4 February, 2019
She was a docile elderly lady and was bewildered by the concept of living alone in a fast world. It was not even a year since she was widowed. She was taking care of her ailing husband for quite some time now that when he finally gave up on his physical body it was difficult for her not to wonder if death was an easy remedy for all his suffering. She was slowly reconciling to the fact that she has to live alone her children being settled abroad when she realized that a lump in her breast that she has long been neglecting deserved attention. She gathered all her courage and called up her sister in law. The next day she was in hospital. Even in the wildest of her dreams she never dreamt she would develop breast cancer. But truth is always stranger than fiction and so the lump turned out to be cancerous.
This is a common scenario that we come across on a day to day basis. 70 % of people with cancer are above 65 years of age. In other words every one in three men and one in four women above 70 years are at risk of developing cancer. And Breast cancer is the most common cancer amongst women in india and worldover. Clearly being elderly is a risk factor for breast cancer. Being elderly also delays seeking medical consultation especially in cancer. And even when diagnosed there is a bias towards suboptimal treatment because of the fear of tolerating treatment. More often than not they seek alternative therapy ,deny operation or chemotherapy. If there are no comorbid conditios then age alone is not a deciding factor for avoiding or reducing treatment. Because that will compromise with the outcome.
So this world cancer day lets brace ourselves against this epidemic. Definitely there is something which each of us can do to bring down the crisis.
Be Aware of changes in the Breast :
The first step towards being aware of changes in the breast is Breast Self Examination. A woman needs to be aware of her breast and its changes . Any abnormal change needs expert consultation.
Signs to be ware :
Be Screened :
Screening refers to regular check ups either by a doctor or health care professional and periodic testing with x-rays of the breast. Women more than 50 years of age need yearly mammograms alongwith six monthly health check ups. In India because breast cancer occurs 10 years earlier in women it is more prudent to start early screening (i.e > 40 years).The biggest advantage of screening mammogram is that cancer can picked up at a stage where it not even felt and early detection improves outcomes of treatment.
Avoid or reduce Risk :
There are a number of factors that increase the chances of developing breast cancer. They are called risk factors because they do not directly cause breast cancer. Some of them are beyond our control / unmodifiable while others are modifiable.
Being a Woman:
In 80 – 90% of breast cancers there is no factor discerned other than just being female. Yes! Being a female is a risk factor for breast cancer. That does not preclude men from getting breast cancer. Male breast cancer is rare about 1 % and all male breast cancers are invariably hereditary.
As you grow older:
As age increases the chances of developing breast cancer increases. In older women the cancer is often picked up late because of they seek medical help late or are not ready to undergo active treatment. Age is not a contra indication for treatment and most women fare better if there are no comorbities.
If you never had children:
Having no children at all increases the risk for breast cancer. But having the first child beyond 35 years of age is more riskier than having no children at all. Having children or planning your pregnancy amounts to modifiable risk factor. About four or more full-term pregnancies have a protective effect on breast cancer.
If you had early puberty :
Suppose you had your first periods before 12 years of age that increases your risk for breast cancer just like having periods beyond age 55 does. Early menarche and late menopause increases the duration of hormonal exposure to the breast stimulating proliferation.
If you are fat after your periods stopped:
Obese women in the post menopausal group have an increased risk for breast cancer. Even though ovaries have stopped functioning in the post menopausal women, the fat takes over and acts as a potential source of estrogen. Being obese before menopause is protective for breast cancer. Obesity is a modifiable risk factor. It also means that regular physical activity decreases the chances of breast cancer.
If you wine and dine: Junk food makes you fat and increases your risk for breast cancer. Similarly red and processed meat seems to increase the chances of breast cancer. Dietary intake of poultry or dairy products stimulated by hormones(space)may increase the risk of breast cancer . Previously excess alcohol was postulated to breast cancer. But presently even alcohol intake as less as one per day is adequate to increase the chances of getting breast cancer.
If you took Birth Pills or hormones:
The birth pills of yesteryears had only estrogen in a higher dose. So having birth pills on a regular basis for five years or more put you at risk for breast cancer. Over the past decade the birth pills contain low dose estrogen with progesterone that has been shown to be safe with no additional risk of breast cancer. But what is more relevant in today’s scenario is use of hormones, either for infertility, or replacement for menopausal symptoms.
If you had multiple cancers in the family
One out of 10 breast cancers run in the family. If someone had multiple first or second degree relatives with breast or ovarian cancer either maternal or paternal then it increases their chances of inheriting the faulty gene and therefore developing breast cancer. There are at least a dozen such genes associated with breast cancer.
If you’ve had radiation in childhood
Previously lymphomas used to be treated with mantle radiation which subsequently increased the chances of breast cancers in young women. So anyone who received radiation to the breast field needs to be vigilant for breast cancer.
If you really are curious to know about your risk of breast cancer there are several breast cancer risk assessment tools developed by the national cancer institute are available online. Even though the tool has been developed based on the Western data it might still give us a rough idea about the impending risk.
Manage your Genes :
About 10 % of breast cancers are hereditary. They are capable of passing on from one generation to another. Even though a number of genes are implicated the most common are BRCA 1 & 2. Mutations in these genes increase the lifetime risk of breast cancer to 50 to 80 % by age 75.It is important to know if you harbor these genes and if so take measures to reduce the risk such as,
1.Increased surveillance : For women at high risk MRI of the breasts is recommended yearly in addition to mammogram so as not to miss interval cancers. Every six months imaging is done to be doubly sure that the cancer is not missed.
2.Chemoprevention : Some tablets like Tamoxifen or Raloxifene halves the risk of breast cancer. They are usually recommended in women beyond 35 years of age after childbearing is complete.
3.Risk reducing surgeries : Risk reducing surgeries include removal of both ovaries and breasts or both . In high risk women removal of the ovaries reduce the risk of both breast and ovarian cancer. The double benefit is because they knock out the source of estrogen in the body. Removal of the breasts is usually done alongwith reconstruction to restore the shape and volume of the breasts.
This article has been contributed by:
Dr. S. Veda Padma Priya, Sr. Consultant - Breast Oncology, Max Hospitals
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