Breast Cancer

Source: The American  cancer society

Breast cancer has become a major killer disease for women in Africa and more so in Kenya. In this 2 part series we shall look at breast cancer more deeply and develop understanding and see through way and means of preventing deaths from breast cancer. Your views are welcome

What are the risk factors for breast cancer?

A risk factor is anything that affects your chance of getting a disease, such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth, larynx (voice box), bladder, kidney, and several other organs.

But risk factors don't tell us everything. Having a risk factor, or even several, does not mean that you will get the disease. Most women who have one or more breast cancer risk factors never develop the disease, while many women with breast cancer have no apparent risk factors (other than being a woman and growing older). Even when a woman with risk factors develops breast cancer, it is hard to know just how much these factors may have contributed to her cancer.

There are different kinds of risk factors. Some factors, like a person's age or race, can't be changed. Others are linked to cancer-causing factors in the environment. Still others are related personal behaviors, such as smoking, drinking, and diet. Some factors influence risk more than others, and your risk for breast cancer can change over time, due to factors such as aging or lifestyle.

Risk factors you cannot change

Gender

Simply being a woman is the main risk factor for developing breast cancer. Although women have many more breast cells than men, the main reason they develop more breast cancer is because their breast cells are constantly exposed to the growth-promoting effects of the female hormones estrogen and progesterone. Men can develop breast cancer, but this disease is about 100 times more common among women than men.

Aging

Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older.

Genetic risk factors

About 5% to 10% of breast cancer cases are thought to be hereditary, resulting directly from gene defects (called mutations) inherited from a parent. See the section, "Do we know what causes breast cancer?" for more information about genes and DNA.

BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. If you have inherited a mutated copy of either gene from a parent, you have a high risk of developing breast cancer during your lifetime. The risk may be as high as 80% for members of some families with BRCA mutations. These cancers tend to occur in younger women and more often affect both breasts than cancers in women who are not born with one of these gene mutations. Women with these inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer.

In the United States BRCA mutations are found most often in Jewish women of Ashkenazi (Eastern Europe) origin, but they can occur in any racial or ethnic group.

Changes in other genes: Other gene mutations can also lead to inherited breast cancers. These gene mutations are much rarer and often do not increase the risk of breast cancer as much as the BRCA genes. They are not frequent causes of inherited breast cancer.

• ATM: The ATM gene normally helps repair damaged DNA. Inheriting 2 abnormal copies of this gene causes the disease ataxia-telangiectasia. Inheriting one mutated copy of this gene has been linked to a high rate of breast cancer in some families.
• p53: Inherited mutations of the p53 tumor suppressor gene cause the Li-Fraumeni syndrome (named after the 2 researchers who first described it). People with this syndrome have an increased risk of developing breast cancer, as well as several other cancers such as leukemia, brain tumors, and sarcomas (cancer of bones or connective tissue). This is a rare cause of breast cancer.
• CHEK2: The Li-Fraumeni syndrome can also be caused by inherited mutations in the CHEK2 gene. Even when it does not cause this syndrome, it can increase breast cancer risk about twofold when it is mutated.
• PTEN: The PTEN gene normally helps regulate cell growth. Inherited mutations in this gene cause Cowden syndrome, a rare disorder in which people are at increased risk for both benign and malignant breast tumors, as well as growths in the digestive tract, thyroid, uterus, and ovaries. Defects in this gene can also cause a different syndrome called Bannayan-Riley-Ruvalcaba syndrome that is not thought to be linked to breast cancer risk.
• CDH1: Inherited mutations in this gene cause hereditary diffuse gastric cancer, a syndrome in which people develop a rare type of stomach cancer at an early age. Women with mutations in this gene also have an increased risk of invasive lobular breast cancer.
• STK11: Defects in this gene can lead to Peutz-Jeghers syndrome. People affected with this disorder develop pigmented spots on their lips and in their mouths, polyps in the urinary and gastrointestinal tracts, and an increased risk of many types of cancer, including breast cancer.

