Poll: Majority of parents concerned about bad air quality, impact on ...

Risk Factors For Breast Cancer

Dr Ananya Mandal

The exact causes of breast cancer are not well understood.

There are however several risk factors that raise the possibilities of breast cancer.

Of these risk factors some may be modified or changed like lifestyle factors while others are non-modifiable.

The causes and risk factors of breast cancer are outlined as follows:

Non-modifiable risk factors

Age

The risk of breast cancer rises with age and most cases are diagnosed in women over 50 years of age and those who have had their menopause.

Eight out of 10 cases of breast cancer occur in women over 50. This means that all women between 50 and 70 years of age should be screened for breast cancer every three years.

Women over the age of 70 are also likely to get breast cancer and may need regular screening.

Gender

Although women are more at risk of getting breast cancer, this cancer can also occur rarely among men. Women are 100 times more likely to get breast cancer than men.

Breast density

The normal breast contains lobules that produce milk and ducts that carry it.

This glandular tissue contains a higher concentration of breast cells than other breast tissue and thus makes the breast dense.

Women with more dense breast tissue may have a higher risk of developing breast cancer because there are more cells that can become cancerous. High breast density also makes diagnosis of a breast lump difficult using a mammogram.

Younger women tend to have denser breasts and with age the glandular tissue in the breast decreases and is replaced by fat reducing its density.

Family history

Women who have a close relative with breast cancer or ovarian cancer have a higher risk of developing breast cancer. Although most of the breast cancers are not hereditary there are genes that determine the likelihood of getting breast cancer.

Women who have two or more close relatives from the same side of the family that includes mother, sister or daughter who have had breast cancer under the age of 50 are eligible for genetic screening to look for these genes and regular surveillance and breast cancer screening.

Those with a previous history of breast cancer

Women who have had breast cancer in one breast earlier are more likely to get breast cancer of the other breast or the same breast again.

Those with previous benign breast tumors

Usually a  non-cancerous lump in the breast do not indicate breast cancer.

Breast cancers, especially those that are sensitive to hormones, are stimulated to grow by the female hormone estrogen. Women, who have begun their periods at a younger age and entered menopause at a late age, are exposed to longer duration of estrogen secretion from the ovaries compared to those who have had a shorter reproductive period in life. In the same way, not having children, or having children later in life, may slightly increase the risk of

Breast Cancer causes

Modifiable risk factors

Being overweight or obese

Those who are overweight or obese are more at risk of developing breast cancer. It is hypothesized that these women may be having higher levels of estrogen in their blood. And women who are overweight or obese after the menopause have higher production of estrogen.

Alcohol intake

Women who take high amounts of alcohol are more likely to get breast cancer.

For every 200 women who regularly have two alcoholic drinks a day, three more is diagnosed with breast cancer compared to same number of women who do not drink at all.

Exposure to radiation

Imaging studies like X rays and CT scans may raise the risk of getting breast cancer slightly. Women who have been exposed to radiation therapy for cancers earlier are at a greater risk of breast cancer. — news.Media net

Polly Newcomb, PhD, MPH

Dr. Polly Newcomb is a cancer epidemiologist who focuses on cancer genetics, etiology, screening and survival. Her work, which has been continuously funded by the National Institutes of Health for over 30 years, has advanced through many long-term collaborations, large, multi-site case-control studies, the establishment of cohorts and biorepositories, and participation with consortia such as the Colorectal Cancer Family Registry Cohort. Her focus on survival includes a study evaluating the molecular correlates of colon cancer outcomes in clinical trials. Dr. Newcomb has identified numerous new modifiable risk factors (and ways to calculate risk) for breast and colorectal cancer as well as environmental exposures that can impact patients' outcomes after cancer diagnosis. She also studies non-modifiable factors such as genes that may put people at a higher risk of cancer. Together this knowledge of modifiable and non-modifiable risk factors helps inform cancer-prevention studies at the population level as well as in the laboratory and clinic. Dr. Newcomb's eminent career has made a lasting impact on what we know about cancer risk and survival.

