Delayed first pregnancy risk factor for breast cancer

HEALTH|BEAUTY

Globally there were 2,880,849 cases of breast cancer in 2018, according to Globocan statistics.  It made 11.6% of all cancer cases in the world, which makes breast cancer the second most diagnosed cancer, after lung cancer.  

"The difference is only in hundreds meaning breast cancer could be the leading cancer globally in the next Globocan report," says Dr Noleb Mugisha, the head of cancer prevention at UCI.

In Uganda, 2,318 people were diagnosed with breast cancer in 2018, according to Globocan 2018 statistics. Last year, the total number of cancer patients received at the Uganda Cancer Institute (UCI) was 5, 026.

Breast cancer made about 10% of the cases "which is a big number" says Dr Mugisha. Breast cancer is rising because of lifestyle even though in some populations the biggest risk factor is genetics. However, even if we say so, genetics is responsible for only 5% to 10% of breast cancer cases.

So what are the biggest risk factors?
Diet and body weight
The biggest risk factor for breast cancer is diet and body weight, says Dr Mugisha. "The more the global population becomes affluent, the amount of meat people eat goes high, the amount of fat people take in goes high, the amount of alcohol consumed also goes high, all these are going to increase the risk of breast cancer," he says.

 Unchecked estrogen hormones/ Delayed first pregnancy  
The risk of breast cancer is also associated with unchecked estrogen hormones. "If a woman delays their first conception up to the age of 40, their risk for breast cancer goes higher because all this time their estrogen hormones have not reduced because of anything in their body that increases the risk."

"The cells in the breast become cancerous. So delayed first pregnancy is a risk," says Dr Mugisha.

Not breastfeeding
When a mother chooses not to breastfeed, it increases their risk of getting breast cancer, according to Dr Mugisha.
He says there have been also questions about family planning methods.

"They do not change the risk for breast cancer that's why we would recommend getting it from an authorised family planning center," he says.

Other risks
Obesity (having High fat in the body) is a big risk so that means eating high fat diet is a risk, explains Dr Mugisha. A sedentary lifestyle (doing minimal physical activity) is also a risk factor for breast cancer.

Consuming excessive alcohol is also a risk. Research has shown that the risk of breast cancer increases with the increase in the quantity of alcohol consumed.

Genetics is another risk factor for some people too however in the Ugandan setting it is not known what proportion of patients have a genetic predisposition.  

"So in principle everybody is at risk but there are those individuals who have a gene that is responsible for breast cancer, a BRCA gene."

"Also in Africans and people with African roots globally, breast cancer seems to occur at a younger age and it's also more aggressive. More aggressive in the sense that it progresses faster and it's also more difficult to treat."

"It tells us that the biology of our breast cancer is different from the Caucasian which is true with many diseases including COVID-19," says Dr Mugisha.

He explains the world is affected differently because of the genetics, exposures are different. "We are human beings but we are different in the way our bodies work," he states.

Manifestation and treatment
Like all cancers breast cancer doesn't begin with pain. Many breast cancers will begin with a swelling in the breast that you can press with your hands and feel, explains says Dr Nixon Niyonzima the Head of Research and Training Directorate at UCI.

 "If it's too small for the hands to feel a mammogram or an ultrasound scan will show it." "After that we go ahead and examine it. We put in a needle and removing some cells from that swelling and examine if its cancer or not.  If we find they are cancer then we go ahead and start the treatment," explains Dr Mugisha.

He states breast cancer treatment is by surgery if the swelling is operable. "But even if its operable we usually  add chemotherapy because it's rare for us to tell that we totally removed the cancer in that there are no any other cancer cells in the body," he explains.
"Perhaps if we had hi-tech investigation capacity we could confirm that there is no cancer in the body, but unfortunately we don't have that privilege yet," adds Dr Mugisha.

He explains after surgery one is usually given chemotherapy, then radiotherapy, and finally hormonal therapy, "we give all the four modalities of treatment to a patient to maximize the chances of curing the cancer once and for all."  

"That's the importance of screening early. Come for screening and when the results come, it's important to follow through with the doctor's recommendation to the very end," he says.

Dr Mugisha explains breast cancers can be different biologically, and they will behave differently ."One patient can be treated and they respond very well to a treatment while another patient is treated and they do not respond very well."

"We have different treatments even when it comes to chemotherapy for different types of breast cancers," he explains.
"Breast cancers also have different types. One woman can have a particular type and another woman a different type."

"The drugs for treatment are different and the response to treatment are likely to be different that's why it's important that treatment for breast cancer is sought in the right treatment centers for cancer," he adds.

