Breast cancer an ever-present risk

Women with no apparent family history of breast cancer should still practice due diligence, specialists caution.

A misconception among women is that one is safe from the disease if there is no history of breast cancer in the family. As a result, some women may take a more casual attitude towards the disease “Even if one has no known family history of cancer, external factors such as environmental exposures, prolonged exposure to female hormones and lifestyle features may contribute to an increased relative risk of breast cancer,” said Dr Winnie Ng, a consultant clinical oncologist.

Ng added: “There are numerous underlying causes of cancer. One cannot assume that only genetics play a part. Alcohol intake and smoking are also lifestyle factors that increase risk of breast cancer development.” Additionally, prolonged exposure to female reproductive hormones is also a known risk factor. These are women who have their first menstrual period at a young age, have never been pregnant, have their first full-term pregnancy at a late age, or are using oral contraceptives. Additionally, a delayed menopause increases the risk of developing breast cancer. Postmenopausal women on hormone replacement therapy or who are obese are also at an increased risk of breast cancer.

“Therefore, women with no family history of breast cancer should not take screening lightly as it is essential for early detection and recommended for women across all age groups, and those exposed to higher-risk factors. The easiest method of screening is by self-examination of the breast.”

Those with a family history of breast cancer or genetic mutations that are inherited would fall under the category of non-modifiable risk factors. If a woman has a breast cancer-diagnosed mother or sister, her risk of developing breast cancer increases 1.5- to 3-fold. Mutations in breast cancer susceptibility genes such as *BRCA1 and BRCA2 are also associated with a substantial increase in breast cancer incidence. Certain benign breast conditions also contribute to increased risk, while additional exposure to ionising radiation, such as multiple diagnostic chest X-rays or chest irradiation at a young age, also increases the risk of breast cancer.

Symptoms of breast cancer may include breast enlargement or lymph node enlargement under the arm, an itchy or irritated breast, a change in breast colour, or an increase in breast size or shape. Self-examination may reveal that the breast skin feels hard, tender, or warm, and that the nipple skin is red, peeling, or flaking. Some individuals may observe skin dimples or an inward-turning nipple, also known as nipple retraction. These symptoms may or may not accompany breast discomfort.

With regard to genetic testing, Professor Dr Pathmanathan Rajadurai, a consultant pathologist, said there are two types of tests for breast cancer: germline testing, which detects inherited mutations, and somatic testing, which detects mutations that arise randomly in the tumour.

“Next generation sequencing (NGS) germline testing for BRCA1 and BRCA2 mutation detection can be performed on patients with a strong family history of breast, ovarian or pancreatic cancers. It is recommended that a patient receive genetic counselling prior to and after testing for hereditary mutations to allow them to make informed decisions regarding genetic testing. For instance, counselling can assist in determining if individuals are suitable candidates for genetic testing.”

Ed: *BRCA and BRCA are a human gene and its protein product, respectively. The official symbol has italic for the gene and non-italic for the protein and is an abbreviation for BReast CAncer.