A A M J Anveshana Ayurveda Medical Journal

Transcription

1 A A M J Anveshana Ayurveda Medical Journal ISSN: Review Article Breast Cancer and Risk Factors Bansode Chitrkala G 1 Sabale Kisan 2 A b s t r a c t Globally incidences of breast cancer increases, breast cancer comprises 22.9% of all cancer (excluding non-melanoma skin cancer) in women. The incidence of breast cancer is rising in every country such as India. In 2015 approximately 40,290 women are expelled to die from breast cancer. More than 3.1 million US women with a history of breast cancer were alive on 1 st January, 2014.Some of these women were cancer-free, while others still had evidence of cancer and may have been undergoing treatment. Certain factor called risk factor increase the likelihood that a woman will develop breast cancer. Many factors known to increase the risk of breast cancer are not modifiable, such as age, family history, early menarche, and late menopause. Factors that are modifiable include postmenopausal obesity, use of combined estrogen and progestin menopausal hormones, alcohol consumption, and breastfeeding. Keywords: breast cancer, risk factors of breast cancer, incidences of breast cancer. 1 PG Scholar, 2 Professor & Guide, Department of Rognidan &V.V, L.K.R. Ayurveda Mahavidyalay, P.G Training and Research Centre, Gadhinglaj, Maharashtra, (India). CORRESPONDING AUTHOR Vd. BANSODE CHITRKALA G PG Scholar, Department of Rognidan &V.V, L.K.R. Ayurveda Mahavidyalay &P.G Training and Research Centre, Gadhinglaj, Maharashtra. (India). dhanvantaree@gmail.com AAMJ / Vol. 2 / Issue 4 / July August 2016

2 INTRODUCTION The vast majority of breast cancers begin in the parts of the breast tissue that are made up of glands for milk production, called lobules, and ducts that connect the lobules to the nipple. The remainder of the breast is made up of fatty, connective, and lymphatic tissues. Breast cancer is typically detected either during a screening examination, before symptoms have been developed, or after a woman notices a lump [i]. In 2015, an estimated 231,840 new cases of invasive breast cancer will be diagnosed among women, as well as an estimated 60,290 additional cases of in situ breast cancer.in 2015, approximately 40,290 women are expected to die from breast cancer. In 2015, about 2,350 men will be diagnosed with breast cancer and 440 men will die from the disease [ii]. More than 3.1 million US women with a history of breast cancer were alive on January 1, Some of these women were cancer-free, while others still had evidence of cancer and may have been undergoing treatment. A risk factors anything that cause breast cancer. Many factors known to increase the risk of breast cancer are not modifiable, such as age, family history, early menarche, and late menopause. Factors that are modifiable include postmenopausal obesity, use of combined estrogen and progestin menopausal hormones, alcohol consumption, and breastfeeding. Many breast cancer risk factors affect lifetime exposure of breast tissue to hormones (early menarche, late menopause, obesity, and hormone use). Hormones are thought to influence breast cancer risk by increasing cell proliferation, thereby increasing the likelihood of DNA damage, as well as promoting cancer growth. Although breast cancer risk accumulates throughout a woman s life, research suggests that the time between menarche and first pregnancy may be particularly critical. Many established risk factors for breast cancer are specifically associated with ER+/luminal breast cancer; less is known about risk factors for ER- or basal-like breast cancers. Understanding of risk factor which may help reduce the risk of breast cancer include avoiding weight gain and obesity, engaging in regular physical activity, and minimizing alcohol intake. Factors associated with an increased or decreased risk of breast cancer are discussed below: I. Personal and Family History: 1) Age: Breast cancer incidence and death rates generally increase with age. During , the median age at the time of breast cancer diagnosis was 61.This increase in risk over the past 4 decades is due to longer life expectancy, as well as increases in breast cancer incidences due in part to changes in reproductive patterns, menopausal hormone use, the rising prevalence of obesity, and increased detection through screening. Between the ages of 60 and 84, breast cancer incidence rates are markedly higher in white women than black women. However, black women have a higher incidence rate before age 45 and are more likely to die from breast cancer at every age.probabily of breast cancer rises with age, but breast cancer tends to be more aggressive in younger women. 