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With Breast Awareness Month upon us, this year’s theme is all about ‘Give Hope. Save Lives’. It is also about being cautious as one in every twenty-eight women are expected to develop breast cancer in their lifetime and this probability goes up to one in every 22 women when we consider only urban India. These are some estimates to prove that there has indeed been an increase in the number of breast cancer patients and if one looks at the overall picture, the incidence of breast cancer is quite high in India with over 1.6 lakh new cases diagnosed every year as per data from WHO. Breast cancer is also the leading cause of death by any cancer, accounting for 11.1% of all cancer deaths in India. Younger women are in fact at greater risk.
The average age at which the disease is diagnosed in western countries is 62 years whereas in India the median age at which breast cancer is diagnosed is between 45 and 49 years. These are worrying statistics especially if you are a young woman as the incidence of breast cancer can disrupt your life during the prime of your career. It may pose a challenge for women who are involved in bringing up a young family or are planning to start a family soon.
The risk factors
This makes it important to understand all the risk factors leading to this increased incidence and how younger women are more prone to getting a more aggressive form of breast cancer. Our current lifestyle is a big contributor with lack of exercise, ever-increasing levels of stress, obesity, alcohol and tobacco usage and delay in childbearing being the main culprits. Many of these factors cause hormone imbalance, and increased oestrogen exposure thus increasing the chance of developing cancer. In some cases, the incidence of cancer can be due to hereditary where the family has a strong history of different cancers. For example, the mother or aunt had breast cancer or ovarian cancer due to gene mutations which got passed on to the daughter. In the case of breast cancer, these genes are the BRCA1 and BRCA2 genes which get passed onto the next generation leading to a 50-85% possibility of a new breast cancer incidence in that generation. This kind of hereditary cancer happens in 10% of all cancers which
are detected.
Early detection of breast cancer at any age is key. This is even more critical in young women because breast cancer that occurs in a young woman is mostly aggressive in nature, potentially presenting with a large tumour size and high proliferation rate. Delays in diagnosing breast cancer can cause problems. Many younger women ignore the warning signs — such as a breast lump or unusual nipple discharge — because they believe they’re too young to get breast cancer. All these result in poor disease outcomes if the management of cancer is not done properly.
Treatment & therapy
Treatment of breast cancer is a stepwise process where a combination of surgery, chemotherapy and hormone therapy is used, and this formulation depends on the results of certain diagnostic tests done on the patient which determines the stage of the disease. Surgery is performed to remove the cancerous part. Surgery can be either breast conservation surgery or total mastectomy.
Chemotherapy is administered either before or after the surgery. One of the major complications as a result of chemotherapy is the impact it has on the fertility of a young woman who is of childbearing age. In this case, sometimes embryo preservation or oocyte preservation is suggested to the patients. This has varying degrees of success with the biggest limitation being that of the cost of these treatments. There is also a possibility of avoiding chemotherapy all together for a certain subtype of early-stage breast cancer (hormone receptor-positive).
For early-stage breast cancers which are hormone receptor-positive, there are various risk assessment tools which can determine the need for chemotherapy eg., Can Assist, OncotypeDX, Endopredict, Mammaprint etc.
One of these tests can be advised to the patient which helps figure out the chances of cancer recurrence with the help of a risk score. If the risk score is low, patients can avoid chemotherapy and with proper guidance of a fertility expert can go ahead with family planning post completion of the treatment.
Screening & family history
One of the best ways a young woman can reduce the chance of breast cancer is by being proactive about it. This includes regular screening with yearly mammograms along with ultrasound from the age of 40. Those who have a family history of cancer should start their yearly mammograms 10 years before the age of the index case in their family.
Clinical breast examination is also advised once every three years for women in the age group of 20 to 30 years and every year for women above 40 years of age.
To conclude, breast cancer, especially in young women, has significant complications resulting in reduced quality of life for the patient and the complete family.
A woman should take all possible steps to decrease her risk of breast cancer with healthy lifestyle choices and regular screening.
(The author is a consultant
surgical oncologist.)