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Introduction
18.1 million People were diagnosed of cancer worldwide in 2018. Cancer of the lungs being the first followed by breast cancer which have claimed the life of more than half a million women. The grim reality is that this figures have been projected in the developing world to increase each year due to factors such as urbanization, adoption of western lifestyle and increased life expectancy (before now, women die of other ailments and do not live to be diagnosed of cancer).
The Nigerian scenario is rather alarming. Osagie Ehanire, the minister of health speaking to news men said, cancer is an emerging disease threat in Nigeria, requiring a well-thought-out strategy to fight against the growing trend. In 1960, 1999 and 2016, the case per 100000 women has been 13.7%, 24.7% and 26.7% respectively.
Breast cancer remained the commonest cancer in Nigeria for a long time now and the incidence is still on the increase - Osagie Ehanire
Breast cancer is a group of diseases in which cells in breast tissue change and divide uncontrolled, typically resulting in a lump or mass. Most breast cancers begin in the lobules (milk glands) or in the ducts that connect the lobules to the nipple. It is most at times asymptomatic. Painless lump, changes in size, shape of the breast and lymph node enlargement are some of the subtle symptoms.
Risk factors
The definitive cause is not known. But there is great evidence suggesting some risk factors to be implicated in the pathogenesis and development of breast cancer. These can be classified as being either modifiable or non-modifiable risk factors. Non modifiable risk factors include being a female , getting older, inheriting defective genes, Race, ethnicity, being taller and dense breast tissue. Modifiable risk factors include: obesity, sedentary life style, tobacco and alcohol intake, certain drugs and radiation exposure.
10 Powerful and simple preventive measures against breast cancer.
In this article we will unravel some secrets and share some simple and effective preventive measures to better your understanding of some factors that increase someone's chances to develop breast cancer. The best approach to breast cancer management is the prevention of it’s occurrence since treatment of breast cancer could be difficult especially when it's not detected on time and it also requires financial buoyancy.
1. Reduce or completely avoid alcohol and smoking.
A cup of alcohol per day increases the risk of breast cancer by 7-10%, while 2-3 drinks per day increases risk by 20%. Alcohol avoidance does not only reduce the risk of breast cancer but many other cancers. Cardiovascular diseases also have as their risk factor, alcohol consumption. Incidence of cancer death is higher in smokers (27%) than non-smokers. There are tobacco cessation programs and specialists that may help rehabilitate an addict.
2. Adhere to regular physical activity and a healthy body weight throughout life.
Obesity is a common risk factor for breast, liver, gallbladder, kidney and colon cancer. There are 1.9 billion obese or overweight individuals as at 2017. Thus, making obesity an epidemic. Obese Individuals are advised to visit their doctor or dietician for appropriate diet guidance and weight reduction regiments. A study showed 12 % risk reduction in people who exercise regularly.
3. Minimize exposure to radiation.
Studies have shown a linear dose response relationship between radiation exposure and carcinogenesis (creation of cancer cells). In other words, the higher the dose of radiation, the most likely it is for one to develop one form of cancer or another. There is need therefore for the general population and especially women at risk to reduce time spent under the sun. Diagnostic and therapeutic radiation should be administered only when there is absolute necessity especially in the teenage age and early adulthood.
4. Avoid prolonged and unsupervised use of Hormonal contraceptives.
Studies have shown that post menopausal hormone replacement therapy (estrogen and progesterone formulations) increases risk of breast cancer. This risk does not apply to women who have undergone hysterectomy. The use of combined oral contraceptives increases risk only during active use. The general rule requires women in both reproductive and menopausal age to seek medical advice before using any hormonal agent.
5. Preventive chemotherapy (chemoprevention).
This area has gained a lot of attention over the years. It is used for women at high risk. With the help of a health care professional, an individual’s risk is assessed. Certain drugs such as tamoxifen are used to protect the breast from estrogen-mediated cell proliferation. Newer agents are being employed in this regard.
6. Surgical prevention.
For women at high risk, partial or complete mammectomy (mastectomy) is carried out. This procedure is mostly used for women with family or personal history of breast cancer.
7. Genetic counseling.
Women who test positive for one of the defective genes such as BRCA 1&2 (there are many other genes implicated in breast cancer) are strongly advised to go for genetic counseling. An expert may suggest preventive surgery when appropriate. This is crucial because inheriting these genes results in 7 out 10 women developing breast cancer. With this faulty gene, there is a risk of having cancer at an early age and in both breasts.
8. human epidermal growth factor 2 (HER2) vaccines.
Other measures such as human epidermal growth factor 2 (HER2) vaccines for the prevention of recurrence in women with a history of HER2 positive breast cancer are promising paradigms.
9. Early first pregnancy and breast feeding have a preventive role against breast cancer.
Studies have shown that early first pregnancy reduces the risk of estrogen receptor(ER) positive breast cancer. Late first pregnancy (≥30years) have been shown to increase the risk of ER positive breast cancer by 27%. However, socioeconomic factors tend to play a huge role in marriage and child birth. The beneficial effects of breast feeding on maternal and child health is tremendous . Breastfeeding not only reduces breast cancer risk but also confers other health benefits to the mother including reduced risk for endometrial and ovarian cancers.
Epidemiologic studies indicate that the risk for breast cancer in parous women is reduced by 4.3% for every 12 months a woman breastfeeds and is reduced by 7% for each birth independently.
10. Routine breast self examination
Women are advised to routinely carry out a breast self examination on themselves to rule out the presence of any lump in the breast. It makes early diagnosis possible; hence treatment with better prognosis is achieved.
When should I get screened??
The US department of health suggests thus:
Women at moderate risk of breast cancer should discuss with doctors the pros and cons of breast cancer screening before making an informed decision about mammography screening every 2 to 3 years.
Women at high risk (e.g. carriers of confirmed BRCA1/2 gene mutations, with family history of breast cancer or ovarian cancer, history of receiving radiation therapy to the chest before age of 30, etc.) should seek doctor’s advice for annual mammography screening and starting age for screening.
All screening tests have their limitations and they are not 100% accurate. There are false-positive and false-negative results.
We strongly advise women to use the Gail breast cancer risk assessment tool (BCRAT) and the Tyrer-Cuzick risk assessment tool (it incorporates genetic and clinical breast cancer risk factors) to estimate a woman’s risk of developing breast cancer.
This's a very beautiful and educating post. Thank you Pharm. Makwin Luther!