Oc­to­ber is Breast Cancer month

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Oc­to­ber is Breast Cancer Aware­ness Month in Canada. Each year in Canada, Oc­to­ber is rec­og­nized as Breast Cancer Aware­ness Month. Breast cancer is the most fre­quently di­ag­nosed cancer among Cana­dian fe­males, af­fect­ing thou­sands of women and their fam­i­lies each year. In 2008, an es­ti­mated 22,400 women will be di­ag­nosed with breast cancer and 5,300 will die of it. One in nine women is ex­pected to de­velop breast cancer - with the risk in­creas­ing sig­nif­i­cantly af­ter the age of 50. One in 28 will die from the dis­ease. Although, since the mid-1990s, the in­ci­dence of cancer and death has de­clined, it con­tin­ues to be a life-threat­en­ing is­sue for thou­sands of Cana­dian women. The Na­tional Union of Pub­lic and Gen­eral Em­ploy­ees (NUPGE) con­tin­ues to en­cour­age its 340,000 mem­bers to take an ac­tive part in the fight to end this dis­ease. An es­ti­mated 170 men will be di­ag­nosed with breast cancer and 50 will die of it. Breast cancer death rates have de­clined by 25% since 1986. In­ci­dence and death rates for breast cancer have de­clined since 1969 in women aged 20-39. Sur­vival has been im­prov­ing grad­u­ally. To­day sur­vival ranges between 87% and 89% for women aged 40 and older. For women un­der 40, sur­vival is 81%, ex­clud­ing Quebec.

What you can do

Many women are alive and well to­day be­cause their breast cancer was de­tected and treated early. The Cana­dian Cancer So­ci­ety rec­om­mends that women: • Have a mam­mo­gram ev­ery 2 years if you are between the ages of 50 and 69. If you are between the ages of 40 and 49, dis­cuss your risk of breast cancer and the ben­e­fits and risks of mam­mog­ra­phy with your doc­tor; • Have a clin­i­cal breast ex­am­i­na­tion by a trained health pro­fes­sional at least ev­ery two years if you are between 40-69; • If you are 70 or older, talk to your doc­tor about a screen­ing pro­gram for you; • Talk to your doc­tors about any changes. There is no sin­gle cause of breast cancer but there are cer­tain fac­tors that may ap­pear to el­e­vate the risk. Th­ese in­clude: • Age – Risk of di­ag­no­sis in­creases as a per­son ages • Per­sonal his­tory – If a per­son has pre­vi­ously bat­tled the dis­ease • Fam­ily his­tory – Es­pe­cially if a mother, sis­ter or daugh­ter has en­coun­tered breast cancer • Fam­ily his­tory of ovar­ian cancer • Tak­ing hor­mone re­place­ment ther­apy for more than five years• Dense breast tis­sue • Other pos­si­ble risk fac­tors – Poor diet, lack of ex­er­cise, smok­ing, and obe­sity Some­times, women de­velop breast cancer with­out any of th­ese risk fac­tors. A lot of women af­fected by breast cancer don’t have a fam­ily his­tory of the dis­ease. Even more sur­pris­ing, some women have risk fac­tors and never en­counter the dis­ease. Un­for­tu­nately, be­cause of this un­cer­tainty, early de­tec­tion means a lot. Health pro­fes­sion­als rec­om­mend that you see them if you find any changes with your breasts such as: • Size and shape • If you find a lump on your breast or a lump in your armpit area • Skin changes on your breast (such as peel­ing) • Phys­i­cal changes you find in the ap­pear­ance of the nip­ple Here are 9 ways to change your life:

