Though there is no failsafe prevention or cure for breast cancer which is striking women at younger and younger ages, sophisticated treatment options are opening up a brave new word for sufferers. Here’s how to improve your chances of battling the disease.

 

At the age of 29, the last thing that entered Julie Priestley’s mind when she discovered a small lump while rubbing moisturizer into her breasts was cancer.

“I just thought the lump was a swollen gland,” says Priestley, who, like most women under the age of 40, thought breast cancer only afflicted older women. Ten months later, Priestley has had breast-conserving surgery, undergone chemotherapy and radiation and is about to undertake five years of hormone replacement therapy which will trigger early menopause.

“If there’s one thing I can advise all young women is to check your breasts at least once a month and consult a doctor as soon as you find a lump,” advises Priestley, who joins the ranks of millions of under 40s worldwide diagnosed with breast cancer. “The reason many women don’t report lumps is because breast cancer is usually painless.”

Says Johannesburg breast cancer expert Dr Carol-Ann Benn, “Of approximately 350 breast cancer cases, 40 percent have been in women under 40, with some victims as young as 19 testing positive. At this stage, we can’t really pinpoint a single cause. It appears as if a combination of factors may be responsible for this surge of breast cancer in young women.”

The main problem with breast cancer in women under 35 is that breast lumps are often ignored by both patient and doctor, because of the misconception that cancer does not occur in young women, says Benn.

“If you find a lump just before your period, don’t panic; it usually goes away during or after your period has finished. If the lump is still there a week after your period is over, see your doctor immediately as breast tumours in young women can be aggressive,” says Benn, adding that early detection and diagnosis are the key to the best treatment.

Benn believes that a clinical examination, mammography and ultrasound, and needle tissue biopsy should all be done to determine the diagnosis the moment a lump is detected.

About 40 percent of women who are diagnosed with breast cancer will die from the disease. A quarter of breast cancers are diagnosed before the age of 50. There are several possible reasons, including genetic causes, as to why more and more young women appear to be contracting breast cancer.

The deepest cut

When Marsha Lee, a 35-year-old financial director, was recommended a mastectomy within a week of diagnosis, it blew her mind.

“The main reason women fear cancer is undergoing a masectomy,” says Dr Benn.

As Dr Benn says, the main reason women fear cancer is undergoing a mastectomy. “But the good news is that breast conservation and reconstruction now play a major role in management, and many women find that early reconstruction is a major psychological support.”

“When a friend suggested I get a second opinion, I was told to take my time and consider all the options. That made me feel much more relaxed,” says Monica, who discovered that the size of the tumour, breast and state of health are all taken into account when considering treatment options.

Marsha had both lumps removed, had chemotherapy and a bilateral mastectomy, and was put on hormone therapy for five years.

“My husband, family, and doctors helped me through the worst,” she says. “I was climbing the corporate ladder and believed the sky was the limit.”

“And though I haven’t put my career totally on hold, I have changed my priorities and discovered a better life in many respects. I treated cancer like a project, and now my ambition is back.”

Though she had the chance of harvesting her eggs before chemotherapy, Marsha didn’t fancy the idea of a surrogate mother bearing her child. “My husband and I have come to terms with it.”

“It sounds ridiculous, but breast cancer has taught me that life is precious and fragile. I thank God daily for being given a second chance, and I make an effort of filling my life with quality relationships. I would never have realized this before. Now the sky really is the limit.”

 

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THE TESTS

Ultrasound
An ultrasound will show if the lump is filled with fluid – a cyst – which is usually benign.

Mammogram

A mammogram is a type of x-ray which can pick up small areas with calcium deposits that may indicate cancer in certain cases, and can show other lumps, pick up benign breast lumps, called fibroadenomas, a combination of fibrous and glandular tissue most often found in young women.

Your specialist will then have several options, and, depending on the result, may advise watchful waiting, which means that the lump seems to be benign, but that you should keep an eye on it and be re-examined in time; or you may be referred for fine needle aspiration or biopsy.

Fine needle aspiration
A relatively painless process in which a fine needle is inserted into the lump to remove fluid from a cyst. If the fluid is not blood-stained and the lump disappears after the aspiration, it is usually not a cancer. If there is any blood or some of the lump remains, it may indicate cancer.

Biopsy
A biopsy removes cells from the body for examination and diagnosis. If a cancer is suspected, a larger piece of tissue is removed from the lump, since a malignant tumour may also contain non-cancerous cells. These cells are then sent to the lab for diagnosis. You may also have the whole lump removed surgically and examined.

