It’s wrong to think you only need to be concerned about your mum’s side of the family when it comes to breast cancer. Dr See Hui Ti, medical oncologist at Parkway Cancer Centre, says your genetic predisposition to breast cancer is determined by both maternal and paternal DNA. So, your own risk depends on how many members on each side of the family have had the disease.
But, Dr Evan Woo, a consultant for breast and plastic surgery at KK Women’s and Children’s Hospital, says genetically inherited breast cancers are not common – they make up only five to 10 per cent of cancers.
If several of your relatives had breast cancer, you may be carrying one of two abnormal genes associated with it – the BRCA1 and BRCA2 gene. Carriers have an 80 to 90 per cent risk of developing breast cancer at some point in their lives and a 20 to 40 per cent risk of developing ovarian cancer.
Women who have a family history and believe they are at risk can go for genetic counselling at the National Cancer Centre Singapore, to determine if they require genetic screening tests. This involves a series of blood tests and costs around $1,500. The amount is not covered by Medisave, so you should discuss your options with the genetic counsellor before taking any action.
Angelina Jolie famously removed both her breasts in a double mastectomy when she found out she had breast cancer gene. But Dr Savitha Ramachandran, associate consultant for plastic and reconstructive surgery, at KK Women’s and Children’s Hospital, says as long as you’re vigilant, there’s no need for such drastic measures.
Go for yearly screenings from the time you’ve been identified to carry either the BRCA1 or BRCA2 gene. Breast cancer detected and treated in its early stages has a very high survival rate, whether you carry the gene or not
Even if you opt for a double mastectomy like Angelina Jolie did, surgery will not eliminate your risk entirely. It can reduce your risk of breast cancer by up to 90 per cent, but there is still a remaining 10 per cent. You’ll still need to go for regular checks, such as chest X-rays.
Does your risk of breast cancer increase with cup size? The experts say no – it’s not how voluptuous you are, but how dense your breasts are. High breast density is associated with higher breast cancer risk, says Dr Savitha. Women with more milk ducts, milk glands and supportive tissue relative to fatty tissue in their breasts are said to have higher breast density, which can be observed on a mammogram.
If you have high breast density and have found a lump, a mammogram may not be enough to determine its nature. “The mammogram may present a false negative,” says Dr See. A false negative is when the mammogram test result is negative for a cancerous tumour, but you actually do have cancer. You may need a breast ultrasound or MRI to determine the nature of the lump.
What about breast implants? There is no link between having breast implants and an increase risk of developing the disease. The problem that implants pose is they could obscure the detection of a lump lying beneath it. Such patients should opt for magnetic resonance imaging (MRI) scans instead of mammograms.
Dr See also dismisses the claim that underwire bras can cut off lymph drainage and cause toxins to build up, increasing your susceptibility to breast cancer. “Not true,” she says. “Nevertheless, if your bra is so tight that it cuts off lymph drainage, then your bra size is wrong.”
Some people warn that the harmful radiation from mammograms can cause damage to your cells and cause mutations that result in cancer.
“The level of radiation from a mammogram is the same as you would get from a transatlantic flight,” says Dr See, referring to the ultra-violet and cosmic radiation that airline passengers are exposed to. In other words, the radiation risk is very low.
Besides, says Dr Woo, even if a radiation risk for mammograms can be proven, it would be insignificant – a one per cent association with breast cancer, as compared to the benefit of early detection, which can point to a 90 per cent recovery rate.
As for mobile phone radiation, the jury is still out. There isn’t enough scientific evidence to suggest a clear link.
Breast self-examinations are a good practice but should not be used as a substitute for mammograms, cautions Dr Woo. “In order for you to detect a cancerous lump in your breast, it must already be significantly large,” he says. Relying on self-examinations alone can delay the diagnosis.
In addition, Dr See says mammograms are much more effective because they can spot micro-calcifications, or small calcium deposits in breast tissue that could indicate the presence of breast cancer and could be easily missed during a self-examination.
The doctors’ advice: do a monthly self-exam one week after your menses, and continue to go for yearly mammograms so that any potentially malignant calcifications do not slip under the radar. During your self-exam, feel for any firm or solid lumps. If you have lumpy breasts, look for any changes or new lumps.
You should look out for bloody, milky or clear nipple discharge, nipple retraction, skin dimpling or persistent eczematous rashes over the nipple. If any of these symptoms emerge, consult your doctor as soon as possible.
The medical community is divided on this one. There is no evidence that links oral contraceptives or fertility treatments to a risk of breast cancer.
But studies have shown that hormone replacement therapy (HRT), used to treat menopause symptoms such as hot flashes, can increase your risk. Both Dr Savitha and Dr Woo agree that you should speak to your doctor before deciding whether or not to undergo HRT. It’s a personal choice and depends on whether you feel your menopausal grievances outweigh the cancer risk.
Good news for women who have naturally lumpy breasts – Dr See says pre-existing lumps do no put you at a greater risk of breast cancer. But you should remain vigilant and monitor your breasts for any changes or new lumps in your breasts.
No superfood has been proven to fight cancer. Fahma Sunarja, senior dietitian at Parkway Cancer Centre, says: “Foods like blueberries, turmeric, walnuts, garlic and broccoli contain phytonutrients, antioxidants and vitamins that are good for your health and should be included in your diet, but they do not provide targeted protection against any form of cancer.”
What does put you at greater risk is body weight. The higher your body mass index (BMI), the higher your chances are of getting breast cancer, warns Fahma. You can prevent this with regular exercise and a healthy diet.
You should also avoid consuming alcohol. When alcohol is broken down in the body, a toxic chemical called acetaldehyde is produced, which can damage DNA and proteins. Alcohol also reduces the absorption of nutrients like folate, carotenoids and various vitamins that can help decrease cancer risk. It also increases blood levels of oestrogen, a sex hormone linked to increased risk of breast cancer.
Fahma also recommends eating less red meat and processed food, which have been associated with increased risk of cancer.