It does not produce cancer. So always have a positive attitude towards life.
13. Stay informed about the medical advancements.

Timing of breast cancer surgery
A British study showed that lumpectomy and mastectomy done for breast cancer in the post ovulatory or secretory phase has a higher survival and lesser recurrence rate. The experts speculate that the hormone progesterone may have a beneficial effect at the time of surgery. Hence breast cancer surgery should be done in the postovulatory phase in menstruating women.

What steps should you take to help in early detection?
1. Visit an experienced gynecologist.
2. If symptoms of breast cancer occur.
3. If you are a woman 20 years or older and do not know how to perform breast self examination.
4. If you are a woman 35 years or older and have a family history of breast ovarian uterine or colon cancer.
5. If you are a woman of40 years and above and have not had a baseline mammogram.

When should you do breast self-examination?
Every woman should do breast self-examination every month over the age of 20
2 days after the completion of the periods
Post-menopausal women and pregnant women should do it on a fixed date each month.
Nursing women should also examine their breasts once a month immediately after the feed when their breasts are empty.

Can breast cancer be prevented?
Follow the guidelines to lower the risk.
Tamoxifene– This is an anti estrogen drug. This is normally given to women suffering from breast cancer. But nowadays it is also given to women at high risk of developing breast cancer. If taken for 4 years lowers the risk by 45%.
Prophylactic Mastectomy– This drastic measure is chosen by some women at very high risk.
Reasons may include one or more of the following:
  • Mutated BRCA gene detected by genetic testing
  • Strong family history
  • Lobular cancer in-situ
  • Breast cancer in one breast

Not all patients benefit by taking this step. Some patients with very high risk may never develop breast cancer. In others, breast cancer may be detected at a very early stage by rigorous screening techniques and appropriate management undertaken without their life expectancy being affected. Lastly, there is always a chance however remote of breast cancer occurring in the residual breast tissue. The patient should always seek a second opinion and discuss all the pros and cons in detail before considering this option

Five-year survival rates for individuals with breast cancer
85% for stage 1
66% for stage 2
41% for stage 3
10% for stage 4

I sincerely hope this article will help you to take responsibility for your own health and also act as a reminder for your annual Pap smear and ultrasound scan of your pelvis. Call your doctor now and do not neglect. Pass on the cancer awareness campaign to your friends and family far and near.
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