Breast cancer: the importance of timely diagnosis and self-examination

Irina Baker – Master of Science, nutritionist consultant, Certified Nutrition Consultant for Fitness and Wellness (USA)

Until recently, it was generally accepted that breast cancer was a hereditary disease. However, it has now been established that the genetic factor accounts for no more than 5–10% of all cases. Numerous studies conducted to identify the causes of the growing epidemic of the most common cancer among women point to two categories of risk factors: unmodifiable and controllable. Book by American doctor Susan Love Dr. Susan Love's Breast Book breaks them down as follows.

Unmodifiable risk factors

Age and genetic

For most women, the primary factor is age - in other words, the risk of breast cancer increases with age. Overall, about 85% of cases occur in women over 50 years of age, while only 5% occur among those under 40 years of age.

While the peak incidence is recorded at around 60 years of age, it is known that in most cases carcinogenesis manifests itself long before this. Depending on the woman’s age, her hormonal status and, accordingly, the growth rate of cancer cells, the formation of a tumor diagnosed by modern methods takes from 2 to 20 years. The younger the patient, the more aggressive treatment may be required.

Genetic factors suggest a family history of breast or ovarian cancer. The risk of hereditary transmission of the disease is due to the presence of specific genes BRCA 1 and BRCA 2. Genetic predisposition significantly increases the risk of the disease, however, as mentioned above, it “does not make a difference” in the overall picture of breast cancer incidence. Modern (but expensive) genetic testing methods can determine the degree of risk associated with a gene mutation.

Unchangeable factors include a previous history of breast cancer (risk of recurrence) and, to a lesser extent, special conditions and diseases of the breast in the absence of carcinogenesis, as well as cancer of the uterus and rectum.

Risk factors associated with life choices

Hormonal risk factor

It determines the degree of harmful effects of the hormones estrogen and progesterone on a woman’s body. It is believed that the more menstrual cycles a woman has had throughout her life, the higher her risk of developing breast cancer. In this regard, early puberty (first menstruation before the age of 12 years) and late menopause (after 55 years), that is, more than 40 years of menstruation, act as risk criteria. In the last decade, the trend toward early puberty has become increasingly clear. Multiple births (pregnancies) reduce the number of cycles and therefore reduce the risk.

There is an opinion that in some cases, hypersensitivity to the effects of estrogen develops in a girl even before her birth. In the case of carrying a large fetus (more than 4.2 kg), excess estrogen produced by the mother’s body can damage the mammary glands of the fetus girl and make them more vulnerable to subsequent mutations.

Reproductive factor

The presence of children and childbearing age: depending on the fact of childbearing and the age at which the first birth occurred, the “childhood” factor can either increase the risk of the disease or play a protective role.

Risk factors include late childbirth (after 30 years of age) or absence of childbirth. According to statistics, in 25% of all cases the disease is initiated precisely for this reason, while early pregnancy (before 18 years of age) and multiple births reduce the risk of developing cancer.

If a woman did not have the opportunity to give birth, but her reproductive period was very long (more than 40 years of menstruation), then the risk of developing breast cancer is significantly higher than for a woman who gave birth to her first child before the age of 30. At the same time, a first-time mother over 30 years of age has a higher risk of the disease compared to a woman who has never given birth or been pregnant. This is explained as follows. In the case when a young woman gives birth, pregnancy hormones, among other things, also perform a “hardening” function, giving her mammary glands increased resistance to mutations and negative influences. The same hormones in a previously nulliparous woman over 30 years old are capable of stimulating the breasts, which by that time had already undergone mutational changes. The key to understanding such a significant role of the reproductive factor is the length of the period from puberty (beginning of menstruation) to the first birth (pregnancy). It is during this period of time that the breast is especially sensitive to carcinogenic effects. From the moment of puberty until the period of hormonal birth “restructuring”, all the so-called external factors, which will be discussed below, produce the most aggressive, mutational effect on the breast. Then, not later. In the case of pregnancy occurring at a young age, a certain protective mechanism is triggered, building a kind of shield, a barrier to the mutation of cells in the breast in response to the effects of carcinogens, and thus the subsequent development of cancer is prevented.

