Breast Cancer (Part 1)

Introduction:

Breast cancer is the most common type of cancer in women (men are rarely affected). Many studies have shown that if found early enough, patient survival can be greatly enhanced and total cure may be achieved. Screening mammography is now recommended for all women over 50 years old. If there is a family history of breast cancer, then most physicians would begin screening even patients who are 40 years old or younger. The risk of developing the disease increases with advancing years with the elderly being at greatest risk.

Risk Factors:

Studies indicate that genetic predisposition, hormonal factors, as well as environmental injuries may all play a role in the causation of breast cancer. While much effort has been placed in identifying those women at increased risk, 70-80% of all cases occur in women without apparent risk factors. The overall lifetime risks of developing and dying from breast cancer in the U.S. are substantial with 12 out of each hundred women contracting cancer, and between 3-4 dying of it.

Regarding genetics, studies have shown that first-degree relatives of breast cancer patients, i.e. parents, siblings and children, have twice to three times the risk of developing breast cancer as compared to the general population. At present it is estimated that up to 5% of all breast cancer patients may have a definite genetic abnormality that was inherited and contributed to the development of their disease. Today special tests may identify such rare breast "cancer genes." It is hoped, however, that ongoing studies will demonstrate more common genetic markers.

Hormonal factors associated with the development of breast cancer include early menstruation age, older age at onset of menopause, older age with first pregnancy as well as absence of pregnancies. The age at the first full term pregnancy is a more accurate predictor of risk than is the number of pregnancies. Long term use of birth control pills or estrogens for more than 10-15 years has been associated with an increased risk of breast cancer. Oral contraceptive use for more than ten years can increase the risk of developing cancer before 45 years of age. Use of oral contraceptives for more than 4 years before a first pregnancy can lead to a marked increase in the risk of developing breast cancer at a relatively early age.

Living in affluent and westernized countries is associated with an increased risk of breast cancer. Asian women have one of the lowest risks of breast cancer. However, female immigrants of Asian descent and their female children have a risk similar to other westernized women. This of course suggests a dietary link, however studies have failed to show a link between dietary fat and breast cancer development. Alcohol intake, even if moderate, has been associated with a 40-60% increase in breast cancer risk.

Women who have been diagnosed with benign breast disease should not be complacent and must realize that they also have an increased risk of developing breast cancer. The most common benign breast disease is fibrocystic breast disease. This is characterized by cysts and fibrous tissue that gives the breast an irregular feel but requires almost invariably a breast tissue examination (biopsy).

A high index of suspicion must be maintained if the diagnosis and a chance at early treatment and perhaps a cure are not to be missed.