2) Sex: Breast cancer is the second higher incidences in India after cervical cancer. Being a women is the most significant risk factor for developing breast cancer, Although men can get breast cancer, too, Higher the exposer to famine hormone(estrogen and progesterone)higher the risk of developing of breast cancer. Women breast cells are continuously changing and growing mainly due to the activity of the female hormones. Men have a low risk of developing breast cancer than women. In 2015, about 2,350 men will be diagnosed with breast cancer and 440 men will die from the disease. [iii] 3) Family history: There is a strong inherited familial risk. Women with close relatives who have been diagnosed with breast cancer have higher risk of developing the disease. If one had one first degree female relatives (sister, mother, daughter) diagnosed with breast cancer have increased risk will be double. If two degree relative has been diagnosed, their risk is 5 times higher than averages. If brother or father having breast cancer, the risk is higher. Family history of ovarian cancer also increases the risk of breast cancer. About 5% to 10% breast cancers are familial and hereditary. [iv] 4) Gene predisposition: Genetic predisposition, such as mutations in BRCA1 and BRCA2 genes, contribute to some of the excess risk of subsequent breast cancers, particularly among women diagnosed at young age. Approximately 5%to10% of all women with breast cancer may have a germ line mutation gene BRCA1orBRCA2.mutations of BRCA1 and AAMJ / Vol. 2 / Issue 4 / July August

3 BRCA2 are responsible for 85% breast cancer.brca1 and BRCA2 are more common in women of Ashkenazi Jewish ancestry. The estimated lifetime risk for developing breast cancer on women with BRCA1or BRCA2 mutation is 56%to87% and he risk for developing bilateral/contralateral breast cancer is about 205 to 40%. Compared to women population those have a 7% risk of developing breast cancer till 70 years of age. [v] 5) Benign breast disease: Non- proliferative lesions are not associated with overgrowth of breast tissue and have little to no effect on breast cancer risk. Examples of nonproliferative lesions include fibrosis (also known as fibrocystic changes), simple cysts, and mild hyperplasia. Proliferative lesions without atypia are associated with a small increase in the risk of breast cancer (1.5 to 2 times the risk of those who do not have one of these lesions) and include non-atypical (or usual) ductal hyperplasia and fibroadenoma. [vi] Proliferative lesions with atypia are associated with the greatest breast cancer risk about 4 to 5 times higher than average risk. These include atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH). [vii] 6) Breast density: Breast tissue density (a mammographic indicator of the amount of the breast s glandular and connective tissue relative to its fatty tissue) has been shown to be a risk factor for the development of breast cancer, with risk increasing with the level of mammographic breast density. Although breast density is influenced by genetics, it is also affected by a number of other factors. In most women, it will change over time, decreasing with age. It is further reduced by pregnancy and menopause. Breast density is generally lower among women with higher body weight because of the higher proportion of fatty tissue.some drugs also affect breast density, including tamoxifen (decreases density) and combined menopausal hormone therapy (increases density). Alcohol may also increase breast density. 7) Personal history: A person who first diagnosed ovarian or uterine cancer has higher risk of breast cancer. The risk is higher if the diagnosis was at a younger age. Man diagnosed with prostate cancer having higher risk of breast cancer. Mother with child has soft tissue sarcoma having higher risk of developing breast cancer in life. Compared to women without a family history, risk of breast cancer is about 2 times higher for women with one first-degree female relative who has been diagnosed, nearly 3 times higher for women with two relatives, and nearly 4 times higher for women with three or more relatives. II. Reproductive Factors a. Menstrual history : Breast cancer risk increases with early menarche and late menopause. In recent era, incidences of early menarche start before 12 age. When girl start menstruating at a young age the time between breast development and first full term pregnancy is