In the past 10 years of my practice, a lot has changed with respect to disease, its treatment, demography, or even the causes of disease. Suffering from communicable diseases, we now face the onslaught of non-communicable or lifestyle diseases.
Lifestyle diseases, as the name suggests, is in itself an “individualized disease”. The prevalence of breast cancer has gone upto 21.5% in Indian women, which means, almost 1 in every 4 women have breast cancer. It depends largely on our lifestyle choices- sleep patterns, alcohol consumption, stress levels, medication history, dietary choices, Race(American African are more prone than Caucasians) intake of preservatives etc. Breast cancer though will also be greatly dependent on genetics, time of menarche, menopause etc. This reminds me of a patient who came to me last week, Mrs. Joshi.
Why do I Have cancer?
As Mrs. Joshi walked into my clinic, I could see the evident stress and tension on her face. She sat down with a thump into the chair, and asked me, “WHY ME? I don’t smoke or drink. Then why do I have cancer”?
I did not have any easy answer to that. I knew she had been diagnosed with Ductal Invasive breast cancer(many other types of breast cancer are also prevalent, some benign and some malignant). This meant that cancer started in the milk ducts and had “invaded” or spread to the surrounding breast tissues. It is the most common type of breast cancer, almost 80% of breast cancer cases are of this type. Breast cancer is not limited to women, it also affects men.
Today, I had to do the toughest work of a doctor, telling Mrs. Joshi that breast cancer has multiple risk factors and the precise causes for cancer are still unknown. So I said, “Mrs. Joshi, this is a difficult phase for you and your family. We can’t blame only one risk factor as the reason for this. This is a condition which has multiple causes behind it, most of the times, many of these causes inter-play with each other. The strong Mrs. Joshi, pulled herself together, and asked, “So what are the causes for breast cancer?
Causes of Breast Cancer
I was proud of her strength. I replied, “advancing age, especially if you are above the age of 50 years makes you more prone to Breast cancer. Also, a family history, where your mother, sister or daughter has had breast cancer, increases your risk of having it by 2-3times. Also, a genetic angle is there to it, wherein the presence of BRCA1 or BRCA2 genes (1 in every 200 women have it) when present may predispose a woman to have breast cancer. Though genetics may not ensure that a woman would have it.
Relationship with dietary habits and the incidence of breast cancer are still debatable. To answer your previous question though, regular alcohol intake may surely make you more susceptible to having breast cancer”.
Does menstrual history play a role in developing breast cancer?
She nodded in understanding before saying, “so most reasons for someone having breast cancer are not avoidable? Although at my age, will my menstrual history also be responsible for it?
I smiled at the fact that she related advancing age and menses even under such stressful conditions.
So I proceeded, “Yes Mrs. Joshi. You are right. Menstrual history is an important reason along with obstetric history. The chances are higher if a girl has her first periods before the age of 12 years. This was very rare 20 years back but is common now. A menstrual cycle of shorter/longer than 26-29 days may also be a cause. Another important reason which cannot be overlooked in today’s scenario late pregnancies. If a girl has her first child after the age of 30 years (again something that is becoming increasingly common nowadays) she is at risk of breast cancer.
Even the consumption of oral contraceptive pills (OCPs) has been debated to increase the risk of breast cancer, though researches have suggested that this risk is nullified if there is no consumption of OCPs for 10years. Finally, menopause occurring after the age of 55 years, poses a risk for breast cancer.
Do hormones play a role in developing breast cancer
She took a minute before asking her next question and seemed to be digesting this information. Finally, she asked me, “So, Dr. Patil, it has something to do with hormones as well then?”
She had stumped me again with her insightfulness. I had never imagined that this consultation was going to be so fact based as opposed to the emotional onslaught I expected from her.
This time, I pulled myself together, and answered in all honesty, “Mrs. Joshi, you have again hit the ‘bull’s eye’. It is the hormones that play a very major role here, especially, Estrogen. A woman experiences high and low levels of estrogen and progesterone all through menses, childbirth, and menopause. Estrogen levels rise in the body from birth upto puberty, then they vary throughout the lifetime when a woman is fertile. They rise just before ovulation and then fall. Estrogen levels suddenly rise during pregnancy as well, these high levels are very helpful during pregnancy as they stimulate the growth of the woman’s body to take care of the baby who is about to come. Estrogen has a unique function to instruct fat cells to divide, thus increasing the number of fat cells in the body. So, what I am trying to say is, Estrogen is not the “devil” here.
The problem gets complicated when our diets become high in fats (especially saturated fats), lifestyle becomes more sedentary, muscle mass reduces and fat increases within the body, pushing us towards obesity. In such a scenario, estrogen is still doing its primary function, increasing the number of cells- but here, the original number of cells have themselves gone up”.
Can breast cancer be prevented
Mrs. Joshi, understandingly said, “I could have prevented it with lifestyle changes?”
I sighed, and said, “Mrs. Joshi, I don’t know if this could have been avoided or not. But yes, with a good healthy diet, regular exercises, and a healthy lifestyle, chances of warding off a lot of diseases included breast cancer are better. Here, your exposure to estrogen within the body was higher than normal due to irregular menstrual cycles and Hormone replacement therapy mostly constituted by estrogen, added to that is also your eating habits and your weight.
Slight changes in the diet and lifestyle go a long way. Agreed that you do not consume alcohol or smoke, but the lifestyle is a much larger term. Maintaining a healthy weight as per your height and age is important, regular exercises- both aerobic and weight-bearing- are an essential part of our well-being, eating healthy meals- especially reducing the consumption of refined flour (maida and bakery products), and foods with preservatives help in maintaining weight. Low-fat foods are vital too- while keeping the total fat energy percentage to 20-30% of the total energy, increasing omega-3 fatty acids and reducing saturated fats.
Soya- to eat or not to eat
She looked up, and said, “One last question- So Should I eat soya or not?”
She stunned me once again. I answered, “Soya contains isoflavones, which act like estrogen and mimic some of the natural activities of natural estrogen. Some researchers suggest that due to its estrogen-like components, soya may increase estrogen levels, which has not been established yet. In a few types of research, heavy soya isoflavone doses were given to rats, and the incidence of breast cancer was seen to rise. No such results were seen in humans. So it is safe to say, that consumption of organic or natural soya (non- Genetically modified) is fit for human consumption.
Satisfied, Mrs. Joshi, smiled and said, ”well, that means, my family history, my genes, my menstrual history, and my menopause- all played a role in my having breast cancer- and I did not have control over any of these. On the other hand- my diet, exercise regimen, my weight and lifestyle choices, which I had a control on- I did not take care of them.”
So, to cut long story short “You mean to say, that the hormones and the body do their work, but we fail to live up to our side of the responsibility!”