I introduce myself politely as a third year medical student.  She doesn’t respond.  She looks preoccupied and lost in world of her own. As I begin to look at her chart and ask her to divulge her story, I realize that sitting before me is a lady who has been newly diagnosed with breast cancer.  What was most surprising to me is that this lady had no prior history of any risk factors.  Furthermore, she looked like a relatively healthy middle aged woman.

The mere sound of the words ‘BREAST CANCER’ evokes an intense sense of fear in women everywhere, particularly here in the Western hemisphere where the prevalence and incidence of breast cancer is increasing steadily.  The scary thing is that even women who immigrate to the Canada and U.S still have the same risk as their fellow Canadian and American neighbours.  What does this mean? Just because you’re Afghan does not exempt you from having Breast Cancer.  The mere fact that we are women poses a huge risk.  As such, it is imperative to recognize the symptoms, risks and take the necessary preventive measures in order to catch it early because it is treatable.

Some important facts:

• Every year, about 200,000 women are diagnosed with breast cancer, among whom 50,000 die of the disease.
• One in eight women will be diagnosed with breast cancer in their lifetime if they survive past the age of 40.  Breast cancer, like most cancers, is very closely associated with age.
• The mean age of breast cancer is roughly 64 years old.
• Breast cancer is the second most common cause of cancer producing death among women.
• Breast cancer is the most common cancer among women over the age of 50

What are the Risk Factors?

The most important risk factor is a family history of breast cancer.  If a woman whose mother or sister has had breast cancer, her risk increases by 1.8 fold.  The risk further increases to 3.0 fold if her mother or sister(s) were diagnosed with breast cancer in premenopausal age (roughly before age 50 years).  If bilateral breasts were involved, her risk further increases to 5.0 fold.

Some women carry the gene for breast cancer, BRCA1 and BRCA2.  However, these cases are rare and only account for 5-10% of cases of breast cancer.

A lot of women do not know this but increased exposure to ESTROGEN further increases a woman’s risk of breast cancer.  Estrogen is a female hormone whose levels begin to decline after menopause.  A woman would have increased exposure to estrogen if she started her period early (earlier than 14 years of age);  if she started menopause later (after the age of 50 years);  if she did not have any children or if she had children past the age of 30 years;  and most importantly, if she has been obese, especially after menopause.  Fat cells are involved in the production of estrogen.  As such, obesity and weight gain are major and CONTROLLABLE risk factors for breast cancer development.

So why is the incidence of breast cancer on such a rise in the United States and Canada?  Most of it may have to do with hormone replacement therapy that had been administered to women who had undergone surgical removal of their ovaries/uterus and also as a preventive measure against osteoporosis.  Estrogen is protective against heart disease and osteoporosis but it is strongly tied to breast cancer.  Many breast cancers have estrogen receptors.  As such, the higher the amount of estrogen, the more rapidly these cancers grow and the less will they respond to treatment.

Furthermore, oral contraceptive pills are also implicated in the development of breast cancer.  The most important thing to remember when taking oral contraceptives is that if you choose to do so, take the pills consistently without having to change dosages too often or without having to come on and off of them.  Fluctuating levels of hormones in the body is not healthy and it throws everything out of balance.

Most importantly, rates of obesity are on a high in the Western hemisphere.  As previously mentioned obesity is a risk factor for breast cancer, among other diseases.  And it cannot be mentioned enough that obesity is a CONTROLLABLE risk factor.

Another controllable and important risk factor is smoking.  Among other cancers, smoking increases the risk of breast cancer.  So if you haven’t thought about quitting, now is the time.  Speak to your family physician about treatment options because it is not an easy task to accomplish on your own. 

Screening for Breast Cancer

Every woman should make a date to see her physician and schedule a mammogram for her 40^th birthday.  Screening for breast cancer is with the use of a mammogram.  It is a simple procedure - and luckily for Canadians - it is a FREE procedure that is conducted on women at the age of 40 and above to screen for the presence of micro calcifications, indicative of breast cancer.  However, if a woman has a family history of breast cancer, she should get a mammogram earlier, at age 35 years and every year after that.

Yet, it cannot be stressed enough the importance of conducting breast self examinations.  Usually, this should be done every month one or two weeks after the last menstrual period.  And what you would be looking for is a tough, hard lump – like a ‘frozen pea’. For more information on how to conduct a proper breast exam, visit the following website:  http://www.cancer.org/docroot/CRI/content/CRI_2_6x_How_to_perform_a_breast_self_exam_5.asp

Also, it is important to note if there are any of the following: changes in the skin of the breast, in the symmetry of the breast or nipple (i.e. if a nipple is upturned or seems larger than the other), if there is any tenderness, inflammation, or any discharge (particularly bloody discharge).  If you note any of these changes, it is important to follow up with a visit to your family physician.  No one knows your body better than you do and you need to be protective of it.  If the physician does not take heed of these signs and brushes you off, please take control of your health and insist a mammogram/MRI/Ultrasound to address any concerns.

Luckily for my patient whom I had mentioned in the beginning, her cancer has been discovered early.  How did they discover it?  Her cancer was discovered on routine mammogram.  She did not notice any lumps in her breast even though she would do a breast exam every few months.  Not all breast cancers manifest as lumps.  This further outlines the importance of a routine mammogram.  So what is my patient’s prognosis?  Sadly, she will lose her breast through a procedure called a mastectomy.  But lucky for her, she will survive and battle this disease.  When I asked her how she feels, she responded, ‘I don’t care about losing my breast.  I want to keep on living…I want to see my grandchildren grow up…I will fight this’.

The important message in all this is that this is a disease that may be conquered. Prevention and early detection are the keys to battling this deadly disease that may strike at any time.  So please take heed of the necessary measures and get yourself checked regularly.