Introduction

Breast cancer has now become a major health concern across the globe. An estimated 2 million people develop breast cancer every year. Country specific estimates vary from approximately 230,000 in US to 150,000 in India. The statistics for Africa, Central Asia and Middle East are unavailable. By next decade, Breast Cancer will be the cause of maximum women deaths in the world. It affects the Afro-Asians women at comparatively younger ages and more than half of the cases are detected at an advanced stage. The middle age is an important phase of a woman's life, both as a life partner and as a mother. It is a pity that women are now getting entangled in this rising menace of Breast Cancer, when they are in their most productive phase of life cycle.

Preventive Measures:

Breast Cancer is broadly of two types, the first type is influenced by the lifestyle related factors and the second type is caused by the faulty genes. The proportion of genetically induced cancers is fortunately low, and most of the breast cancers are a result of lifestyle related factors, which makes it all the more important to make people aware of the disease and the preventive measures which can save them from this disease. The deciphering of Human DNA and techniques such as Multi gene sequencing has ushered a new era, helping to ascertain the defective genes pre-emptively, due to which timely intervention is possible, and hence leading to prevention of cancers.

Certain hormones such as estrogen and progesterone play an important role in development of cancer. Estrogen promotes cell growth and progesterone causes cell maturation and stabilization. It is in the growth phase that cell undergoes malignant transformation, i.e. cancer formation occurs. Therefore, factors such as early menarche[start of menses], late menopause[stopping of menses], alcohol, obesity and lack of exercise, stress, etc cause increased estrogen exposure and increase the chances of developing cancer. Whereas; timely pregnancy, proper and adequate lactation, healthy lifestyle induce progesterone and decrease the chances of cancer occurrence. Smoking is an independent risk factor for developing cancer. A healthy stress free lifestyle, timely pregnancy, adequate lactation and abstinence from tobacco and alcohol are some measures, which can definitely decrease the incidence of Breast Cancer.

Process of Detection:

Besides the above mentioned preventative measures, screening can be done to detect this unfortunate disease at an early stage, to save a precious life. The American Cancer Society Guidelines Screening highlight:

• Yearly mammogram with ultrasound (Sonomammography) should be done starting at age 40 and continuing for as long as a woman is in good health
• Clinical breast exam (CBE); examination by doctor about every 3 years for women in their 20s and 30s and every year for women 40 and over
• Women should know how their breasts normally look and feel and report any breast changes to a health care provider immediately
• Those who have family history of Breast Cancer, should start Screening Mammogram 10 years before the index case. This means that if a woman's mother or aunt were detected with Breast cancer at the age of 45 years, she should start her yearly Mammogram at the age of 35, rather than at the age of 40

Genetic Breast Cancer

The genetic (hereditary) variety of breast cancer is caused by certain genes. Amongst them, the most common genes are BRCA 1 & BRCA 2 and these constitute 5 to 10% of all breast cancers. A woman carrying BRCA gene has 50 % lifetime risk of developing breast cancer and this type of Breast Cancer tends to occur at younger ages.

Who should undergo BRCA testing?

This is an important question, which need to be properly answered, and people be made aware of this important information.

US Preventive Service Task Force suggests the following to undergo BRCA testing:

• Cancer at < 50 years
• Multiple cancer recurrences or cancer in both the breasts
• Both breast and ovarian cancers in the same woman
• Male having Breast Cancer
• Ashkenazi Jew Ethnicity

The above-mentioned are just recommendations from the West. The Afro-Asians guidelines are yet to be formulated. The BRCA testing should never be done as over the counter test. It has to be prescribed by a Breast Oncologist and should only be done after a genetic counselling session. The direct medical harms of genetic testing are minimal, but knowledge of test results may have harmful effects on a person’s emotions, social relationships, finances, and medical choices. Professional Societies also do not recommend children to be tested for BRCA, and test is not recommended until a patient has achieved adulthood and genetic counselling has been done. These genetic tests are now being done in India as well at accredited laboratories, which has considerably reduced the test costs.

What is to be done for those who test positive for BRCA?

There are two courses of action, which are taken to prevent cancer related death. First, Intensify screening, by starting it at an early age of around 25 to 30 years. MRI is conducted along with Ultrasound and Mammogram, and MRI and Mammogram are usually done every 6 monthly in an alternate fashion. Second, Offer Risk Reducing (Prophylactic) Mastectomy with simultaneous or successive removal of ovaries, whenever a woman feels comfortable. It is a very important and difficult decision to remove one's normal breasts, but with advances in reconstruction techniques a woman is able to get her breasts back, thus minimally affecting the routine life. . Angelina Jolie is a living example of it. Therefore, BRCA testing if timely done and with appropriate interventions, the risk of Breast cancer can be reduced by 90%.

Breast Cancer can be prevented with certain lifestyle changes in all women and properly informed genetic analysis in select women. Certain methods like Screening and Risk reducing surgery are really effective in saving life from this menace.