Dr Mugisha says there are many medical workers in this country that want to treat cancer in their small clinics and that's where the error happens.  

"Somebody could think when you remove the breast tumor you remove the cancer that's wrong." You could remove a swelling but you find that there are cells that had already moved away from that swelling and moved into the blood stream and are being deposited maybe in the live and lungs and one year later the same patient comes coughing blood or with a swollen abdomen or even confusion because the cancer went to the brain."

"It's so important that breast cancer treatment is sought from the right places however difficult it might be," says Dr Mugisha
"True we have very many patients, patients have to wait, drugs can have very bad side effects but patients have to bear with that."  
The beauty is that after all this treatment is over all the side effects disappear, the hair grows, the nails return to normal."

"Unfortunately many people come late but we hope that we can reduce this proportion of those who come late."
"Breast cancer is one of the cancers that has treatment that has been proved and works and there many patients that actually survive breast cancer," says Dr Mugisha.

Breast cancer checks (mammogram and ultrasound scan)
Breast cancer screening starts with Clinical Breast Examination (CBE) for all the women when one comes for a checkup, explains Dr. Mugisha. "It is done by us health workers using our hands, in an effort to discover signs of breast cancer."   
"When something is found in that requires further investigations, usually the investigations are image studies," he explains.
He explains for women below 40 an ultrasound scan is done.

For those 40 years and above a mammography is done. "The reason is that mammography is good for breasts whose tissue is already a bit loose, it's not as firm as for a teenager. When the breast is very firm a mammogram is not the best because when we are doing mammography we press the breast between plastic plates and squeeze it so that the x-rays can go through well enough to show the swelling that might be inside the breast."

"If the breast is still dense you cannot squeeze it much because it's still firm. If you squeeze it you hurt the person you are screening."  
"It's best to use ultra sound scan which sends sound waves through the breasts to show swellings, to avoid squeezing the breast for those below 40," says Dr Mugisha.

"Of course a stenographer could squeeze using the probe but that is not as Intense like when we squeeze the breast using a mammogram," he adds.

How best to deal with breast cancer
"The most important tool that anyone has against breast cancer is self-breast examination," says Dr Mugisha "You are with your breasts at all times, you can even examine it every day as you take a bath. That's the best remedy." "The people we have diagnosed with early stage breast cancer many have always said ‘I found this swelling.'"  

"If everyone can examine their own breasts many breast cancers would be discovered early," he says.
Dr Mugisha says people come with an ulcerated breast tumours and say "I saw it last week" meaning that for many people it's like a taboo to touch and talk about their breasts.

"We recommend that everyone learns to examine their breasts. There is no rocket science to it. It's pressing the breasts against the ribs if there is any swelling, anything that feels unusual take it to the health worker to confirm to you what it is."
"Even if it's a swelling that is not cancer its good you know and get it treated because later on if its cancer then it's probably discovered early, treated and cured," he says.

Dr Mugisha says for who are 30 years and above go for breast cancer screening, and it's a strong recommendation for women because for them the risk is higher of having breast cancer diagnosis.  

How often you screen depends on the distance to hospital, how far or near is it, how much time you have, and if the screening affordable.

For those younger it's important to learn how to self-examine the breasts. Keep abreast of the status of the breasts at all times.
Solution for career women who delay first conception.

Lifestyle is a very difficult, it's like religion, they are very difficult to change. But if one is a career woman it would be good in their career to also want to have a family, says Dr Mugisha.

"It's hard, but this is why the incidence of breast cancer is on the increase, because the lifestyle society is tending to increases the risk of breast cancer, including pursuing a career as opposed to starting a family early."

"It's Hard to advise bit if I can give recommendations to a career woman I would say factor in family or bear the risk of breast cancer."
"What is unfortunate about disease prevention, it's a hard sell to make because people are not sick, and it's hard to market good lifestyle," says Dr Mugisha.

He says the onus is parents of children to know that lifestyle is inculcated in childhood, it is hard in adulthood to change one's lifestyle.
"But for a career woman what can really tone down the risks, is do your physical activity properly."  "Jog for one hour for days a week, make  sure you have adequate fruits and vegetables, minimise the meat, the high fat diets, even the  high calorie diet," he says.

For example rice, posho and cassava. Taking too much of calories is also not good because excess of it, is converted into fat.  
"Also cut out the alcohol, and the smoking, it will reduce the risk of breast cancer. In addition, do regular breast screening, it should be a lifestyle," he says.

For those 40 years and above go for a mammogram, if the doctor says come after three years, go.  Chances are higher when the breast cancer swelling begins they can catch it, treat and cure, says Dr Mugisha.