Breast Cancer

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Dealing with concerns about the possibility of breast cancer is one issue that takes up a great deal of my time as a female GP. Breast cancer is one of the most common diseases in the UK – 1 in 9 women will be diagnosed with breast cancer at some point in their lives here – and that number is increasing – and while there are things that cause breast cancer that cannot be changed such as genetics, there are factors that can make a difference to your chances of being diagnosed with this physically and psychologically very damaging condition.

Thankfully, being overweight or obese does not increase the chances of breast cancer in women before the menopause, but it does have a significant impact after the menopause. According to Cancer Research UK, obese women have a 30% higher risk of postmenopausal breast cancer than women with a healthy weight, and as such 1 in 7 obese women will develop the condition compared with the national average of 1 in 9 I have previously mentioned.

Weight gain can also increase the risk of breast cancer – before the menopause, gaining 55lb during adulthood makes a diagnosis of breast cancer 45% more likely, and gaining up to 20lb after the menopause can significantly increase the risk. So maintaining a healthy weight throughout life is an important factor in preventing breast cancer – it is not a good idea to plan to lose weight at the menopause on the basis that weight does not affect your breast cancer risk until then, losing weight around the menopause is absolutely possible but is a lot more difficult than doing it a few years earlier!

Starting your periods early or finishing them late also increases the risk of breast cancer – there is nothing you can do about this one; it is related to oestrogen, the hormone that relates to your periods, and is known to be a key factor in the development of the condition. Having your first child after the age of 30, or not having children at all is also associated with an increased risk, probably because of effects on the same hormones, while breast feeding any children you have reduces your risk.

Regarding eating and drinking, a high fat diet and drinking more than the recommended amount of alcohol (14 units per week for women) are also associated with increased breast cancer risk. Regular exercise appears to reduce the risk.

Taking the contraceptive pill or HRT, does increase the risk of developing breast cancer but this is a small increase. I get asked about breast cancer risk and the pill or HRT all the time and I have a standard answer: for the pill, if it is really important for you not to be pregnant and the pill is the most practical method of contraception for you, then a very small increased risk of breast cancer when you are pre-menopausal and your risk is already very low is probably better than the trauma of an unplanned pregnancy. For HRT my answer is similar, if you can basically manage through your menopause then taking a carcinogenic hormone does not make sense. But if you go to pieces and life becomes unmanageable during this time, as many women experience, and taking a very small dose of a hormone every day makes life normal again, then the very small increased risk of breast cancer is probably worth it. These are just my considered opinion, if your own health expert gives you different advice then please listen to them!

So how do you know if you have breast cancer? Most people (I say ‘people’ because about 2% of those who are diagnosed with breast cancer in the UK each year are men) notice a lump, either in their breast tissue or armpit, but there are other changes to look out for. These include:

  • A difference in size/shape of a breast
  • Nipple changes, including changing shape, a rash, or becoming inverted
  • Dimpled skin anywhere on the breast
  • Nipple discharge

If you notice any of these changes please contact your GP straight away. There are other, less serious causes for all of these symptoms so try not to worry. The vast majority of breast lumps turn out to be harmless lumps of fat.

Sometimes your GP will be able to reassure you straight away, but most of the time you will need some further assessment in the form of an ultrasound or mammogram, and a biopsy if these find any abnormality. As with most forms of cancer, if this is your diagnosis then there are various options available to you – surgical removal of the lump itself (‘lumpectomy’ or ‘wide local excision’), or the whole breast (mastectomy) and either chemotherapy or radiotherapy, and there are drugs such as herceptin that are effective in some people with breast cancer. The best combination of treatment for an individual with breast cancer really depends on the details of their cancer – the exact type of cancer, whether or not it has spread, whether or not it may respond to herceptin etc – so I am not intending to go into detail here, suffice it to say that if you have breast cancer please follow the advice of the specialist who knows you, but also ask as many questions as you feel you need to, and make sure you get answers!

A word about mammograms: the earlier your breast cancer is diagnosed, the greater your chances of getting through it unscathed! Treatments and statistics are improving all the time, but women still die from breast cancer, and regular mammograms once you are the appropriate age are an essential (if painful) way of reducing your chances of serious consequences if you do develop breast cancer. Please go for your mammograms!

So how do you avoid breast cancer? Essentially you can minimise your risks by looking at the factors that increasing your risks and changing your lifestyle accordingly, so something like:

  • Maintain a healthy weight
  • Eat a lower fat diet
  • Consume alcohol in moderation only
  • Exercise regularly
  • Only use the contraceptive pill or HRT if necessary

I also get asked about soy in the diet and breast cancer risk. In Asian populations where they eat soy in natural forms and large quantities throughout life it is quite clear that soy reduces their breast cancer risk. In Western populations the situation is less clear and experts are still hotly debating and researching soy consumption and breast cancer – it may increase, decrease or not change the risk of breast cancer in Western populations, nobody knows for certain, and I will report back once the experts agree……

Meanwhile, I find myself repeating the ‘healthy eating and exercise’ mantra yet again – it really is the answer to avoiding most health problems!


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