BREAST CANCER RISK AND SCREENING

Why should I learn about breast cancer?

Breast cancer is the most common cancer among women worldwide. In 2018, 1,62,468 new cases were reported in India, making it the most common cancer in females (27.7%). It is also the leading cause of cancer death responsible for 11.1% of all cancer deaths in 2018. In the western countries, 1 in every 8 women will develop breast cancer in their lifetime. The percentage here is comparatively less (1 in 22 in urban India and 1 in 64 in rural India) but because of our population, the overall number of people affected and the resultant cancer burden is quite high. Also, the average age of diagnosis in India is 46 years, while in the US it is 62 years. This is largely due to the comparatively younger population of India. That being said, there is a myth breast cancer is a disease of the old and breast symptoms are often ignored by patients and often enough by their primary physicians.

Risk Factors for breast cancer

No one is immune to breast cancer. However, some individuals are at a higher risk and others are at a comparatively lower one. Breast cancer risk factors can be either modifiable or non-modifiable.

Non-modifiable factors (that we cannot control) increasing breast cancer risk include:

female gender,
increasing age,
personal history of breast cancer,
Family history of breast cancer,
known mutation in breast cancer associated genes,
early onset of menses or late menopause
A few benign breast lesions like LCIS,
dense breasts on mammogram
history of radiation exposure.

Modifiable risk factors are things we can change, like:

postmenopausal obesity,
sedentary lifestyle,
late childbearing,
Not having any children (unfortunately this is sometimes non-modifiable),
not breastfeeding,
using prolonged hormone replacement therapy (HRT) or oral contraceptive pills (OCP)
consuming alcohol.

What about all the hormones in IVF treatment?

Multiple studies and well conducted research have shown no connection between IVF treatment and breast cancer. In fact, even patients treated for breast cancer in the past can safely undergo treatment for infertility.

What is my risk?

You can consult a breast specialist or an oncologist to understand your personal risk. There are a few BC risk calculators like the Gail model but they are not validated in the Indian population and should not be relied upon.

How can I reduce my risk?

Eat healthy and maintain an active lifestyle. Watch your weight particularly after menopause. Try to have your first child before the age of 30 years Breastfeed for up to 1 year if possible. Use exogenous hormones for short durations only – HRT to 1 year and OCPs to 5 years Limit alcohol consumption.

What about screening and mammogram?

Screening is looking for a disease in an individual that has no symptoms or complains related to the disease. It is important that a screen detected disease be treatable and the earlier diagnosis due to screening have a positive effect of the treatment outcome. Fortunately, all of this are applicant to breast cancer. Mammogram is one of the tools of breast cancer screening. However, there are other modalities of screening which are equally important. These are:

Self Breast Examination (SBE),
Clinical Breast Examination (CBE), and,
Imaging modalities including ultrasound, mammogram and MRI.

For an average risk individual, every woman over the age of 20 years should be aware of the possible breast cancer symptoms (i.e breast lump, nipple discharge or crusting, sunken nipple, any new fullness/flatness in the breast shape, thickness or orange peel appearance if the skin) and perform self breast examination every month 7-10 days after her first day of period. Postmenopausal women can chose any date for their monthly self exam. Starting at the age of 30, women should approach a breast specialist to have an annual clinical breast examination. At the age of 40, the need for biennial mammography should be discussed by the physician and can be performed then or at 50 years based on her individual risk. SBE and CBE should continues even once mammography begins. All screening methods should continue till the age of 75 or later if the individual retains good health and performance status.

What if I find something?

First of all, don’t panic. Majority of breast lumps are benign. Visit a physician at the earliest. Following a clinical breast examination, you will be asked to do breast imaging (usually an ultrasound/mammogram) and based on these findings, a biopsy may be advised. This is known as triple assessment and is essential to prove or refute a diagnosis of breast cancer.

I don’t want to screen, its too much effort

The earlier you detect a cancer, the better your chances of survival are. If mammogram shows limited disease as well, the tumour can be removed with a healthy margin without sacrificing the breast. 5 minutes a month can save your life!

I am a guy, why should I care?

1% of all breast cancers occur in males. Because of the lack of awareness and the relatively small amount of breast tissue, men typically consult a doctor at a later stages in the disease and almost always present after skin involvement/ulceration.