usually longer. Breast cancer risk is about 20% higher among girls that begin menstruating before age 11 compared to those that begin at age 13.The longer a women menstruating,the higher her lifetime expose to the hormone estrogen and progesterone. All of these factors are associated with higher risk of breast cancer in her life. b. Pregnancy history: First child at a younger age and having a greater number of children is associated with decreased risk. Whereas having a first child at a younger age and having a greater number of children is associated with decreased risk of breast cancer in women due to decreased level of estrogen. Women who give birth and breast feed by the age of 20 may have ever greater protection.in contrast for instance,having the first birth after the age 30 double the risk compared to having first live birth at age less than 25.Never having children triples the risk. c. Breast feeding: Women who give birth and breast feed by the age of 20 years have great protection from cancer. Especially those women's done breast feeding for more than 1-2 years which results into less risk of cancer. Some reasons regarding breast feeding are given below: Making milk 24/7 limits breast cells ability to misbehave. Most women having fewer menstrual cycles when they are breast feeding result into lower estrogen level. Women avoiding harmful substances during pregnancy like smoking and alcohol consumption. AAMJ / Vol. 2 / Issue 4 / July August

4 d. Hormonal replacement therapy: Studies suggest that recent use of hormonal replacement therapy increase in breast cancer risk. Women who had used HRT 5 year or more years having higher risk of developing breast cancer. HRT related breast cancer had adverse prognostic characteristic (more advanced stages and larger tumors) women who begin use before 20 years of age or before first pregnancy having more risk. There are two type of HRT and each had different effect on breast cancer risk. Combination HRT contains the hormone estrogen and progesterone Estrogen only HRT contains only estrogen Combination HRT increases breast cancer risk by about 75%even used for less time. Combination HRT also increases the likelihood that the cancer may be found at an advance stage as increasing the risk of that a women diagnosed with a breast cancer will die from the disease. III. Other Factors : a) Tobacco: A recent review by American Cancer Society researchers found that women who initiated smoking before the birth of their first child had a 21% higher risk of breast cancer than did women who never smoked. Smoking may slightly increase breast cancer risk, particularly long-term, heavy smoking and among women who start smoking before their first pregnancy. b) Obesity and weight gain: Obesity increases the risk of postmenopausal breast cancer. Risk is about 1.5 times higher in overweight women and about 2 times higher in obese women than in lean women. Breast cancer risk associated with excess weight is likely due, in part, to high estrogen levels because fat tissue is the largest source of estrogen in postmenopausal women. This association might also be explained by the higher levels of insulin among. After menopause, high fatty tissue higher estrogen level increase risk of cancer. c) Exercise: Researches shows exercise and physical activity reduce the risk of breast cancer. Low fat tissue deposition decrease estrogen level so reduce breast cell activity and reduce chance of breast cancer. Daily about min exercise necessary to doing. Growing evidence suggests that women who get regular physical activity have a 10%-25% lower risk of breast cancer compared to women who are inactive, with stronger evidence for postmenopausal than premenopausal women. d) Occupational exposures: A few occupations have been linked to breast cancer risk. One study found an increased risk among women employed in commercial sterilization facilities who were exposed to high levels of ethylene oxide. This chemical has been shown to cause breast cancer in animal studies. Night shift work has also been associated with increased breast cancer risk. Most studies of nurses who work night shifts and flight attendants who experience circadian rhythm disruption caused by crossing multiple time zones have found increased risks of breast cancer associated with long-term employment. e) Diet: Numerous studies have examined the relationship between food consumption (including fat, fiber, soy, dairy, meat, and fruits and vegetables) and breast cancer with mixed results. Early diet and breast cancer studies focused