Lactation factor

The duration of breastfeeding also has a bearing on the number of hormonal cycles during the reproductive years. As studies and centuries of experience show, early start in multiple births and long lactation (up to six years of “total experience”) create the most reliable protection in the female body against the development of breast cancer. The traditional family structure, characteristic of past centuries, naturally protected women from malignant neoplasms of the reproductive organs.

If a woman did not have the opportunity to give birth, but her reproductive period was very long (more than 40 years of menstruation), then the risk of developing breast cancer is significantly higher than for a woman who gave birth to her first child before the age of 30

However, such recommendations are unlikely to be widely used in our age of different female self-affirmation. This is partly why breast cancer is more common in developed countries. But an increase in the growth rate of the disease is observed throughout the world. The younger generation is no longer in a hurry to start families and have children. The average age of first-time mothers continues to rise, which means the risk of subsequent illness increases. This assumption may not come true if the aggressive influence of external factors is eliminated as much as possible.

External factors

All external influences on the body that can cause mutation of breast cells.

Nutrition

According to the theory outlined in the book by Susan Love, excessive consumption of animal fats can provoke carcinogenesis of the mammary glands. The idea that dietary fats contribute to breast cell mutation has been around for a long time. It is believed that a high content of animal fats can change the processes of estrogen metabolism in the body. Comparative studies show that people whose diet is rich in animal fats have an increased level of estrogen in the blood, while vegetarians, on the contrary, release more estrogen from the body, thereby reducing its level in the blood. However, the hypothesis about the role of fats in increasing the risk of breast cancer has not yet found actual confirmation in studies.

Another way to look at diet as a contributing factor to breast cancer comes down to caloric intake and its effect on insulin. The total number of calories consumed contributes to the development of risk even more than the content of animal fats. Susan Love points out this observed pattern: the taller and fuller a woman, the greater her risk. Women who gained more than 10 kg of their weight at age 18 are at greater risk of developing the disease in the future than those who are 2.5 kg or less over their youth weight.

Breast cancer belongs to the group of insulin-dependent cancers. For this reason, a diet that provokes the development of insulin resistance in the body is also dangerous from the point of view of preventing malignant neoplasms in breast cells.

Observations show that heavy consumption of food of animal origin is the leading cause of earlier puberty. In 2010, approximately 16% of American girls reached puberty (measured by breast development) by age 7, up from 10% in 1997, and about 30% of girls reached puberty by age 8 (24% in 2010). 1997). The trend is alarming because, as noted above, early puberty, and with it the cumulative exposure to female sex hormones, is an undisputed risk factor for the development of breast cancer in the future. It is known that the body is much more vulnerable to the effects of carcinogens early in life. One of the reasons for the occurrence of malignant tumors in the adult body is now believed to be unhealthy diet in childhood.

Excess weight after menopause

According to statistical studies, approximately 13% of breast cancer cases are associated with this factor. After the completion of the menstrual function, the production of estrogen in the body does not stop, but now occurs not so much in the ovaries, but in the adipose (fat) layers. The plumper a woman is, the more estrogen is contained in her blood. Research tests have shown that the body of an overweight postmenopausal woman can produce several times more estrogen hormone than a young and slender woman.

In order to minimize the risk of developing breast cancer, the American Cancer Society recommends that women not exceed one drink of alcohol per day.

Accumulation of visceral fat (in the waist and abdomen) poses a greater threat than increased hip size, since it is directly related to the development of insulin resistance in the body.
Women who have previously been diagnosed with breast cancer and have gained excess weight after (or during) treatment are at particular risk. It has been shown that a 10% increase in weight compared to weight before diagnosis of the disease increases the risk of relapse by 14% compared with those who have gained no more than 5% of weight since diagnosis.

Alcohol consumption

It is known that the risk of cancer increases in direct proportion to the amount of alcohol consumed and does not depend on its type, be it beer or strong drinks. Unlike the pathogenesis of other malignant tumors that occur in people who abuse alcohol, breast cancer can be triggered by very small doses of alcohol. Regular consumption of just one serving of alcohol per day (in any form) can lead to a 15% increased risk of disease compared to non-drinkers, and drinking more than 19 drinks per week increases the risk by half, according to numerous studies. One visible piece of evidence is the fact that in France and Italy - countries where wine is consumed by almost everyone every day - the incidence of breast cancer is higher than in the United States, although the problem of obesity is not as pressing there.