MRI

While many doctors have been reluctant to use Magnetic Resonance Imaging (MRI) because of the cost, studies have shown that MRIs find more tumours than mammograms, especially in the earliest stages. For example, a four-year study of 1 909 Dutch women showed that MRI detected 80 percent of tumours compared with 33 percent detected by mammograms. In addition, a new study published in the New England Journal found that women recently diagnosed with cancer in one breast should immediately get an MRI of the other breast, as mammograms often miss small tumours. The drawback of MRI is that it has a higher rate of “false alarm.”

 

PREVENTING BREAST CANCER

Exercise: Get at least half an hour of physical exercise a week. Because breast cancer is hormone-sensitive, physical exercise lowers the risk of contracting the disease by lowering exposure to oestrogen and progesterone. According to a recent study published in the New England Journal of Medicine, women who exercise for four hours a week showed a 37 percent reduction in the incidence of breast cancer.

Diet: A study published in the 18 July edition of the Journal of the American Medical Association showed that eating more than five fruits and vegetables a day lowers blood pressure and reduces the risk of stroke and heart disease, while frequent exercise dramatically reduces the chance of remission. Cut back on saturated fat, avoid fried fast food, supplement your diet with vitamins, make sure your barbecue grid is cleaned before use, and keep alcohol intake down to five units per week. According to a study conducted by a professor at the University of California San Diego’s medical school, women who ate at least five servings of fruit and vegetables a day and exercised six times a week cut their chances of cancer recurrence in half. While there were no notable improvements amongst women who changed their diet more drastically, women who ate significantly less than the recommended five servings a day had a 40 percent higher risk of recurrence or new primary cancer.

Stop Smoking: If there’s one risk factor that should be avoided at all costs, it’s smoking. A study published in the Journal of the National Cancer Institute showed that the rate of breast cancer among women who smoked was 30 percent higher than among those who had never smoked. Women who started smoking before the age of 20, and those who started at least five years before their first pregnancy, appeared most at risk. In women who had smoked for 40 years or longer, the risk of breast cancer was 60 percent higher than in women who’d never smoked.

 

RISK FACTORS
While many risk factors have been identified for breast cancer, they only account for about 30 percent of the disease.

Age
Age is the most important risk factor. While a 30-year-old woman has a risk of about 1:6000, this will rise to 1:600 by the age of 50. This doubles again by the age of 70 to 1:300.

Family history
While family history is difficult to interpret, the risk of breast cancer is almost doubled if there is a first-degree relative with the disease. Two first-degree relatives increase the risk five to six times.

In addition, there are two patterns of inheritance: the first is familial in which there is some susceptibility which is modified by other factors. The second is a true genetic association. The gene BRCA 1 is thought to cause a 70 percent increase in the risk of breast cancer by the age of 70 and 87 percent by the age of 80.

Previous breast disease

If breast cancer has occurred in one breast then the residual breast tissue is at higher risk of developing cancer. This is estimated at between 0.5 and 1.0 percent cumulatively per year.

There is no connection between lumpy breasts in general and breast cancer. However, there are certain types of cell changes in the breast which are associated with an increased risk of breast cancer. This means that if a biopsy of a breast lump shows some types of benign breast disease, there may be a slightly increased risk of breast cancer. If this is the case, you should have regular mammograms.

Environment
Environmental factors seem to play an increasing role. Western societies have the highest incidence of breast cancer, at 60 to 70 per 100 000. Japan and China have an incidence of about 25 per 100 000. However, when Japanese women move to the USA or Australia the incidence rises to that of the West within two generations, which suggests there may be a link between a high fat diet and breast cancer. Alcohol also appears to play a part, particularly in post-menopausal women on HRT.

Hormonal factors

* The earlier a woman starts her periods, the higher the risk of developing breast cancer in later life. Women who have not had children or have them later in life have a greater risk of breast cancer. If natural menopause occurs after the age of 55 this doubles the risk of breast cancer compared with a women who starts menopause at 45. Surgical menopause, by hysterectomy, in a woman under 35 decreases the risk still further.

* According to a recent study involving over a million women and published in the British weekly medical journal The Lancet, besides placing women at increased risk of developing breast cancer, hormone replacement therapies increase the risk of dying of the disease. Use of combination HRT caused a four-fold increase in the risk of developing the disease compared to oestrogen-only HRT, the study shows. However, HRT also reduces the risk of cardiac disease and osteoporosis, so has to be weighed up against the risk of breast cancer.

 

Published in October 2007 in Aquarius, Dubai, copyright Sharon Marshall 2007.