- Women's Health
Breast Cancer: Lengthening the Odds
A woman’s average lifetime risk of developing breast cancer is approximately 1 in 8. In other words, for all women born in a particular year, 1 in 8 of them should expect to be diagnosed with breast cancer at some point in their lives. There are many variables that influence any individual woman’s risk of breast cancer. Some of those factors are out of her control and other factors are within her power to influence. A woman can realistically reduce her risk of developing breast cancer. Let’s, first of all, look at the factors that a woman cannot control.
Factors outside her control:
v Age of menarche and age of menopause: The risk of breast cancer is thought to be directly related to the length of exposure of breast tissue to the reproductive hormones namely estrogen and progesterone. Early onset of a woman’s periods (menarche) and/or late finishing of the periods means the breast is exposed to these hormones for a relatively longer period. That increases the lifetime risk for that individual. Conversely, women who go into early menopause have a reduced lifetime risk of breast cancer.
v Genetics: There are recognised gene mutations that dramatically increase the risk of breast cancer. Mutation to genes known as BRCA1 and BRCA2 are known to increase an individual’s lifetime risk from the average 12% up to 80% in some cases. The prevalence of BRCA1 and BRCA2 gene mutations in society is not known for sure but some ethnic groups are affected more than others. Among Ashkenazi Jews the prevalence is 1 -2%. In the rest of society it is a lot lower but no ethnic group is completely spared. These mutations are responsible for up to 10% of all breast cancer cases.
v Family history: if a first degree relative such as a mother or a sister has been diagnosed with breast cancer, that fact increases a woman’s risk of suffering the same fate at least two-fold.
v Race: Caucasian women are at a slightly higher risk of breast cancer than black, asian and Hispanic women
v Previous radiotherapy: If a woman has had radiotherapy directed to the chest in the past, her risk of getting breast cancer is significantly increased. This is particularly so if this treatment was in her teens or twenties rather than later in life. This type of treatment is common in conditions such as Hodgkin’s lymphoma which tend to affect young people.
v Benign breast lumps: Some types (not all) of benign breast lumps are known to be associated with a certain degree of increased risk of breast cancer. Following such a diagnosis, surveillance for the disease has to be stepped up. These include papillomatosis, complex fibroadenoma (but not simple fibroadenoma), atypical ductal hyperplasia and a few others.
v Age: The older you get, the higher the risk of breast cancer. That is just a fact of life. For instance, a woman in her 30s has a 1 in 230 risk of being diagnosed with breast cancer. That risk goes up almost 8 times by the time she is in her 6os at 1 in 29.
Factors in her control
Below are those factors that are in a woman's personal control. Act upon these and you directly influence your overall risk of breast cancer. Unlike a lot of challenges in life, these do not require a special talent or level of intellect. They are do-able.
v Obesity: Being persistently overweight or obese is a recognised risk factor for breast cancer. Fat around the waist area is the worst kind in this regard. Efforts to lose and maintain a healthy weight are associated with reduced risk of breast cancer among other important health dividends. A free body mass index (BMI) calculator can be found here:
v Late start of family: Having a first child later in life (above age of 30) is associated with a slightly increased risk of breast cancer. Number of children is also a factor as the more children the woman has, the lower the risk.
v Alcohol consumption: This has a direct relationship with risk of breast cancer. Those who make a habit of regular drinking, especially so if it is heavy, increase their risk of breast cancer. If daily intake is above two units of alcohol, the lifetime risk is increased by at least 50%
v Breast feeding: This has been shown to reduce the lifetime risk of breast cancer. Degree of benefit appears to be directly related to the duration of breast-feeding i.e. the longer, the better.
v Sedentary lifestyle: A life with little or no physical activity/exercise is associated with a higher risk of breast cancer. Evidence shows that even moderate exercise twice or three times a week on a regular basis will have the effect of reducing an individual’s risk of breast cancer by as much as 20%
v The combined pill: The contraceptive pill is known to increase, albeit slightly, the risk of breast cancer. However, evidence also shows that this risk recedes when the woman comes off the pill and is back to the average background risk 10 years after stopping the pill.
v Combined HRT: Presently, hormone replacement therapy is recommended only for the control of menopausal symptoms and, for this, it is strongly recommended that the use is not prolonged. Ideally the use should not exceed 2 years. It is an established fact that those women who start combined HRT at the age of menopause and who use it over a long period have a significantly increased risk of breast cancer. This risk is not associated with the use of estrogen only HRT (usually prescribed to those who have had a hysterectomy)
v Smoking: Many quality studies over the years have shown strong relationship between active smoking and breast cancer. However, there is no conclusive evidence to link breast cancer and passive smoking. Moreover, for women who smoke, the increase in the risk of breast cancer appears to recede and disappear once they quit.
To keep this monster at bay, look for reliable long acting contraceptive alternatives to the pill, don’t leave starting your family late; breast feed your kids, maintain an ideal body weight, alcohol in moderation (or not at all), exercise, don’t smoke and, when the golden age comes, steer clear of combined HRT but, if you must; use it for just a few months. Not a steep mountain and it could be a lifestyle full of fun.