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Prevention of Cancer – 8 – Breast Cancer 1

                                                    Prevention of Cancer PART – 8
(All the articles published in past are available at
Question: In last part, we discussed how Night Shift (including being awake for at least 3 hours between 12 midnight to 5 am) is a significant risk factor for cancer, diabetes, heart disease, stroke, metabolic disorders, infertility, menstrual disturbances, depression and others. Also, if night shift started before age 30, risk is even higher. Disruption of circadian rhythm is one of the possible reasons for this. This disruption leads to changes in many hormones, one important being melatonin. Melatonin has a role in cancer prevention.
Above points emphasize two major themes we have discussed earlier too: 1. Lifestyle changes are important reasons for cancer and other common diseases. And that cancer prevention is linked to prevention of other major diseases too. It is a holistic health approach. 2. Prevention starts at a young age. Earlier the better. Even though cancers are most common after middle age, prevention efforts need to start from childhood and young age.
We also discussed that current lifestyle of many youngsters is like that of a daily night shift i.e. awake at least 3 hours between 12 midnight to 5 am. This is a very serious issue. And is one of the modifiable risk factor for cancer and other major diseases. And it should perhaps be considered as important as smoking and a major campaign is required to change this way of living. Otherwise we are also looking at a serious rise in non communicable diseases like we are witnessing in USA, Europe and other countries. At least start with yourself, family, friends, neighbours, your own circles. As a doctor, your word including science behind this fact, and the supporting recommendations from reputed world bodies will surely have an impact. Doctors should be the brand ambassadors for healthy living.
Ans: Very important point. Doctors as Brand Amabassadors for Healthy Lifestyle. As parents, it is said that children learn best by following what you do, rather than what you say. Same applies to healthy lifestyle. Doctors who lead healthy lifestyle, have a much better impact when they tell their patients and community members at large, to follow healthy living.
Que: You did mention last time that many intriguing points have come from large epidemiological studies. One of them we discussed i.e. Night Shift. Any other important points that our readers should know?
Ans: Yes of course. We were talking about risk factors for Breast cancer last time. After hormone changes, we discussed night shift. A large study involving almost 40 lac women, showed that apart from breast cancer, night shift also increases risk for digestive system cancers, and lung cancer, published in 2018.
A positive study however published in British Medical Journal (BMJ) in 2019 showed that being a morning person reduces risk of breast cancer. The same study also showed that sleeping over 7-8 hours at night increased breast cancer. Means “early to sleep and early to rise”, is an important measure for good health, including for breast cancer, and few other cancers too. Apart from being healthy for heart, brain, mind etc as discussed last time.
We did discuss briefly earlier that no type or amount of alcohol is safe. But studies show that women are far more susceptible to bad effects of alcohol compared to men. A Bottle of Wine Has the Cancer-Causing Potential of 5 (for men) to 10 (for women) Cigarettes, as per a study published in 2019. Means almost double the risk of cancer for women, compared to men. The gender gap widened with more alcohol consumed, largely because of an increase in breast cancer risk. For instance, three bottles of wine equated to eight cigarettes a week for men and 23 for women. In age of equality, social drinking by women is also increasing. And many people consider wine as safe or even healthy. The research shows otherwise. Also, recommendations from world’s largest scientific bodies also say that no type or amount of alcohol is safe. Abstinence is best.
Alcohol related cancers include cancer of the colon and rectum, female breast, liver, oral cavity, pharynx, larynx and esophagus.
Smoking and alcohol is the worst combination, and increases risk of several cancers manifold. For example, men with both habits have a 40 times higher risk (4000 percent higher risk) of head and neck cancer. And we do know that having both habits is not uncommon.
Que: I am a bit confused. So you are saying that alcohol increases risk of several cancers including Breast Cancer. But does smoking also increase risk of breast cancer?
Ans: Yes. A study in USA, following 83,000 women for 15 years, mostly those who did not drink, showed a 35% higher risk of breast cancer related to smoking. Risk was significantly higher for those who initiated smoking many years before first childbirth. Once again emphasizing importance of early age risk factors.
Que: So breast cancer risk is increased by several modifiable risk factors as well. It is not just genetic factors.
Ans: Yes of course. Our genes are same for thousands of years, right??? But cancer cases are rising in last few decades only!!! Multiple studies have clearly shown that at the most 5-10% of cancer cases only are directly related to a genetic mutation. So called hereditary cancers. Same is true for breast cancer cases too. We will talk a little more about this concept next time. And then discuss additional risk factors for breast cancer.
August 14, 2022

Dr Chirag A. Shah; M.D. Oncology/Hematology (USA), 9998084001. Diplomate American Board of Oncology and Hematology. Ahmedabad.

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