1. Eat Fruit

You can’t go wrong with this – al­most all di­etary ad­vice comes down to the sin­gle in­struc­tion to eat more fruit and veg. Diet is thought to be a key fac­tor in one in four cancer deaths – and an­i­mal fat in the diet is the sus­pect in­gre­di­ent in breast cancer. The Ja­panese, who eat a diet of fish, rice and veg­eta­bles that is ex­tremely low in an­i­mal fat, also have low rates of breast cancer. A high-fat diet in­creases the lev­els of the fe­male hor­mone oe­stro­gen in the blood, which en­cour­ages the growth of cancer cells. In pop­u­la­tions with a high-fat diet, women tend to start their pe­ri­ods ear­lier and reach menopause later so they are ex­posed to high lev­els of oe­stro­gen for longer, in­creas­ing their risk of breast cancer. Stud­ies into what ef­fect eat­ing fruit and veg­eta­bles has on breast cancer have pro­duced mixed re­sults. One study found that, when com­bined with tak­ing ex­er­cise, the re­sults were dra­matic. Pub­lished in the Jour­nal of Clin­i­cal On­col­ogy last June, it showed that women who ate their five por­tions a day and walked briskly for at least 30 min­utes halved their risk of breast cancer.

2. Walk

It is en­joy­able, sim­ple and re­quires no equip­ment. Walk­ing is good for all as­pects of phys­i­cal and men­tal health – and cancer is no ex­cep­tion. Brisk walk­ing (or other ex­er­cise) for 30 min­utes a day, five times a week, is all that’s needed. Cur­rently only one in four women man­ages this. If all women did, Cancer Re­search UK es­ti­mates it would pre­vent 1,400 cases a year. Three large stud­ies in Italy and the US showed that in­ac­tiv­ity caused 11 per cent of cases of breast cancer. Ex­er­cise works best be­fore the menopause, but it is ef­fec­tive af­ter­wards, too. It is thought to al­ter oe­stro­gen me­tab­o­lism, re­sult­ing in a weaker ver­sion be­ing made.

3. Avoid HRT

Hor­mone re­place­ment ther­apy is seen as the prin­ci­pal avoid­able risk for breast cancer. At the height of its pop­u­lar­ity, in 2002, an es­ti­mated two mil­lion women were tak­ing HRT in the UK, and mil­lions more world­wide. Tens of thou­sands of women will have de­vel­oped breast cancer, ovar­ian cancer and en­dome­trial cancer (of the lin­ing of the womb) as a re­sult. Over­all, women cur­rently tak­ing HRT are 63 per cent more likely to de­velop th­ese three can­cers than those who are not. Ear­lier hopes that th­ese risks would be coun­ter­bal­anced by a re­duc­tion in heart dis­ease have not been borne out. Gyne­col­o­gists rec­om­mend that women who wish to use it to ease the symp­toms of the menopause do so for as short a time as pos­si­ble. 4. Get screened

Women di­ag­nosed with breast cancer at the ear­li­est pos­si­ble stage have a nine in 10 chance of a suc­cess­ful re­cov­ery. This is the ra­tio­nale for screen­ing – to de­tect a tu­mour by mam­mog­ra­phy when it is still too small to feel. Women aged 50 to 70 are in­vited for screen­ing ev­ery three years – shortly to be ex­tended to ages 47 to 73. It is es­ti­mated that the scheme saves 1,400 lives a years in Eng­land – one life for ev­ery 500 women screened. How­ever, there is a down­side in the shape of false alarms. Screen­ing picks up ab­nor­mal­i­ties in the breast that look like cancer but turn out not to be. Sev­eral thou­sand women each year suf­fer the anx­i­ety and dis­com­fort of be­ing re­called for fur­ther tests and un­der­go­ing biop­sies of the breast to check for cancer – be­fore be­ing given the all-clear. Screen­ing is now more ac­cu­rate, since two views of the breast are taken, re­duc­ing the chances of can­cers be­ing missed.

4. Give birth

Hav­ing chil­dren, es­pe­cially be­fore the age of 30, helps pro­tect against breast cancer. It is down to those hor­mones, again. Over the last cen­tury, eco­nomic progress has led to de­layed child­birth and smaller fam­i­lies as women with their own ca­reers have sought to bal­ance the de­mands of work and home. But re­searchers es­ti­mate that de­lay­ing child­bear­ing in­creases the risk of breast cancer by 3 per cent for each year of de­lay.

