Reduce your risk of breast cancer

Breast cancer is the most frequently diagnosed life-threatening cancer among South African women. One in 27 women will develop this disease.

The good news is that, if it’s detected early, there is an excellent chance of recovery. This is why every woman needs to examine her breasts and underarms regularly every month, to check for any changes.

Risk factors
The causes of breast cancer are mostly unknown but may include several genetic, environmental, nutritional and hormonal factors. Here are some of the main risk factors:

• The chance of developing breast cancer increases as a woman gets older. Seventy-seven percent of women diagnosed    with breast cancer are over 50.
• White women are slightly more at risk.
• Women who carry mutations of the BRCA1 and BRCA2 gene (such as Angelina Jolie) are more at risk of developing breast cancer.
• Having one first-degree relative (mother, sister or daughter) with breast cancer doubles risk. It is important to note that most (over 85%) women who get breast cancer do not have a family history of this disease, so not having a family member with this disease does not mean you won’t get it.
• Previous history of breast, uterus, ovarian or colon cancer.
• Women who drink more than one alcoholic beverage per day. Alcohol inhibits the functioning of your liver which may lead to higher oestrogen levels. We know that raised levels of this hormone appear to make women more vulnerable to breast cancer.
• Recent research suggests that smoking tobacco may increase the risk.
• Radiation therapy to the breast or chest as a child.
• Obesity, especially after menopause.
• Diet high in saturated animal fats may increase the risk slightly.
• Women who started to menstruate before the age of 12 or who had late menopause have slightly higher risk.
• Women who are pregnant for the first time over the age of 30.
• Women who have never had children.
• Using oral contraceptives or Depo-Provera may slightly increase risk. Women who stopped using oral or injective contraceptives over 10 years ago do not appear to have increased risk.
• More than five years of combined hormone therapy (HT) after menopause increases the risk. Risk returns to that of the general population within five years of stopping HT.

Self-examination
Early detection of breast cancer is the key to effective treatment. That is why experts encourage all women to begin monthly breast self-examination (BSE) from around 20 years of age. Become familiar with the structure of your breasts. Be aware of what’s normal for you.  

The following eight steps show you how to perform a BSE:

Step 1 
After a shower or bath, stand in front of a mirror where there is bright lighting. Look closely for any visible changes in your breasts. Note that if the right breast is slightly larger than the left this is not uncommon. Note any change in the following: size, swelling, shape or an obvious lump. Now look at the skin for any skin redness or warmness, dimpling or tethering of the skin (an “orange peel” texture). Thirdly, look closely at the nipples and note a change in level, any retractions or change in skin of the nipple. Lift your arms above your head to see whether there is any dimpling or tethering of the skin.


Step 2
Raise your arm over your head. Examine your right breast with your left hand. Use a skin cream with a gentle lather to make your hand glide more smoothly over the skin.

Step 3 
Use light pressure when examining the breast. Feel for a change in texture of the skin and for any lumps or a thickening of breast tissue. Repeat on the other side.


Step 4
Now use deeper pressure when examining the breast.


Step 5
For pendulous breasts, support the breast with one hand while examining with the other.


Step 6  
A change in the nipple itself may be a sign of problems. Look at it carefully to see for any nipple retraction (nipple pulled inwards) or a new scaly, crusting skin rash around the nipple. Gently squeeze the nipple. A small discharge may emerge which may be clear, dark-green, brown, and black-pinkish or blood stained. If it’s blood-stained, see your doctor immediately!


Step 7 
Check for lymph nodes in the armpit on each side and also feel above the collar bone.


Step 8 
Lie down over a folded towel or pillow. This allows the breast to flow over the chest wall so that the breast tissue is more easily felt. Repeat the manual examination in this position. 


Important things to remember

• The best time to examine your breasts is 10 to 14 days after the onset of your menstrual cycle.
• Finding a lump in your breast can be very upsetting and should be investigated. However, don’t panic. Most breast lumps - up to 90% - are non-cancerous. It is particularly likely that breast lumps in women younger than 30 will be benign.
• A cancerous lump feels firm and hard and does not have smooth edges. It is usually painless. In the early stages, the lump may move freely beneath the skin under the fingers.
• About 50 percent of cancerous lumps occur in the upper outer quadrant of the breast nearest to the armpit.
• Seek an expert opinion for every new lump you find, or if you notice a change.
• Just because one lump was benign doesn’t mean the others will be too.
• Women older than 40 should go to a health expert for a detailed clinical breast examination once a year. Women in their 20s and 30s should have a clinical examination at least every three years.

Mammogram
Women aged 40 and over should have yearly mammograms. Mammograms are safe. An experienced radiologist can detect a lump of 0,5 – 1 cm, while self-examination allows you to detect only a lump of 2cm in diameter.

Prevention
Prevention is always better than cure and should become part of your lifestyle choices. Women may reduce their risk of breast cancer by maintaining a healthy weight, doing regular exercise (such as brisk walking), limiting alcohol use and high-fat foods and breastfeeding their children for as long as possible.

While there is no guaranteed cure for cancer, greater awareness, self-examination and preparation are key to prevention and effective treatment.

Did you know?

• There has been an alarming increase in the number of breast cancer case in South Africa, with approximately five percent of woman being younger than 35 years old. It’s more difficult to diagnose breast cancer in younger women than in older women as the breast tissue is firmer, which makes it more difficult to detect a small lump. An ultrasound exam of the breast is the most reliable way to examine younger women, because this method can detect a lump in firm tissue more easily. Strangely enough, most cases of breast cancer in women younger than 35 are detected during pregnancy or while they’re breastfeeding.
• Men can develop breast cancer too. One percent of breast cancer occurs in men. Men between the ages of 60 and 70 are most at risk. All lumps should be investigated.