RISK FACTORS TO DEVELOP BREAST CANCER

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RISK FACTORS TO DEVELOP BREAST CANCER

Dr. Hugo Raul Castro Salguero
Medical oncologist
[email protected]
www.grupoangeles.org

By definition, cancer consists of transformation of benign cells into malignant cells that grow in an autonomous and disorderly manner caused by mutation or alteration of a gene. Altered cells proliferate until forming a tumor in the form of a nodule of mass that in the breast’s case can be felt through self examination, by the doctor or through special diagnostic methods such as mammography. Until what causes breast cancer is known, we will not know how to avoid it. There are some circumstances or situations that influence alteration of cell functions and produce cancer; those situations are known as risk factors. One risk factor is the condition that allows or facilitates cell alteration; for example, smoking is a risk factor among others for mouth, through and lung cancer.

SKIN SIGNALS OF BREAST CANCER

  • Skin protuberance
  • Umbilicated nipple and change of nipple direction
  • Skin retraction
  • “Orange peel” skin
  • Reddish skin and local hyperthermia
  • Skin ulceration
  • Secretion comes out of the nipple

MAIN RISK FACTORS

  • Gender: 1 male for every 100 female

  • Age: 90% occurs over 40 years of age, with the maximum happening between 40 and 74 years of age. 1.2% happens in persons younger than 40. After that age, frequency increases progressively until reaching a plateau chart between 45 and 55 years of age to finally increase manifestly. The risk of developing risk cancer when a woman is 80 to 95 years old is double than that in women ages 60 to 65.
  • Ethnic and race factors: certain races, among them Jews, have a higher risk of presenting breast cancer before age 70, independent of other factors.
  • Family history, especially first degree relative who have a relative risk >50% of suffering breast cancer before age 70. Most of it is attributable to shared environmental factors. In breast cancer family history, we must distinguish between family, hereditary and sporadic cancer:
    • Sporadic cancer: No previous cancer in two or more generations.
    • Family cancer familiar: when in a certain family several close relatives suffer the illness (grandmothers, aunts, mother), that is to say two or more cases in first or second degree relatives.
    • Hereditary breast cancer: this type presents a 5% rate compared to 13% of family cancer.

RELATIVE RISK FACTORS

  • History of unilateral breast cancer: when a woman has already had breast cancer, the risk of suffering another contralateral increases 5 times more than in all the population
  • Family history of ovarian, endometrial, prostate and colon cancer also increases risk
  • Benign mammary pathology. History of biopsy.
  • Mammographic pattern of dysplasia (currently not considered useful).
  • Precocious menarche (younger than 12 years of age) and precocious start of ovulation cycles (1 year since menarche), for breast cancer in premenopausal women
  • Late menopause (50 years). A woman with natural menopause before age 45 has half the risk of another of the same age with menopause at 55. For every 5 years of difference in menopause age, breast cancer risk increases by 17%. Oophorectomy before age 40 reduces some 70% the risk of suffering breast cancer.
  • Age: some authors consider than having the first child before 20 years of age means a reduction of risk by 50% compared to women who never give birth to children. When age difference between menarche and the first pregnancy is small, the risk of suffering breast cancer is significantly reduced. As to the number of children, it is not clear that this is a protection factor but if so, it would be with more than 4-5 children. Having the first child after age 35 increases the risk threefold. Not having children is also linked to higher risk, while being barren could represent a protection factor.
  • Breastfeeding: it is not clear it protects, but if it does it would only influence premenopausal women. Today is seems that protection asset does not exist as previously was believed.
  • Ionizing radiation: its effect is directly proportional to dose and inversely proportional to age, remaining for life. Over 40 years of age the risk is significantly reduced. What matters is age at which radiation is received.

IN THIS REGARDS AND WHAT REFERS TO MAMMOGRAPHY, WE MUST HIGHLIGHT:

  • Low radiation produced by a mammography
  • Importance and need to have a mammography increases with age (after 45-50 years of age)
  • Radiation is much more negative in young women (10 to 19 years of age), when organs are growing and maturing; not during senescence when they are in an involution phase (especially mammal tissue). Therefore, we can say that the fact of having an annual mammogram entails an insignificant risk.
  • Obesity, especially abdominal and visceral, and more in young women (during puberty), as well as in postmenopausal women. Mainly due to ingestion of animal fat and meats. Normally, it alters menstrual cycles, progesterone secretion and stimulates breast cancer in postmenopausal women as well as worsening its prognosis.  It may be that size is related to a higher risk of breast cancer. It seems like women with breast cancer have high HDL-Cholesterol.
  • Hormone treatments:
  • Hormone contraceptives: when used before the first pregnancy, its protective mechanism possible is that it delays it. It has been seen that in women with breast cancer, contraceptives can accelerate tumor growth. It is advisable for women with family or hereditary history to not take contraceptives without previous ob-gyn evaluation.
  • Hormone replacement therapy with estrogen during perimenopause seems to increase risk slightly, and it is possible this happens in cases of previous mammarian pathology. When progestogens are associated the risk may not diminish, although this is not clear.  Neither are there concluding data, although it seems ingestion for more than 10 years quickly raises incidence.
  • Alcohol: the risk is proportional to consumption, mainly in young people. But influence of alcohol in breast cancer is still unclear.
  • Dietary factors:  the fact that breast cancer is increasing in Anglo Saxon countries and high strata of society makes one think that lifestyle associated to some customs can be fundamental factors for certain women. It seems that a diet rich in animal fat favors appearance of high levels of cholesterol and indirectly, obesity. Thus that factor also increases risk in postmenopausal women.  Fat and obesity would be the ones that starting with cholesterol would onset production of estrogens via suprarenal, and as a consequence, cancer appears.   Diets with little fat and less than 2000 calories have been recommended.  High consumption of fruits and vegetables, as well as unsaturated fatty acids and certain micronutrients seem to reduce risk, although results are not concluding.
  • Smoking seems to increase risk; it is clear that environmental carcinogens and tobacco combustion can be found in mammal tissue. There is research that indicates a increase in relative risk as well as aggressiveness of the tumor.

It also alters metabolism of estrogens and causes earlier menopause.

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