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You might be at risk, lady

Oct 29, 2016
The incidence is increasing in young Indian women; early detection is key to fight the disease
 
Shalu Verma – The Tribune – Oct 29, 2016, 2:06 AM (IST) – Until a decade back, breast cancer was largely considered to be a disease of the developed world. Not anymore. Not only is incidence of breast cancer rising in India, doctors are also reporting the manifestation of more aggressive cancers in relatively younger women today.
 
Breast cancer is, today, the leading cause of cancer related deaths in women. According to estimates of the World Health Organization, roughly 1,44,937 women in India were detected with breast cancer in 2012 and 70,218 died of it, making it one death for every two new diagnoses. With the incidence of the disease rising by more than 20 per cent since 2008, India is expected to have a whopping 2,00,000 new cases of breast cancer per year by 2030.
 
The rise in incidence can partly be attributed to an increase in recorded numbers due to more women being diagnosed. At the same time, a number of lifestyle factors such as increasing urbanisation, adoption of western lifestyles, rise in obesity, sedentary ways of living and changing reproductive behavior, like delayed childbirths, are also believed to be propelling the incidence.
 
It is important to note here that breast cancer can also strike men. More on it later.
 
Does early detection matter?
Do you know that in North America, Sweden and Japan, survival rates of breast cancer patients are as high as 80 per cent? In western countries, regular screening programs have succeeded in early identification and treatment of a large number of women. However, absence of a community-based screening program in India puts the onus on individuals. No wonder, survival rates here are among the lowest in the world.
 
More than 60 per cent of breast cancers in India are diagnosed in stage III or stage IV. By this time, it is too late to cure the patient or significantly prolong her life. Early detection not only presents a good chance of cure and long term survival, but also allows for breast conservation.
 
Breast cancer can be detected early only if a combination of self and clinical breast examination coupled with mammography is conducted regularly by women. It is extremely important for women to keep a close track of any changes occurring in their bodies. Any lump in the breast or underarm area, any unusual discharge from the nipple, any change in the shape or size of the breast should be taken note of and immediately reported to a doctor for further examination. 
 
Modifiable risk factors
You would be surprised to know that obesity can be directly linked to increased risk of 13 types of cancers. Breast cancer is one of them. Apart from excessive weight, there are other modifiable and preventable risk factors such as physical inactivity, smoking, unhealthy eating habits and reproductive behaviours like late pregnancy and reduced duration of breast feeding. In fact, a study cited by WHO concluded that, 21 per cent of all breast cancer deaths worldwide were attributable to alcohol use, overweight and obesity, and physical inactivity.
 
While you cannot eliminate the risk of breast cancer, reducing it is certainly in your hands. Having the right Body Mass Index, indulging in 30 minutes of exercise daily, avoiding smoking and alcohol and trying not to delay childbirth are active ways of curtailing your risk.  
  
Can genetic testing help?
While you can modify some risk factors of breast cancer, the most significant risk factor lies in your genes. In normal cells, the BRCA1 and BRCA2 genes help prevent cancer by making proteins that keep the cells from growing abnormally. However, in case there is a genetic mutation in these genes, the risk of breast and ovarian cancers is high. To better illustrate this point: In people with normal genes, the risk of breast cancer is 12 per cent. The same risk is as high as 50-80 per cent in a person with BRCA1 gene mutation and 40-70 per cent in a person with BRCA2 gene mutation. The BRCA 1/2 mutations run in families. There is a 50 per cent chance that a child born to a parent who carries a mutation in one of these genes shall inherit the mutation. 
 
While the genetic test to determine gene mutation cannot predict ‘if’ or ‘when’ a woman will develop breast cancer, it can certainly determine if she is at risk because of faulty gene(s). If the test puts you in the latter category, you can be better prepared and adopt screening strategies to ensure early diagnosis and good prognosis. You can also make radical informed choices. Angelina Jolie, for example, underwent preventive mastectomy (surgical removal of breast) after discovering in a genetic test that she had mutated BRCA1/BRCA2 genes.
 
Breast cancer might be a deadly disease but it is not undefeatable. By adopting a healthy lifestyle and staying alert to your body’s needs, you can fight off the disease. 
 
Not just a woman’s disease 
Breast cancer should not be mistaken as just a woman’s disease. Men too can develop breast cancer, though it is rarer in men. Breast cancer manifests in men in the same way as it does in women, in the form of a lump or a discharge from the nipple. Lack of awareness about their susceptibility makes many affected men ignore the signs of the disease. It is as much important for men as women to stay alert to abrupt changes in bodies and report to a doctor immediately.
 
The risk factors for men include a strong family history and high levels of estrogen hormone, which stimulates breast cell growth. Men can have high estrogen levels if they have consumed hormonal medicines or have a high alcohol intake, which impedes liver’s ability to regulate estrogen levels in the blood. Having excessive weight can also increase estrogen production in the body. 
 
We recommend
• Perform regular self-examination every month after 25 years of age
• Undergo annual clinical breast examination after the age of 35 
• Undergo annual mammography screening after the age of 40
• Those with a family history of breast cancer must get their genetic testing done for BRCA1/BRCA2 gene mutations
 
The writer is a molecular scientist with CORE Diagnostics, New Delhi
 
Copyright: The Tribune Trust, 2015