BREAST CANCER PART-2
Welcome to the second part of educational series on breast cancer. In first part, we learned that incidence is high in India, with over 200 women being diagnosed every day, but there is optimism with tools for early diagnosis and better treatments.
Question: Now Dr Shah, what leads to breast cancer, what are the risk factors?
Answer: There is a large body of literature on this subject with many very large scale studies. This has been summarized well on the website www.nccn.org for the interested readers. But we don’t know the reason in all cases. Many patients do not fit the profile.
Que: What are the known risk factors?
Ans: We like to divide them as non-modifiable and potentially modifiable.
Non-modifiable risk factors are:
- Family history: breast cancer in a first degree relative is a significant risk factor. More the number of relatives and Younger the age at diagnosis, higher the risk.
- Genetics: many patients with strong family history have an underlying identifiable genetic mutation such as BRCA1 or 2. Test is available for its identification.
- Age: increasing age is associated with increasing risk, especially after age 50, and it continues to increase with advancing age.
- Early Menarche (before 11) and Late Menopause (after 55) – both increase risk, as they likely increase exposure to estrogen. This risk factor is potentially a result of lifestyle changes, but not clearly proven.
Que: What are the potentially modifiable risk factors. I think our readers are more interested in knowing about them.
Ans: Yes, and that is where biggest impact is possible in preventive efforts. Our numbers are still much smaller than in West, thanks to our lifestyle and diet. Unfortunately however, we are changing fast in the wrong direction.
- Obesity – high weight especially significant weight gain at a young age, or after menopause is an important risk factor
- Alcohol consumption – one to two drinks per day significantly increase risk.
- Nulliparity – not having children, or having less number of children.
- Older age at first live birth.
- Current or prior estrogen and progesterone hormone replacement therapy – especially if long term i.e. many years.
- Personal history of benign proliferative disease of breast – having a normal breast biopsy in past without atypical hyperplasia does not seem to increase risk.
Next time we will talk about what can we do to Prevent breast cancer.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA),
Diplomate American Board of Oncology and Hematology.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. 079 26754001 www.shyamhemoncclinic.com