Breast Cancer - Can We Dodge The Bullet?

05/10/2016 13:16

Currently one in eight UK women will experience breast cancer during their lives. It is now the commonest cancer in the UK - remarkable, considering it's mainly a women's illness (1% occurs in men) and the incidence is still rising, albeit more slowly than before. 2016-10-02-1475433850-6775928-Slide1.jpg

I'm a doctor, and I've had breast cancer. I learned a lot, about how I'd do things differently, and I want to share. So how can you reduce your breast cancer risk, or at least spot it early, if you do get it? Let's look at some facts.

What Predisposes Someone To Breast Cancer?

Data from many studies indicate aspects of our lives which are definitely (strong evidence), or probably (less evidence currently) associated with breast cancer.
The Cancer Research UK website provides a complete list.

Genetic suscepibility

Some factors are beyond our control--for example our genetic make-up. People who possess BRCA 1 and BRCA 2 genes have a high risk of breast cancer (both sexes), plus ovarian cancer (women), and prostate cancer (men). Both sexes also have an increased risk of pancreatic cancer.

You can be tested for BRCA gene, particularly if there is a reason why you may have it (for example, if you have Ashkenazi Jewish heritage, or if several family members had breast cancer at a young age).

If positive, you can take steps to protect yourself, including having your breast tissue removed and your breasts reconstructed. When your family is complete, you could consider having your ovaries removed. Not a pleasant prospect, but, for some, preferable to a high danger of developing cancer.

For most of us though, genetics isn't the main culprit, and there are life-style changes which can protect us (see Table 1). 2016-10-03-1475532122-855442-table1huff.png

Life-style and Breast Cancer

  • Female hormones stimulate some breast cancers, including the combined contraceptive pill and combined HRT. Stopping these gradually reduces your risk.
  • Alcohol promotes breast cancer, susceptibility increasing with quantity, but even one unit daily has an impact.
  • Radiation, including X-rays increases risk slightly, but this needs to be weighed against the benefits.
  • Excess body fat increases propensity in post-menopausal women, particularly stomach fat, and especially if weight is gained as an adult.

Factors which probably increase risk (but the evidence is currently incomplete) include smoking, physical inactivity, night shift work, a high fat intake, various medications (you should be warned if taking any), some occupations (again, you should be told), having fewer children and having your first baby later in life.

Conversely, breast feeding your babies decreases your risk of breast cancer.

This is the official list based on the available evidence. I would suggest a few more things to consider:
Aim to eat several fresh vegetables every day.
Avoid high-sugar and processed foods.
Aim to decrease mental stress. Some interesting studies suggest that loss of control and feelings of 'helplessness' can predispose someone to cancer.
Try meditating regularly--it's easy and natural, and it can't hurt.

Getting Diagnosed Early

Sometimes, despite all our best efforts we can develop breast cancer. Early treatment can make a huge difference to your outcome. So here are some important tips (see Table 2): 2016-10-03-1475532289-835591-table2huff.png

  • Any breast lump must be checked out--don't procrastinate. Sometimes the lump may be under your arm.
  • You may not feel a lump (I didn't) so don't ignore other signs.
  • Check any nipple changes: if the nipple turns in on itself (inverted)*; nipple rash, discharge, or bleeding, or a change in shape
  • If a breast is painful or swollen for no reason, and not explained by your menstrual cycle
  • Changes in breast skin, eg thickening, dimpling, prominent swollen pores, redness, other colour changes or bruising.
    • Sometimes the breast skin resembles orange peel (peau d'orange). This is likely to be cancer and should always be checked
*if your nipples have always been inverted this is not a concern - only a change

However, your breasts can't read textbooks and sometimes they just do their own thing. You know your breasts better than anyone, and if you think something isn't right, it probably isn't. It may not be cancer, but it deserves investigation, and if your doctor is reluctant, do insist.

By checking your breasts regularly, you can be more certain when something changes.

Having said all this, most of the time you won't have breast cancer. Nevertheless catching it early can make such a difference to your outlook, so why not have a low threshold for suspicion?

Note: This article express personal views. No warranty is made as to the accuracy or completeness of information given and you should always consult a doctor if you need medical advice

Article first appeared in Fabafterfifty Magazine

Dr Thompson has written 'From Both Ends of the Stethoscope: Getting through breast cancer - by a doctor who knows' an award-winning book to guide people through breast cancer 2016-10-02-1475432797-6219914-bookcoversmall.jpg