Even before I became an oncologist, October was the wow month for cancer awareness. So much attention is given to cancer and in particular breast cancer in this month. Companies will be lining up requesting cancer talks and on site screening.

As a passionate cancer advocate, through out the year I spend time trying to convince people to talk about cancer and to get screened with relative success. Come October and the planner is full to the brim. One day the ‘aha’ moment will come as to how the month of October manages to do what I struggle to do all year by just being October!

Breast cancer is actually a group of diseases under one name. It is not one size fits all sort of disease and has numerous subtypes. Seeing that we have five Mondays in October, we will undress breast cancer layer by layer, shame her and send her in hiding for a good time by fattening our knowledge base on the disease. Knowledge is always the key to a successful battle. One needs to study the enemy well in order to win.

This week we shall look at the breast and risk factors of breast cancer, next week screening for breast cancer and its prevention then week after that we shall talk about the management of curable breast cancer, thereafter the management of incurable breast cancer and in the last week we shall look at survivorship after breast cancer.

I draw your attention to the picture of the breast done in side and front cuts. Breasts are actually found both in women and in men, but in the latter they are often rudimentary. However, for some men breast tissue can be quite prominent. The breast is made up of lobes (buds which produce the milk) and ducts (pipes). The lining of the buds and ducts are where cancers come from the most. They are carcinomas. However, there are some breast cancers that start in the supporting structures around these ducts and pipes. These are called sarcomas. Then in the breast as well we have blood vessels and others called lymphatic system as well as nodes, which can also host a cancer. If the lymphatic system is involved, it’s called lymphoma. This must not be confused with when breast carcinoma spreads to the nodes.

Depending on which type of breast cancer one may have the whole picture of risk factors and management shifts. I would also like to mention a special type of breast disease called phylloides tumour, which is not a cancerous lesion but grows to such proportions that it imitates cancer. This type of disease does not spread beyond the breast and can only be cured with complete surgery.

Carcinomas are by far the most common types of breast cancer and we shall focus on them. They have a habit of spreading to other areas of the body starting in the lymph nodes and later to other organs.

If you draw your attention to the other picture there are about 5 basic lines of risk factors for developing breast cancer. I love this diagram because it arranges them according to the most influential in pyramidal form. Don’t worry too much about the columns on your left we shall tackle those next week during screening and prevention. This week we will shake down the column on the right.

Risk factors for breast cancer and most cancers in general is generally the stem from which myths branch out. As such let’s pay particular attention and possibly demystify them. It will also be prudent for me to mention that look out for the Zambian Cancer Society newsletter, which has a myth-buster article for more on that.

Lifestyle: choosing a healthy lifestyle can reduce the risk for a lot of cancers. A sedentary lifestyle, excessive alcohol intake and unhealthy food choices leading to obesity increase one’s risk of developing breast cancer. If you notice I deliberately expressed it as unhealthy food choices leading to obesity and not obesity within itself. This is because the mechanism for developing obesity goes beyond just food and it must be distinguished early. All these risks are self-explanatory and one must just make an effort to do the needful.

Hormonal and reproductive issues may play a role in breast cancer development. Oestrogen is ‘the female hormone’. An increased uninterrupted amount in the body leads to the development of one the subtypes of cancer. There are many factors, which lead to oestrogen overload. Its really a pity that oestrogen plays such a malignant role because it is a hormone partly responsible as to why the better half of the population look so beautiful and have nice smooth skin! Taking hormone replacement is one of these ways. When a woman reaches menopause she often experiences extreme symptoms such as hot flashes, moodiness and vaginal dryness due to reduced oestrogen levels in the body. Also when a woman does not fall pregnant or breast-feed the body never takes a break from this oestrogen and may increase the risk. This is not an ultimatum though. Not all women who do not have children or breastfeed will develop breast cancer.

Breast cancer like prostate cancer is one of those that you can trace in families. A mistake in the gene we commonly know is called BRCA has been implicated in an increased risk in families. Remember Angelina Jolie and her famous surgery? However, just because the BRCA is negative it doesn’t mean your family is not at risk. This is because we are far from identifying all genes that play a role in different breast cancers in different regions of the world. I will also put race here. It has been established that people of black African descent seem to suffer from more aggressive breast cancer disease and at a much younger age than their peers of other races.

Lastly age is an important risk factor. Older women have an increased risk of breast cancer. Typically this type of breast cancer is hormone positive and if over 60 years has a much milder course compared to when it occurs in younger women (premenopausal).

That in a nutshell is the breast and the risk factors. Next week we will exhaust screening. Looking forward to your emails! Have a blessed week.

‘Success is no accident. It is hard work, perseverance, learning, sacrifice and most of all love for what you are doing or learning to do.’ Pele

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