Know your risk levels

A sketch of a patient with doctor.

Cancer is today the second leading cause of deaths among Indians after cardiovascular disease. When it comes to women, breast cancer has overtaken cervical cancer to become the leading cause of cancer-related deaths in urban India. It is estimated that by 2030 the global burden of breast cancer will increase to over two million new cases per year, and one in 25 women in India will develop breast cancer during her lifetime.

But, as number of cases increases due to a wide variety of factors including increasing life expectancy, urbanisation and altered reproductive and lifestyle behaviours, are we prepared to meet the challenge? Given the lack of awareness about the disease and its risk factors among Indian women, the likely answer seems to be no.

In 2013, Hollywood star Angelina Jolie was in news worldwide when she publicly talked about undergoing preventive double mastectomy after genetic tests revealed she had a high risk of developing breast cancer. Later she also underwent a procedure to have her ovaries removed to reduce the development of cancer. Knowledge about the disease and awareness of your risk factors can therefore be highly empowering for women as more preventive mechanisms emerge out of breast cancer research.

While we do not know with clarity what exactly causes cancer, we do know the factors that augment a woman’s risk of developing the disease. Knowing if you are at a high risk can allow you to take preventive measures.

Here is a list of factors that influence the risk of breast cancer in women.

Age: As compared to Western countries, more women in India are afflicted with breast cancer at relatively younger age. It is important, therefore, to stay alert. Monthly self-examination is important to keep a check on any lump, or change in shape or size of your breast area. Along with monthly self-examination, a clinical breast examination every three years is recommended. After the age of 40 years, an yearly mammography is advisable. For women who are at a higher risk by way of family history or genetic testing results that indicate a mutation in BRCA1 or BRCA2 genes (these are tumour suppressor genes), an yearly mammography is recommended earlier after consultation with oncologist.

Family History: A family history of breast cancer makes a woman more likely to have it herself. The risk is even higher for a woman who has two such close relatives suffering from breast cancer. However, it is important to remember that only five to ten per cent cases of breast cancer are hereditary.

Race: Ethnicity has another role to play in both the risk of incidence as well as the type of breast cancer. For example the American Cancer Society states that Caucasian women are slightly more likely to develop breast cancer than are African-American women but African-American women are more likely to die from the disease. The incidence of breast cancer in Asian women is relatively less than in Caucasian women.

Genetic Mutation: However, in case there is a genetic mutation in these genes, the risk of cancer is high for both breast cancer as well as ovarian cancer. This genetic mutation is what had prompted Angelina Jolie to undergo mastectomy. This risk is derived from genetic testing.

Lifestyle: Urbanisation and Western lifestyles are other factors that augment the risk of breast cancer. In fact the rise in incidence of breast cancer in India has been simultaneous with a rise in urbanisation which brings with it risk factors such as lack of physical exercise, late marriages and late pregnancies, reduced breast feeding, obesity, early menarche, late menopause, smoking and alcohol consumption.

If you fall in the category of high risk, it is highly advisable to follow regular clinical examinations and yearly mammography to make sure your disease, if it develops, is detected in initial stages when it can be cured with less invasive procedures.

(The writer is an oncologist at Rajiv Gandhi Cancer Institute)