Dear Doctor,

I am 24 years old and have never checked myself for breast cancer. My mother always reminds me to even though we do not have any history of the disease in our family. Is it easier to go for a screening test instead? I have felt my own breasts but I can’t tell if there is anything wrong with them. How many times should I go for this checkup?

Alice

Dear Alice,

You are quite young to worry about breast cancer. However, it is wise to be vigilant. Breast cancer is said to occur more in women who get married late, who have no or few children or children at a later age.  Those who do not breast feed their children are more at risk. The risk is increased with advancing age.  Having more children, in a way, protects against breast cancer.  Early menarche and longer duration of menstrual cycles is yet another risk factor for breast cancer. Perhaps this is because with prolonged period of having menstrual cycles, one has greater exposure to the hormones estrogen and progesterone. 

Prolonged use of hormonal contraceptives and or hormone replacement therapy after menopause also increases the risk of having breast cancer later in life.  Using tight brassieres is also said to be a risk factor for breast cancer.  Obesity increases the risk and interestingly, due to a lot of fat in the breast, the image seen in mammography does not remain very clear.

Alcohol is an independent risk factor for breast cancer. Women who drink are at a greater risk for developing breast cancer as compared to those who do not drink.

A woman having a benign tumor in the breast like papilloma, carries a greater risk of having cancer later in life. Apart from these factors, strong hereditary and genetic factors are also implicated. A woman with a blood relative having cancer is more at risk of having breast cancer than somebody for whom family history is negative for it. Ethnic and racial factors are also implicated. Breast cancer is more common in white women as per statistics, but more black women are said to die due to it.  This could be due to lack of awareness, delay in diagnosis and treatment.

Self examination of the breast is vital for early detection of cancer. For this, one must stand in front of a mirror with hands put on side and elbows flexed. Any visible lump should be viewed with suspicion.  Gradually all four sides of the breast should be palpated with flat of the hand. Any lump or swelling felt needs to be investigated to exclude breast cancer. A painless lump in the breast, howsoever small, is highly suggestive of cancer.

Diagnosis is made by mammography and confirmed by biopsy of the swelling. Any discharge from the nipple when one is not lactating is suggestive of ductal carcinoma and the lady ought to be screened for breast cancer.  Prevention lies in a normal, healthy life style and being vigilant about it.

Dr Rachna is a specialist in internal medicine  at Ruhengeri Hospital

rachna212002@yahoo.co.uk