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By Dr Ann
QI’m 35 years old and have two female relatives who have had
breast cancer. Am I more likely to get breast cancer than a woman
who has no family with the disease? Worried.
ABreast cancer is more common than most people think. Even
though we are told that it is the biggest killer of Australian women,
most of us do not wake up in the morning wondering if it will
happen to us. Recent statistics indicate one in eleven women will have
breast cancer in their lifetime. Because this is such a high rate, it means
most of us know someone or have someone in our family who has had
the disease. This does not mean, however, that you automatically are at
higher risk of getting breast cancer yourself.
There are a number of factors that place a woman in the higher-risk
category for breast cancer. One is early menarche (the age at which you
began menstruation). Another is late menopause (the age your periods
stopped). It’s thought that the reason for this is that the longer you are
exposed to estrogen, the more chance of getting breast cancer. Similarly,
if you have not had children you have a 40% higher risk of breast cancer
than a woman who has given birth. Women who have their first child early
in life have a lower risk of breast cancer. The more children you have, the
lower your risk.
After menopause, it is thought that the risk of breast cancer increases
according to body weight. The more weight, the higher the risk, because
fat can convert other hormones to estrogen, increasing your estrogen
level. For women who are pre-menopausal, taking the oral contraceptive
pill raises the risk of breast cancer by 24%, but the overall lifetime
risk is low, because women in this age group have a low underlying
risk of the disease. Hormone replacement therapy with estrogen, which
some women take after menopause, increases the risk of breast cancer
Women with first degree relatives with breast cancer have a higher risk
of the disease. Having a mother or sister with the disease can increase
your risk by 2-3 times. The highest risk exists in those women who have
inherited one of the genes that contribute to breast cancer. If a relative has
had this genetic testing performed, the results may indicate whether other
female family members should be tested too. Women who are relatives
of women who test positive for these genes have an 80% lifetime risk
of breast cancer. But the number of these type of gene-positive breast
cancer is small: they make up only 1-2% of all breast cancers.
Most women with breast cancer notice symptoms which cause them to
see their doctor. Symptoms include finding a lump in the breast on self-
examination, changes in the nipple such as discharge or skin retraction
or scaliness, changes in the skin of the breast such as dimpling or
discolouration, or pain (this usually occurs only in 10% of cancers)
Screening for breast cancer has been investigated extensively by the
National Breast Cancer Centre. Mammograms are effective in detecting
breast cancer, but it depends on the age of the woman having the
mammogram. The problem is that in younger women, the mammogram
may pick up a change in the breast which is not cancer-related (a
false positive), or it may fail to show cancerous changes in a woman
who actually does have a cancer (a false negative). The Centre has
recommended that women between 40 and 49 have free two-yearly
mammograms via BreastScreen Australia. Between 50 and 69 is when
mammograms are most effective at picking up cancers accurately.
Women under 40 and over 70 may have the 2 yearly screens but their
effectiveness is not as high as for the 50-69 year age group.
Women with first degree relatives with breast cancer should see their GP
to discuss which tests would be the best. This will depend on your age,
the nature of the breast cancers in your family, and other health factors.
For everyone else, self-examination and awareness of the symptoms
of breast cancer, combined with using the BreastScreen program is
recommended. Visit the National Breast Cancer Centre’s website www.
nbcc.org.au to learn more.
Dr Ann is a doctor at a Sydney metropolitan area hospital. The opinions
expressed in this column are those of the author and are not intended as
a substitute for medical advice. If you have concerns about your health
please consult your health practitioner.
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