Genetic testing: Genetic tests can be done to look for mutations in the BRCA1 and BRCA2 genes (or less commonly in other genes such as PTEN or p53). Although testing may be helpful in some situations, the pros and cons need to be considered carefully. For more information, see the section, "Can breast cancer be prevented?"

Family history of breast cancer

Breast cancer risk is higher among women whose close blood relatives have this disease.

Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk. Having 2 first-degree relatives increases her risk about 3-fold.

The exact risk is not known, but women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, less than 15% of women with breast cancer have a family member with this disease. This means that most (over 85%) women who get breast cancer do not have a family history of this disease.

Personal history of breast cancer

A woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast. This is different from a recurrence (return) of the first cancer.

Race and ethnicity

Overall, white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer. However, in women under 45 years of age, breast cancer is more common in African- American women. Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer.

Dense breast tissue

Women with denser breast tissue (as seen on a mammogram) have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer. Unfortunately, dense breast tissue can also make it harder for doctors to spot problems on mammograms.

Certain benign breast conditions

Women diagnosed with certain benign breast conditions may have an increased risk of breast cancer. Some of these conditions are more closely linked to breast cancer risk than others. Doctors often divide benign breast conditions into 3 general groups, depending on how they affect this risk.

Non-proliferative lesions: These conditions are not associated with overgrowth of breast tissue. They do not seem to affect breast cancer risk, or if they do, it is to a very small extent. They include:

• Fibrosis and/or simple cysts (sometimes called fibrocystic disease)
• Mild hyperplasia
• Adenosis (non-sclerosing)
• Duct ectasia
• Phyllodes tumor (benign)
• A single papilloma
• Fat necrosis
• Mastitis (infection of the breast)
• Simple fibroadenoma
• Other benign tumors (lipoma, hamartoma, hemangioma, neurofibroma)

Proliferative lesions without atypia: These conditions show excessive growth of cells in the ducts or lobules of the breast tissue. They seem to raise a woman's risk of breast cancer slightly (1½ to 2 times normal). They include:

• Usual ductal hyperplasia (without atypia)
• Complex fibroadenoma
• Sclerosing adenosis
• Several papillomas (called papillomatosis)
• Radial scar

Proliferative lesions with atypia: In these conditions, there is an overgrowth of cells in the ducts or lobules of the breast tissue, with some of the cells and no longer appearing normal. They have a stronger effect on breast cancer risk, raising it 4 to 5 times higher than normal. These types of lesions include:

• Atypical ductal hyperplasia (ADH)
• Atypical lobular hyperplasia (ALH)

Women with a family history of breast cancer and either hyperplasia or atypical hyperplasia have an even higher risk of developing a breast cancer.

For more information on these conditions, see our document, Non-cancerous Breast Conditions.

Lobular carcinoma in situ

In lobular carcinoma in situ (LCIS) cells that look like cancer cells are growing in the lobules of the milk-producing glands of the breast, but they do not grow through the wall of the lobules. LCIS (also called lobular neoplasia) is sometimes grouped with ductal carcinoma in situ (DCIS) as a non-invasive breast cancer, but it differs from DCIS in that it doesn’t seem to become an invasive cancer if it isn’t treated.

Women with this condition have a 7- to 11-fold increased risk of developing invasive cancer in either breast. For this reason, women with LCIS should make sure they have regular mammograms and doctor visits.

Menstrual periods

Women who have had more menstrual cycles because they started menstruating at an early age (before age 12) and/or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen and progesterone.

Previous chest radiation

Women who, as children or young adults, had radiation therapy to the chest area as treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) have a significantly increased risk for breast cancer. This varies with the patient's age when they had radiation. If chemotherapy was also given, it may have stopped ovarian hormone production for some time, lowering the risk. The risk of developing breast cancer from chest radiation is highest if the radiation was given during adolescence, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk.

Diethylstilbestrol exposure

From the 1940s through the 1960s some pregnant women were given the drug diethylstilbestrol (DES) because it was thought to lower their chances of miscarriage (losing the baby). These women have a slightly increased risk of developing breast cancer. Women whose mothers took DES during pregnancy may also have a slightly higher risk of breast cancer. For more information on DES see our document, DES Exposure: Questions and Answers.