Education

Postdoctoral Fellow, Cancer Biology, University of Wisconsin-Madison, 1986

PhD, Epidemiology, University of Washington

MPH, Epidemiology, University of Washington

Pink Battle

A COMPARATIVE analysis of breast cancer data from over a decade ago to now shows interesting figures: the average age of diagnosis has shifted in women from the sixth to the fourth and third decades of their lives. Today, even young girls are falling prey to the disease, making the situation increasingly complex for countries like Pakistan where breast cancer occurs more often in comparison to other Asian countries.

The total number of breast cancer cases diagnosed in 2020 in Pakistan was 25,928, according to GLOBOCAN 2020. This accounts for 14.5 per cent of new cases detected in the country throughout the year. The infamous 'one in every nine women' ratio of Pakistani women becoming afflicted with breast cancer is at once frightening and alarming. Pakistan, sadly, also has the highest mortality rate among Asian countries.

Meanwhile, a study conducted by Zunaira Shoukat and other researchers indicated that a staggering 63.2pc of its participants lacked knowledge about breast cancer and 64.7pc were ignorant about mammography screening. For a country with such a high incidence count, these figures are shocking and point to the need for greater awareness and information about the disease. It was also noted that the lack of knowledge is not due to poor education alone as many educated patients of a higher socioeconomic status displayed negligible understanding about the malady, and more so about the means and importance of reporting it in time.

The reasons for Pakistan's soaring cases and ways to reduce occurrences have been under discussion for a while.

Each year over 83,000 cases of breast cancer are reported in Pakistan.

Non-modifiable risk factors for breast cancer include aging, genetic mutations, family history, etc. Modifiable risk factors are sedentary lifestyles, hormone therapies and certain habits such as smoking. What is more important is that many women, especially in Pakistan, become breast cancer patients without any risk factors, whereas, a risk factor does not necessarily translate into becoming a victim of the ailment. So the next best option is screening, early detection and minimising risks. Treatment is possible when it is diagnosed at an early stage because timely treatment is neither complex nor expensive. Early detection is one of the most pressing concerns worldwide and is achievable with public education and awareness.

Estimates show that each year over 83,000 cases are reported in Pakistan and most cases of breast cancer in Pakistani women are diagnosed at an advanced stage. Apart from a low literacy rate among women, ignorance about symptoms and inhibitions around breast cancer form major reasons for late diagnoses.

One would like to believe that due to initiatives by the government and NGOs, an adult woman unaware of the affliction and its impact is a rare sighting. But, rural areas and a thorough research of facts and figures reveal sad truths.

The American Cancer Society says that women between 40 and 44 years should be given the choice to go for annual breast cancer screening with mammograms while those from 45 to 54 years should be advised to get mammograms done every year. Unfortunately, mammography is only available to a particular segment of society that can afford the facility.

Screening facilities in government hospitals are severely overstretched and rural areas are deprived of primary healthcare, so expecting a specialised screening service is wishful thinking. The PC-1 of a project to establish screening units in seven hospitals across KP in collaboration with the Institute of Radiotherapy and Nuclear Medicine was approved last year to ensure the 'availability of world class screening facilities free of cost' to the masses. The project faced red tape issues and has been delayed; once functional, it will go a long way towards ens­uring the well-being of the people of KP. Another noteworthy project is the recently inaugurated KHAS hospital in Shikarpur in interior Sindh.

A relatively newer standard of care in the management of breast cancer is genetic testing. The BRCA-1 and BRCA-2 gene mutations are the strongest risk factors for breast and ovarian cancers to date. Unfortunately, despite its benefits, the tests have many barriers, especially in lower-middle-income countries — limited access to genetic counselling, affordability issues and complicated testing criteria.

While the efforts of the government and NGOs to spread awareness through communication media are commendable, future health policy frameworks require tangible features, such as more screening centres in remote areas and subsidised BRCA mutation testing for a subset of eligible patients, because we cannot forget that the annual burden of the disease is 12.5pc of new cancer cases.

The writer is an academic medical researcher and doctor working for a tertiary care hospital in Karachi.

navaira_ali@hotmail.Com

Published in Dawn, October 19th, 2023

---