Alcohol can increase the level of the hormone estrogen in the blood, which in most cases is responsible for the occurrence and rapid growth of tumors. Like the carcinogenic effects of excess fat in the diet, alcohol is more harmful early in life. The risk of developing breast cancer is determined not so much by current alcohol status, but by the total harm accumulated over all the years of drinking alcohol, starting from a very young age.

In order to minimize the risk of developing breast cancer, the American Oncology Society recommends that women not exceed one drink of alcohol per day. Dr. Susan Love's advice is more radical and boils down to limited alcohol consumption "only on holidays", in the same dose of one drink, equivalent to one flute of champagne, or one glass of wine, or one can of beer, or one shot of strong drink. An expert on breast disease, she advises: “A balanced, healthy diet that provides the body with sufficient folic acid can counteract the harmful effects of alcohol in the development of cancer.”

Carrying out hormone replacement therapy after menopause

The significant reduction in breast cancer incidence in the United States among postmenopausal women over the past decade is associated with more cautious use of hormone replacement therapy than previously. In the 40s and 50s in America, there was a widespread opinion that functional changes in the female body during menopause should be treated as nothing other than a disease that should be treated with hormonal drugs (estrogen with progestin), replenishing the lack of its own hormones. Prescriptions for “magic pills” were prescribed by gynecologists of “that era” to any woman of “transitional age” without fail, regardless of complaints about her health. The time period from 1988 to 2002 also saw a surge in the widespread use of hormone replacement therapy. In 2002, the results of extensive research received widespread publicity, establishing that long-term (more than five years) use of hormonal drugs by women aged 50–79 years increases the risk of developing breast cancer, heart disease, strokes and thrombosis.

Following this announcement, the use of hormone replacement therapy in the United States and Canada fell by 75%, which was soon reflected in a 2.2% annual decline in breast cancer incidence. Another important discovery was made in 2011 at the University of Oxford. It found that among women who used hormone therapy five years after menopause, there was no increased risk of developing breast cancer compared with those who started using it before or immediately after menopause (the risk increased by 43%).
The current expert view is that it is advisable to use hormones only when absolutely necessary and for a short time.

Radioactive exposure

Recognized as a consistent risk factor for many types of cancer. Breast cancer can occur 15–30 years later in women exposed to high doses of radiation (about 8,000 rads) during treatment for another cancer. The risk from radiation exposure varies depending on age - higher if the exposure occurred during adolescence and almost none if the exposed woman was over 40 years of age.

Adverse effects of the external environment (electromagnetic radiation, ecology, pesticides, occupational hazards, night shifts, psychosomatic factors, etc.) are among those risk factors that, cumulatively with the others above, can stimulate the development of the disease.

Men also have a risk of being diagnosed with breast cancer, but they account for no more than 1% of all cases of the disease.

The above list of main risks is not small and thus explains such a wide prevalence and increase in the incidence of breast cancer. However, one should not assume that the presence of risk inevitably leads to the development of the disease. And vice versa.

For those who want to know their cumulative risk:

On the Internet, it is easy to find survey tests offered on the websites of the relevant clinics.
Having tested myself at the time of diagnosis, I received a reassuring result in all tests (my personal risk at that time was in the range below average). However, the disease, unfortunately, manifested itself. (author's note, 10 years in remission)

Alarming symptoms: what should you pay attention to?

In most cases, early breast cancer is asymptomatic. Therefore, it is important for a woman to monitor the appearance, shape and structure of her mammary glands. It is especially important to pay attention to the following changes:

• The appearance of new lumps in the mammary gland.
• Nipple soreness, hardening, pathological discharge from the nipple, nipple retraction.
• Enlargement of the gland, the appearance of a tumor in the axillary region and deformation of the gland.
• One of the symptoms may be a dry nipple.
• Seeing blood from the nipple is especially dangerous.
• Pain in the gland can also be a symptom of breast cancer

The most important thing is regular examinations and screenings, and timely response to any suspicious signs. The key to defeating the disease lies in its early diagnosis and early treatment.

Source: KOSMETIK international journal, No. 2 (56) / 2014, pp. 78-81