Dear Doctor,

I am 22 years old and I have a history of breast cancer in my family. I lost two of my aunts to it. My question is, how often should I go for breast cancer check-ups and what should I look out for on my own?

Pauline

Dear Pauline,

Having breast cancer in the family is a strong risk factor for developing breast cancer. Early onset of menstruation, late menopause, hormonal contraception, not having children or not breast feeding children, are other risk factors for breast cancer.  Taking hormone replacement therapy during menopause and exposure to radiation also increase the risk of having breast cancer. Lack of exercise, high fat diet, high cholesterol levels and obesity also predisposes one to breast cancer. Alcohol and tobacco use are other risk factors. Early onset of alcohol use or smoking, greater the quantity used, greater is the risk of breast cancer in a woman. Previous trauma to the breast tissue and use of very tight brassieres also increase the risk of developing breast cancer later in life.

Self-examination of breasts helps in early diagnosis of breast cancer.  A woman needs to stand in front of a mirror with hands extended on hips. Any visible lump or swelling should be taken note of. Self-examination by palpating all four quadrants of breasts after lying down helps to detect any tumour in the early stages. Any discharge from the nipple, puckering or retraction of nipple, should raise the doubt of breast cancer. Mammography helps to detect the lump or tumour in early stages. Diagnosis is confirmed by biopsy of the lump. This differentiates breast cancer from other benign tumours. Treatment is by surgery, chemotherapy and or radiotherapy. Treatment depends on site of tumour, whether local or advanced and whether it has positive hormone receptor sites or not.

Previously, mammography was considered to be a very good tool for early detection of breast cancer. But now the ‘risk versus benefits’ are being considered. In mammography, one is exposed to risks of radiation. False positive shadows may lead to unnecessary treatment of breast cancer. Moreover, very small tumours or tumours in the duct can be missed by mammography. It is recommended to do mammography at least once in two years.

Primary prevention of breast cancer lies in a healthy life style. Regular physical exercise, healthy balanced diet, avoiding use of very fatty food, smoking and or alcohol consumption, helps in minimising the risk.  Very regular physical exercise and use of fish reduces risk of breast cancer in women who are prone to it, due to various risk factors.

Drugs like tamoxifen can be used in women with high risk for breast cancer for prevention. Removal of any doubtful lump, removal of breast tissue, are other measures used for prevention of breast cancer.             

Dr. Rachna Pande is a specialist in internal medicine.

E-mail- rachna212002@yahoo.