“The only person who can save you is you” – Sheryl Crow
Introduction
Breast cancer is the most common, and the biggest killer, cancer in women in India and worldwide. In India, one woman is diagnosed with breast cancer every three minutes, and one woman dies of breast cancer every six minutes. Out of one hundred breast cancer women, forty-fifty die within five years in India, but less than five die in the US. The difference in death rates is because in India women come for treatment late, when cancer has advanced to Stage III or IV, and has low survival rate.
Rise in Breast Cancer
Breast cancer in India is rising at a rapid rate. And is affecting younger women, those in 30s and 40s. In 2018, breast cancer had 1,62,468 new registered cases and 87,090 reported deaths. By 2030, the number of cases will rise to about 200,000 a year and deaths to about 100,000 a year. Twenty-five years ago, about 30% patients were blow age fifty. Now, about 50% are.
Improving Survival Rate
Breast cancer survival rate in India is among the lowest in the world because it is detected late. Late detection is because of lack of awareness of breast cancer. Increasing awareness can reduce the death rate. Even if we start a cancer awareness program today, 20-30 years will pass before its effect becomes discernible.
Breast cancer cannot be prevented. But its incidence can be reduced by a few simple lifestyle changes; and the survival rate can be improved by early detection. But let us begin with what is cancer and what is breast cancer.
What is Cancer
Our body is composed of many different types of cells. These cells grow and divide in a controlled manner to produce more cells as required by the body. Also, the older cells and the damaged cells die.
However, sometimes, the genetic material of one cell gets damaged or changed [mutation] and the cell becomes immortal: that is, it will not die. When this ancestor cell divides, its descendant cells are also immortal. This gives rise to a limitless number of immortal descendant cells. The number of cells is far more than what the body needs. The extra cells then form a mass that is called a tumour.
These immortal cells are called cancer cells. The cancer cells are immortal; capable of limitless division, and thus of limitless growth in the number of cells; and capable of spreading [Metises] to other parts of the body through blood and lymph system.
There are more than 100 types of cancers. Not all cancers form tumours. Cancers of the blood and the bone-marrow [leukaemia], for example, do not form tumours.
Most cancers are named for the body part in which they begin: colon cancer, prostate cancer, ovarian cancer, breast cancer and so on.
What is Breast Cancer
Breast consists of lobules (milk producing glands), ducts (tiny tubes that carry the milk from lobules to the nipple) and blood and lymphatic vessels. Breast cancer is a malignant tumour that starts in the cells of the breast. It begins in the ducts; sometimes in the lobules: and rarely, in other cells of the breast. It then spreads through the breast lymph vessels to lymph nodes under the arms and thence to other parts of the body
Who is at risk of Breast Cancer
Every woman is at risk of breast cancer. In India, one in 28 women will get breast cancer. Certain factors increase the risk of BC.
- Cancer is a disease of old age: most cancers begin to strike at age 60 and above. But now cancer is also striking, though only rarely yet the teenagers. Risk of breast cancer, for example, is about 0.25% for a 30-year-old woman but increases to about 11% in a seventy-year old. In different countries, breast cancer risk in a 70-year-old is 54% to 154% higher than in a 30-year-old. Thus, as longevity has increased, so has the cancer incidence.
- Heredity. If first degree relatives [mother/father/brother/sister] had cancer, the risk of cancer is increased.
- Genetics. A person can be genetically predisposed to get cancer. A woman who has a family history of breast cancer is statistically more likely to get breast cancer. However, only a small percentage, less than 0.3% of population, is genetically disposed to get cancer. And less than 3-10% of all cancers are because of genetic predisposition. In women with BRCA 1 and BRCA 2, the probability of getting breast and ovarian cancer is more than 75%. Mutations in a few other genes [PTEN, CDH 1, TP 53 etc.] also increase the risk though not as much.
Angelina Jolie, Producer | Director | Actress had both her breasts removed in 2013 to reduce the risk of breast cancer because of a gene mutation (BRCA1) she has.
- Obesity. In obese postmenopausal women breast cancer risk is twice that of the non-obese women.
- Diet.Diet contributes to up-to 80% of cancers of colon, prostate and breast; and contributes to cancers of pancreas, lung, stomach and esophagus. Alcohol, red meat, sugar increase the risk of cancer.
- Smoking, night work, no children or child born after age 30, recent use of oral contraceptives (reverts to normal on stopping), HRT, and Chemicals in environment – increase the cancer risk.
- Menopause. Late menopause increases the risk.
Reducing the Risk
Healthy weight, physical activity – brisk walking, cycling, swimming – 45-60 minutes five or more days a week, breast feeding, no red meat, less sugar, and less alcohol lowers the risk.
Controversy about whether diet rich in whole grains, fruits, vegetables and legumes and low in total fat (butter, oil), more vitamins, Marine Omega 3 fatty acids (found in seafood (e.g. fish oils) and in walnut, seeds, flaxseed oil etc.), and antiperspirants and bras reduce the risk. Abortion and Breast Implants have no effect.
Selective Estrogen Receptor Modulators such as tamofoxien reduce breast cancer risk but increase the risk of thromboembolism and endometrial cancer.
So, eat well and exercise and you would have done your bit to reduce your cancer risk.