on fat intake. However, a recent meta-analysis of animal fat intake and breast cancer, which included more than 20,000 breast cancer cases, concluded there was no association. Similarly, reducing dietary fat in postmenopausal women did not affect risk of breast cancer in the Women s Health Initiative dietary intervention. f) Alcohol: Numerous studies have confirmed that alcohol consumption increases the risk of breast cancer in women by about 7%-10% for each 10g (roughly one drink) of alcohol consumed per day on average. Women who have 2-3 alcoholic drinks per day have a 20% higher risk of breast cancer compared to non-drinkers. One of the mechanisms by which alcohol increases risk of breast cancer is by increasing estrogen and androgen levels. Alcohol use has been more strongly related with increased risk for ER+ than ER- breast cancers. g) Radiation: Woman who treated early age of 30 with radiation have chance to develop breast cancer. Girls and women treated with high-dose radiation to the chest between 10 and 30 years of age, such as for Hodgkin lymphoma are at increased risk for breast cancer. The risk of developing breast cancer increases in chest radiation if give to adolescences. AAMJ / Vol. 2 / Issue 4 / July August

5 h) Diethylstilbestrol exposure: Old sixty women used Diethylstilbestrol for miscarriages risk; recent research shows that these drugs increase the risk of breast cancer in women. Exposure to estrogen: Estrogen stimulates breast cell growth. If getting higher dose of estrogen for long time having risk of developing breast cancer. Using estrogen for a long period, affects risk of developing breast cancer. Exposure to early menstruation, late menstruation and exposure to DDT which increased estrogen level which cannot be control risk of developing breast cancer. CONCLUSION Risk factors that cause breast cancer affecting mostly breast cell, fatty tissue, estrogen level. But we cannot surely say that causing breast cancer. Understanding of risk factor which may help reduce the risk of breast cancer include avoiding weight gain and obesity, engaging in regular physical activity, and minimizing alcohol intake Prevention is better than cure like avoiding this risk factor which affecting breast cells and there growth. It is important to knowing causative factor to reduce the incidences of breast cancer and mortality and morbidity. Early detection of cancer can cure by chemotherapy, surgery and radiation in Key recent era. Be alert is always better. ΛΛΛΛ REFERENCES i. T J, Verkasalo P.K, Banks E. Epidemiology of breast cancer.lancet Onco, l2(3) ii. Bernstein L, Pike MC, Ursin G, Reproductive factors and breast cancerrisk according to joint estrogen and progesterone receptor status: a metaanalysis of epidemiological studies. Breast Cancer Res, 2006, 8:R43. iii. Nechuta S, Paneth N, Velie EM.Pregnancy characteristics and maternalbreast cancer risk: a review of the epidemiologic literature. Cancer CausesControl, 2010, 21(7): iv. McTiernan A, Thomas DB. Evidence for a protective effect of lactation on risk of breast cancer in young women. Results from a case-control study. v. Am. J. Epidemiol, 1986, 124 (3): 353â 58. Newcomb PA, Storer BE, Longnecker MP, Mittendorf R, Greenberg ER,Clapp RW, Burke KP, Willett WC, MacMahon B. Lactation and a reducedrisk of premenopausal breast cancer. New England Journal of Medicine,1994, 330 (2): 81â 7. vi. Lacroix, M; Leclercq, G. The portrait of hereditary breast cancer. Breast Cancer Research and Treatment,2005, 89 (3): 297â 304. vii. Breast cancer figure and facts viii. Jame Abraham, JameGully, CarmenJ. allegra The bethesoa handbook of clinical oncology, Third edition; ix. Davitta, Halliman and rosenberg's, Cancer principle and practice of oncology review; third Edition x. Kumar K, Jamil K (2006) Methylene tetra hydrofolate reductase (MTHFR)C677T and A1298C olymorphisms and breast cancer in South Indian population. Int J Cancer Res 2: » CrossRef» PubMed» Google Scholar xi. Kumar KC, Murthy S, Jamil K (2007) Possible Association of Splice SiteMutation of Dihydropyrimidine Dehydrogenase (IVS14+1G>A) in Adverse Drug Reactions in Some Invasive Ductal carcinoma Patients. Int J Pharmacol 3: » CrossRef» PubMed» Google Scholar xii. Khan M, Jamil K (2008) Genomic distribution, expression and pathways of cancer metasignature genes through knowledge based data mining. Int J Canc Res 1: 1-9.» CrossRef» PubMed. Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Bansode et.al,.: Breast Cancer and Risk Factors. AAMJ 2016; 4: ΛΛΛΛ AAMJ / Vol. 2 / Issue 4 / July August