By Dr Prathima Reddy
MBBS, MRCOG (London), FRCOG (London), FACOG (USA)
Director, Senior Obstetrician and Gynaecologist – Fortis La Femme Hospital, Richmond Road Bangalore
Breast Cancer is the most common cancer in Indian women and accounts for 27% of all cancers in women. About 1 in 28 women are likely to develop breast cancer during their lifetime. In the urban areas the incidence is 1 in 22 as compared to the rural areas where 1 in 60 women develop breast cancer. The incidence begins to rise in the early thirties and peaks at the age of 50 – 64 years.
What causes Breast Cancer
The exact cause of breast cancer is not known. However, several factors affect our risk of developing breast cancer. The chances of developing the disease depends on a combination of our genes and bodies, lifestyle, life choices and the environment.
Being a woman and age are the two biggest risk factors.
The other risk factors are:
Early puberty – Women who started their periods at an early age have a slightly increased risk of breast cancer. The earlier you began your periods, the higher your risk, but this effect is small and gradual. The increase in risk is probably because of the longer exposure to the female hormone estrogen.
Late menopause -Women who go through the menopause later than average have a slightly increased risk of breast cancer. The later you go through menopause, the higher your risk, but this effect is small and gradual. The increase in risk of breast cancer seen in women who have a late menopause is probably because these women are exposed to the female hormone oestrogen for longer than women who go through the menopause earlier.
Genetics – In a small number of women, breast cancer runs in the family. Of all women who develop breast cancer, up to 15% has a significant family history of the disease and about one in 20 has inherited a fault in a gene linked to breast cancer. Women who have inherited faults in known breast cancer genes such as BRCA1 or BRCA2 are at increased risk of developing breast cancer.
High breast density-The amount of tissue compared to fat in your breasts is known as ‘breast density’. Having high breast density (a low proportion of fat) is one of the biggest risk factors for breast cancer. The density of your breasts tends to gradually fall over time, but because age is also a risk factor for breast cancer, this does not mean that your risk of breast cancer reduces as your breasts change. In fact, your risk of breast cancer increases as you get older.
Ethnicity – A white woman is more likely to develop breast cancer than a black, Asian, Chinese or mixed-race woman.Ashkenazi Jews and Icelandic women have a higher risk of carrying inherited faults in breast cancer genes, such as BRCA1 or BRCA2, which are known to increase the risk of developing breast cancer.
Life choices, Lifestyle and Environment -Factors that increase the risk of breast cancer are: Weight gain, lack of exercise, alcohol, hormone replacement therapy, the combined oral contraceptive pill, ionizing radiation, radiotherapy, stress and possibly shift work.
Pregnancy and Breastfeeding reduce the risk. Age and number of pregnancies affect the risk. The earlier the pregnancies and the more the number of pregnancies, the lesser is the risk of cancer.
Breastfeeding slightly reduces your risk of breast cancer and the longer you breastfeed, the more your risk of breast cancer is reduced. Breastfeeding may reduce breast cancer risk by altering the balance of hormones in the body and by delaying the return of your periods.
What can I do to reduce my risk of Breast Cancer?
Unfortunately, there is nothing that you can do to change most of the above risk factors. Lifestyle modifications should as detailed above should be made.
But all women should be breast aware – this means knowing what is normal for you so that you are aware as soon as something changes. The sooner you notice a change the better, because if cancer is found early, treatment is more likely to be successful. Get into the habit of looking at and feeling your breasts from time to time. This will help you to notice any change if it occurs.
What is Breast Self-Awareness?
Breast self-examination (BSE) and clinical breast examination are inexpensive and noninvasive procedures for the regular examination of breasts. Evidence supporting the effectiveness of these 2 screening methods is controversial.
Even with appropriate training, breast self-examination has not been found to reduce breast cancer mortality. In fact, most of the expert groups now recommend breast self-awareness instead of BSE.
Breast self-awareness is a woman’s attunement to the normal appearance and feel of her breasts, so that she can seek medical advice if she notices any changes such as pain, a mass, new onset nipple discharge, or redness.