It's October again, my favourite month. This year I have just turned 33 and I am loving every moment of my life. This is also the pink month. That's right, Breast Cancer Awareness Month. Wear the pink ribbon to support breast cancer awareness. The published statistics shows that every 1 in 19 women in Malaysia is at risk of getting breast cancer. However, we believe this number to be higher i.e. perhaps 1 in 11 as there were many late detections compared to earlier ones.
Breast Cancer may be fatal but you will be able to survive if detected early enough! So for this blog entry, I am also going to include steps for breast self examination. This simple 5 step test in the shower or on your bed could well save your life, so I hope all my readers can make this a weekly routine, especially if you are above the age of 35 or have a family history of breast cancer.
What are the risk factors for breast cancer?
Risks you cannot change:
1. Gender - Women are 100x more likely to develop breast cancer than men.
2. Age - The older you get your risk increases more.
3. Genetic risk factors - 5-10% of breast cancer cases are thought to be hereditary.
- BRCA1 and BRCA 2 are the most common cause of hereditary breast CA. Lifetime risk for families with BRCA1 is on average 55-65% with as high as 80% and more common in Caucasians. For BRCA 2 mutations, the risk is lower around 45% and more commonly found in Asians and Hispanics. Usually the disease with these mutations occur in much younger women and more often affects both breasts. Women with these mutations also have a higher risk of developing ovarian cancer.
- Changes in other genes - These gene mutations are much rarer and often do not increase the risk for breast cancer as much as the BRCA genes.
- ATM gene which helps repair damage DNA. Inheriting 2 abnormal copies of this gene causes ataxia-telangiectasia. Inheriting 1 mutated copy of the gene is linked to a high rate of breast cancer in families.
- TP53 gene gives instructions for making a protein called p53 that helps stop the growth of abnormal cells. Inherited mutations of this gene cause Li-Fraumeni syndrome which has an increased risk of developing breast cancer, leukemia, brain tumours and sarcomas.
- CHEK2 gene : Can also cause Li-Fraumeni syndrome and even if it does not, increases breast cancer risk 2-fold if mutated.
- PTEN gene normally helps regulate cell growth. Inherited mutation of this gene can cause Cowden syndrome, which people are at increased risk of both benign and malignant breast tumours.
- CDH1 inherited mutations causes hereditary diffuse gastric cancer and women with mutations in this gene also has an increased risk of invasive lobular cancer.
- STK11. Defects in this gene can cause Peutz-Jeghers syndrome which has an increased risk of many types of cancer including breast cancer.
4. Family history of breast cancer - Risk is higher among women with close blood realtives who have the disease.
5. Personal history of breast cancer - If you have had one before, the chance for a new breast cancer is 3-4x more.
6. Race and ethnicity. African American have a higher risk - Asians, Hispanic and Native-American have a lower risk.
7. Dense breast tissue.
8. Certain benign breast conditions.
- Non-proliferative lesions - no increase risk. Includes fibrosis, simple cysts, mild hyperplasia, adenosis, ductal ectasia, Phyllodes tumour, a single papilloma, squamous and apocrine metaplasia, epithelial-related calcifications, other benign tumours & Mastitis.
- Proliferative lesion without atypia (no overgrowth of cells). Increase risk slightly by 1.5-2X normal. Includes usual ductal hyperplasia, fibroadenoma, sclerosing adenosis, papillomatosis and radial scar.
- Proliferative lesions with atypia (with overgrowth of cells). Increase risk 3.5-5X higher than normal. These type of lesions include atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH).
9. Lobular carcinoma in situ (LCIS) - the cells that look like cancer cells are growing in the lobules of the milk producing glands of the breast but they do not grow through the wall of the lobules. Women with this condition have 7-11X increased risk of developing invasive cancer in either breast.
10. Menstrual period - early menarche (before 12 years old) or late menopause is also a risk factor.
11. Previous chest irradiation for other cancer treatments - i.e. higher risk when exposure given earlier in life compared to later.
Lifestyle-related factors and breast cancer risk
1. Women with no children or late childbirth has higher risk for breast cancer.
2. Oral contraceptive pills - but reduces once stopped.
3. Depo-Provera contraception injections increases breast cancer risk.
4. Hormone therapy after menopause increases risk for breast cancer. Combined hormone therapy increases risk to getting and dying of breast cancer. Bioidentical hormones although safer in handling menopausal symptoms have not shown any evidence that they are safer and more effective in breast cancer.
5. Estrogen therapy does not increase risk for breast cancer, but increases risk for ovarian cancer and formation of blood clots and strokes.
6. Breast feeding slightly reduces risk for breast cancer especially if continued to 1.5-2 years.
7. Alcohol consumption is linked with an increased risk for developing breast cancer. The more you drink in a day, the higher the risk.
8. Being overweight or obese after menopause increases breast cancer risk. The risk appears for those who gained weight as an adult, rather than overweight since childhood. Excess fat in the waist area contributes more to the risk.
9. Higher levels of insulin in the body increases breast cancer risk.
10. Physical activity i.e. exercise reduces breast cancer risk. Walking 1.25-2.5 hours a week reduces risk by 18%.
11. There is no strong evidence that taking supplements reduces risk for breast cancer.
12. Chemical compounds in the environment is thought to increase risk for cancer but studies are still inconclusive.
13. Long term heavy smoking is linked to higher risk of breast cancer.
14. Several studies suggest that women who work at night (night shifts) may have an increased risk of developing breast cancer.
Breast cancer is a major issue due to the many deaths and disability caused by it. In Malaysia it is the number one cancer for women and the mortality is high if not detected earlier. The best way to get early detection is via breast self examination. Its a simple 5 step home examination that allows you to detect any abnormalities in your breasts. If you detect anything weird about your breasts as per mentioned in the diagrams, do not hesitate to see a doctor. Funnily, a lot of people I meet are so scared to see a doctor and get a diagnosis. I think we should encourage people to seek proper treatment as early as possible. It is frustrating to get patients at stage 3-4 whom have noticed changes earlier but ended up going to a bomoh or sinseh because they were to scared to see a doctor. And when they deteriorate and die in the hospital, it is the doctors fault. Doctors are healers based on science and evidence, we can only do so much or know as much as what the patients is willing to tell you and based on the clinical findings and examination.
So what are the 5 steps:
Your breast self-exam should be done the same time every month, 7-10 days after
the start of your period if menstruating. If not, use a fixed day each month.
Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
Here's what you should look for:
- Breasts that are their usual size, shape, and color
- Breasts that are evenly shaped without visible distortion or swelling
If you see any of the following changes, bring them to your doctor's attention:
- Dimpling, puckering, or bulging of the skin
- A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
- Redness, soreness, rash, or swelling
Step 2: Now, raise your arms and look for the same changes.
Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.
Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.
Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.
5 simple steps to be done every week. Early detection saves lives. I hope all my readers would make this a habit. For my next entry, I will explain about medical aesthetic methods to maintain and beautify your breasts :).
