I hope I find you in good health. A senior colleague and good friend of mine who is now working down under in Australia requested me to write about breast cancer after reading some of my articles on the Financial Gazette website. He felt this could benefit most of our women and this coming from a general surgeon, the man knows what he is talking about so I couldn't agree with him more. So this week we will talk about cancer of the breast. This is a malignancy that can occur in either one or both breasts.

Just after I started writing this column in July one reader sent me some pretty nasty pictures of breasts affected with cancer. She attributed this cancer to the use of antiperspirants and deodorants. Now I must confess from going through the literature I couldn't find anything linking antiperspirants to breast cancer, but I will take you through some of the risk factors for developing this disease. At this time, age is a major identifiable risk factor. More than 80% of breast cancer cases occur in women over 50. The odds by age are as follows;
- Cancer in women younger than 30 is very rare, accounting for only 1.5% of all breast cancer cases.
- At the age of 40, a woman's chances for breast cancer are 1 in 217.
- At 50, they are 1 in 50.
- If a woman lives to be 85, the odds of her having breast cancer are 1in 8.
Ethnicity also plays an important role as the mortality rate in Africans is twice that of Caucasians. Social and economic factors make it less likely that African women will be screened, so they are more likely to be diagnosed at a later stage.

Inherited genetic factors and family history play an important role in breast cancer. An estimated 10% of all women with the condition have a strong family history of the disease, which often appears under the age of 50. Over exposure to estrogens is another significant factor, because the growth of breast tissue is highly sensitive to estrogens. The more a woman is exposed to estrogen over her lifetime the higher the risk for breast cancer. A year 2000 study suggested that the chance of estrogen increasing breast cancer risk in pre-menopausal women is related to how it is metabolised. In some women very powerful estrogen products or metabolites are generated. These metabolites appear to pause a higher risk for breast cancer. Fortunately the study suggests that healthy diet and exercise may be able to alter this process. There is a higher risk for breast cancer in post menopausal women taking hormone replacement therapy particularly with prolonged use and with formulations containing both estrogens and progesterone. Breast abnormalities such as dense breast tissue or benign proliferate breast disease are associated with a higher risk for breast cancer. The following physical characteristics have been associated with greater risk:
- Obesity, the risk appears to be greater in those who gain weight after the age of 18.
- Women with heavy, dense bone tissue are at a greater risk for breast cancer

Environmental factors such as exposure to estrogen-like chemicals and radiation exposure increase the risk of breast cancer.

Breast cancers in their early stages are usually painless. Often the first symptom is a discovery of a hard lump. Fifty percent of such masses are found in the upper outer quarter of the breast. The lump may make the breast appear elevated or asymmetric. The nipple may be retracted or scaly. Sometimes the skin of the breast is dimpled like the skin of an orange. In some cases there is a bloody or clear discharge from the nipple. Many cancers however, produce no symptoms and cannot be felt on examination; they can be felt only with the use of a mammogram.

While women can do nothing about their genetics, ethnicity or age there is a lot that can be done to lower the risk of breast cancer.

A number of studies have suggested that regular exercise particularly if it is vigorous, offers some modest protection against breast cancer. Many fresh fruits, vegetables contain chemicals that may be cancer fighters. Experts are investigating whether any specific vitamins, nutrients, or teams of them maybe specifically valuable. Avoiding alcohol reduces the risk of breast cancer. A well conducted 2003 analysis of several studies suggested that for every daily drink there was a 7.1% risk increase in breast cancer. Several studies reported that breast-feeding is associated with a lower risk for cancer in pre-menopausal women.

Early diagnoses of breast cancer significantly reduce the risk of death. Every woman between the age of 20 and 40 should have physical examination by a health professional every 1 to 2 years. Those over 50 should be examined annually. Women are encouraged to perform self examination each month although this should not replace the annual check up by their doctor. Other methods of diagnosis like imaging techniques, biopsies and lymphatenectomies maybe used.

The three major treatments for breast cancer are surgery, radiation, and drug therapy. No one treatment fits every patient, and some combination therapy is virtually always required. The choice is determined by many factors including age of the patients and (among women) menopausal status, the kind of cancer, its stage and whether the turmor contains hormone receptors or not.

Till next week take care of yourselves and each other.