Beyond Family History: How Weight, Exercise and Alcohol Shape Breast Cancer Risk

Dr. Anil Kamath, a senior consultant in surgical oncology at Apollo Hospitals on Bannerghatta Road in Bengaluru, has set out what women should know about breast cancer during Breast Cancer Awareness Month, and his central point is that family history is only part of the picture. Weight, exercise and alcohol all figure in his account of who is at risk.

He begins with the scale of the problem. Breast cancer is among the cancers most often diagnosed in women worldwide, and in his words, lack of awareness and delayed consultation remain a serious concern. The awareness month exists, he writes, to help people recognise warning signs and seek medical help early enough for treatment to work.

The disease starts when cells in the breast change abnormally, grow without control and form a mass of tissue. Those malignant cells can invade other parts of the body and the lymph nodes. Most breast cancers begin in the milk-producing lobules or in the milk ducts. Women are affected far more often, but men can develop it too. Kamath is careful to add that not every breast lump is cancer, though any lump or unusual change should be looked at by a doctor to establish the cause.

On risk, he says the likelihood rises with age. A family history of breast or ovarian cancer, and genetic mutations such as BRCA1 and BRCA2, can raise the risk substantially. He also lists irregular menstrual cycles, obesity, a sedentary lifestyle, alcohol consumption and exposure to radiation. Having one or more of these factors does not mean a person will develop the disease. He encourages women to examine their own breasts and learn what is normal for them so abnormalities can be caught early.

The warning signs do not always involve pain. He lists a new lump or thickening in the breast or underarm; changes in the size, shape or contour of the breast; dimpling or puckering of the skin; an inverted or deformed nipple; unusual nipple discharge, including blood; and redness or scaling of the skin. These may point to other breast conditions, he notes, but a professional should rule out the worse possibility.

On detection, Kamath says cancer found while still confined to the breast is more likely to be treated successfully. Self-examination, though, cannot replace the screening tests a doctor recommends. Mammography, a specialised X-ray of the breast, can find cancer early, even before an abnormality can be felt by hand. Age and personal risk determine when screening should start and how often it should happen. People with a family history or higher risk may need specialised tests, and a doctor will recommend the most suitable one based on risk factors and the patient's preferences.

Prevention, he says, cannot be guaranteed. But maintaining a healthy weight, exercising regularly and limiting alcohol can reduce risk. Higher-risk women should ask their doctors how best to lower it. He also stresses that breast cancer is not contagious and that a diagnosis does not mean treatment will fail.

Confirming a diagnosis takes a combination of imaging, physical examination and biopsy, in which a tissue sample from the suspicious lump is examined to see whether it is cancerous. Ultrasound and mammography help show the lump's location and size. Treatment depends on the patient's condition, general health and the stage of the disease, and usually draws on surgical oncology, medical oncology, radiation oncology, pathology and radiology. Surgery may be breast-conserving, removing the tumour while leaving healthy tissue, or a mastectomy, the complete removal of the breast. Radiation therapy may be added to destroy remaining cancer cells.

Kamath urges patients to have realistic expectations of outcomes and to rely on their team of doctors to help them cope with the disease and its treatment. His practical advice for readers is to report any new lump or change in the skin or nipple promptly and to follow a screening plan tailored to their own risk.