Breast Cancer FAQs
In India, 1 in 22 women is diagnosed with breast cancer.
It is extremely rare for women under the age of 30 years to get breast cancer. Only 4% of Indian women diagnosed with breast cancer are in the age group of 20-30 years. 16% cases of breast cancer are diagnosed in women between 30 and 40 years of age, and 28% are in the 40-50 age group. The remainder 52% are over the age of 50 years. So its roughly 50% over the age of 50 years and 50% under the age of 50 years.
If we look at the available statistics (of the year 2012), the number of newly diagnosed breast cancer cases in the United States was 2,23,714 compared against 1,44,937 women in India. That's over 60% more than the number of cases in India. However, in the United States, 43,909 of the 2,23,714 women (~20%) died of breast cancer compared against 70,218 women (~50%) in India. While breast cancer appears to be more common in the United States, more Indian women diagnosed with breast cancer die from it.
Sadly, when women aren't aware of their risk for breast cancer, they don't opt for screening. In fact, less than 3% women in India undergo screening for breast cancer. As a result, the vast majority of breast cancer cases in India are diagnosed at Stage 3, when the survival rates are about 40%. Regular screening can facilitate early diagnosis when breast cancer is treatable.
A diagnosis of breast cancer is definitely scary, and knowing one's risk can be either reassuring (in case of a low genetic risk) or concerning (if a high risk is identified). What is important to understand, however, is the fact that a risk is not a diagnosis. The purpose of risk assessment is to provide the appropriate intervention. If a woman's risk for breast cancer is high, the intervention is regular screening. Screening can achieve a diagnosis as early as Stage 1, when the survival rates are over 90%. With breast cancer, early diagnosis comes with a positive outlook for successful treatment. Regular screening can pick up breast cancer at an early stage, get women started on a treatment plan, and help them get back to fulfilling and productive lives at home and at work.
That is a question that runs through most minds when there is a family history of breast cancer (or any other disease too, for that matter). When a first degree relative (such as a parent or a sibling) is diagnosed with breast cancer, this becomes positive family history and is considered a risk factor. Having said that, the vast majority of breast cancer cases are sporadic; only 5-10% breast cancers are considered to be hereditary and caused by genes passed down from one generation to the next.
- A genetic counselor will take into account your family history and other risk factors to give you a better assessment. There are a few signs of genetic breast cancer that are important:
- - Early onset breast cancer (< age 50 years
- - Bilateral breast cancer (cancer in both right and left breast)
- - Relatives with breast cancer (maternal AND paternal relatives)
- - Family history of other cancers (such as ovarian, thyroid, skin, sarcoma, colon, etc.)
- - A male with breast cancer (not common, but can be extremely significant)
- - "Triple negative" breast cancer
Most cases of inherited breast cancer are associated with abnormalities in 2 genes - BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2). Everyone has these 2 genes as their job is to suppress tumors in breast and other tissues. When these genes have abnormal changes and are passed down from one generation to the next, they aren't able to do their job of suppressing tumors effectively, and this increases the risk for cancer. Abnormal changes in BRCA genes account for 1 out of every 10 cases (10%) of breast cancer. Having said that, an abnormal BRCA gene confers an increased risk - not a diagnosis - of breast cancer. Not everyone who has a BRCA gene abnormality will go on to develop breast cancer, and individuals without BRCA abnormalities may also develop breast cancer.
Studies have shown that, of the 5-10% inherited breast cancers, certain variations in DNA called SNPs (single nucleotide polymorphisms) account for a significant contribution to a higher risk for breast cancer. Other genes involved are TP53, PTEN, ATM, STK11, etc. Genetic counselors are experts in medical genetics and can evaluate family history to determine the most appropriate genetic test, if applicable, and help you decide if genetic testing is right for you or not.
While a high risk for breast cancer sounds scary, it could serve as great motivation to take charge of your own health. There are several things you can do (in addition to life-saving screening) to take control of risk factors for breast cancer. This includes reducing risks attributed by modifiable risk factors including alcohol consumption, obesity, tobacco consumption, nutrition and diet. For example, regular exercise has been shown to reduce breast cancer risk by 10-20%. Your genetic counselor will discuss available options for risk reduction.
Genetic counseling is aimed at assessing and communicating risks for a variety of genetic conditions including cancer. A genetic counselor will conduct a detailed intake of your medical and family history, interpret the information gathered, make a risk assessment, and help you understand what this means for you and your health. As experts in medical genetics and psychological counseling, genetic counselors will answer all your questions, clarify bits of misinformation (such as breast cancer is only passed down from the maternal lineage), give you a risk assessment, and help you decide if genetic testing is right for you. Some people may choose to get tested, others may not, and that’s fine. Genetic counselors focus on what your needs are, and are a great resource to learn about the role genes play in your health and wellbeing.
- - Speak with your parents and relatives about their health history
- - Make a note of any cancers (type, age of diagnosis, treatment, current health, etc.)
- - Ask about BOTH sides of the family. Your genes come from your Mom AND Dad. Paternal history is equally important.
- - Make a list of questions to ask
- - Set aside about 45 minutes for your appointment