Breast cancer awareness
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If you have a higher risk of developing breast cancer, it is important not to delay screening.

It is October, and yes, it is pink ribbon month!

Sadly, we all know someone who has had breast cancer or who has succumbed to this disease. Are we making any progress in the fight against this disease?

Fortunately, we can say that we do due to early screening methods and the fact that there are improvements in breast cancer treatments. The first and foremost important aspect is to determine a person’s risk to develop breast cancer.

Screening mammography is most valuable for those patients that are likely to develop breast cancer and for whom early intervention will result in reduced mortality. Most women have an average risk (<15% lifetime risk) of developing breast cancer.

Factors associated with a greater breast cancer risk are the following:

Increasing age – according to an American database (Surveillance, Epidemiology and End Results, SEER) your chance of getting breast cancer before 49 years is 2.1% but it increases to 7% for those 70 years and older, if we only look at age as a single risk factor.

Female gender – breast cancer occurs 100 times more frequently in females than in males, this is no surprise to us.

Bodyweight – interestingly enough, a high BMI in premenopausal women is associated with a lower breast cancer risk, but the opposite is true in postmenopausal women.

Tall stature – a study found that women >175cm tall were 20% more likely to develop breast cancer than those <160cm. It is thought that nutritional exposures during childhood could be responsible for this finding.

Non-cancerous breast disease – those with other breast diseases (for example fibro-adenomas) are at increased risk of developing a cancerous condition of the breast.

Bone mineral density – bone contains estrogen receptors that are sensitive to circulating estrogen levels. Bone mineral density is therefore a surrogate marker for long-term exposure to exogenous (hormone replacements) or endogenous (produced by the body) estrogens. It is found that women with a higher bone density have a higher breast cancer risk.

Hormonal factors – those women with an intact uterus taking a combination of estrogen/progesterone replacement were shown to have a higher risk of estrogen receptor-positive (ER+) breast cancer. In women who had a hysterectomy, a single-agent estrogen was shown to reduce breast cancer risk. Contraceptives increase breast cancer risk temporarily therefore this association disappeared after 2- 5 years after discontinuation. It is therefore important to use hormones (of whatever kind) wisely and in consultation with a physician that is up to date with women’s health.

Reproductive factors – it is found that women having their first period (menarche) at an early age (before 13 years) has a higher breast cancer risk. One study found that for every year delay in menarche, the risk was reduced by 5%. Women never bearing children also have a higher risk for breast cancer as are women with late-onset menopause.

Radiotherapy to the chest area – women who had radiotherapy to the chest area between ages 10 and 30 were found to have a higher incidence of breast cancer.

Personal and family history of breast cancer – a personal history of breast/ovarian/fallopian tube cancers increases a woman’s risk of developing cancer. In terms of breast cancer, if you have a history of breast cancer in one breast, you have a chance of getting cancer in the other breast too. The risk associated with a known family history of breast cancer is also influenced by the number of first-degree relatives (your mother, mother’s sisters, sisters) that developed breast cancer and the age of their diagnoses. More first-degree relatives with breast cancer and if they were diagnosed at an early age (<30 years), your risk is higher.

Genetic mutations – specific mutations that predispose to breast cancer are rare and believed to only make up 5 to 6% of cases. Examples of such mutations are BRCA1, BRCA2, p53, CDH1 and PTEN. Indications to test for these mutations will be determined by your oncologist. Most of these tests are performed overseas and are costly. For some patients, the outcome of these tests will determine their treatment regime.

If you have a higher risk of developing breast cancer, it is important not to delay screening as prescribed by your gynaecologist. Your specific patient profile will determine the age and frequency of screening that will be beneficial. Remember, higher risk does not guarantee a breast cancer diagnosis. It merely motivates us to look after ourselves and to manage our risks!

Dr Janet Strauss is a Medical Doctor and Chief Operations Officer at Medwell SA – The Home Health Care Specialists. For more information visit this website

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