5. Breast-feed

Breast-feed­ing pro­tects against breast cancer, as well as be­ing best for the baby. But smaller fam­i­lies and the rise in the num­ber of work­ing moth­ers has meant the time spent breast­feed­ing has re­duced. Breast-feed­ing for six months re­duces the risk, ex­perts say. Yet many women never get that far. In Eng­land, 77 per cent of moth­ers start breast-feed­ing but more than a third switch to bot­tle-feed­ing in the first six weeks.

6. Lose weight

Obe­sity in­creases the risk of breast cancer – but only af­ter the menopause. A large Euro­pean study called Epic found post­menopausal women who were obese had a 31 per cent high- er risk of breast cancer than women with a healthy weight. Re­duc­ing obe­sity could save 1,800 cases of breast cancer a year. Obe­sity in­creases the risk of other can­cers in­clud­ing those of the bowel, womb, kid­ney and oe­soph­a­gus. Over­all it is es­ti­mated that 7. per cent of can­cers in women and 3 per cent in men are due to be­ing obese or over­weight. In the UK, 12,000 peo­ple might avoid get­ting cancer each year if they main­tained a healthy body weight.

7. Get a stress­ful job (re­ally)

A 2005 Dan­ish study pub­lished in the Bri­tish Med­i­cal Jour­nal found high lev­els of daily stress re­duced the risk of the dis­ease by 40 per cent. The re­searchers sug­gest that stress may be ben­e­fi­cial by re­duc­ing lev­els of oe­stro­gen. They draw a dis­tinc­tion between daily stress of the sort ex­pe­ri­enced by women in high-pres­sure jobs and stress­ful life events such as be­reave­ment, which have pre­vi­ously been linked with an in­crease in cancer. Stress can have other dam­ag­ing ef­fects, too – on the heart, for ex­am­ple, and by in­creas­ing the risk of com­pen­satory be­hav­iour.

8. Live some­where clean

It has long been claimed that exposure to pol­lu­tants used in the man­u­fac­ture of prod­ucts from plas­tics to cos­met­ics has an “en­docrine dis­rupt­ing” ef­fect. A re­port from the World Wide Fund for Na­ture last year claimed their role in breast cancer had been ne­glected. It pointed out that less than half of new breast cancer cases can be ex­plained by ge­netic and life­style fac­tors and chem­i­cals in the en­vi­ron­ment could be the miss­ing link. Other stud­ies have con­tra­dicted this sug­ges­tion and ex­perts point out that com­pared with the nat­u­ral lev­els of oe­stro­gen in a wo­man’s blood, the level of the chem­i­cals is too small to have sig­nif­i­cant im­pact. Still, mov­ing to an un­pol­luted re­gion is un­likely to do harm and could en­cour­age tother ben­e­fi­cial changes, such as eat­ing healthily, ex­er­cis­ing more, and drink­ing less. Don’t be ner­vous or anx­ious about find­ing changes in your breasts. Of­ten th­ese changes may not be re­lated to cancer – but it’s worth- while to tell your doc­tor as soon as pos­si­ble New re­sults from breast cancer clin­i­cal trial show non-breast cancer re­lated causes ac­count for most deaths. New find­ings from a land­mark breast cancer clin­i­cal trial in­volv­ing the drug letro­zole show that, in this group of pa­tients, women were more likely to die from non-breast cancer-re­lated causes than from breast cancer-re­lated causes. The re­search team found that non-breast cancer re­lated causes ac­counted for 60% of deaths. The top causes of death in­cluded: car­dio­vas­cu­lar dis­ease in­clud­ing stroke (15%), other ma­lig­nan­cies (15%), in­fec­tion (6%), mul­ti­ple causes (5%), and non-car­dio­vas­cu­lar or­gan fail­ure (4%). The re­sults were par­tic­u­larly strik­ing for older women. Among women aged 70 years or older, non-breast can­cer­re­lated causes ac­counted for 72% of deaths. The new re­sults are pub­lished in the Fe­bru­ary 12 is­sue of the Jour­nal of the Na­tional Cancer In­sti­tute. The orig­i­nal study re­sults were first pub­lished in The New Eng­land Jour­nal of Medicine in Oc­to­ber 2003 and in­volved 5,170 post-menopausal breast cancer sur­vivors with a me­dian age of 62 years (range 32 to 94 years). It de­ter­mined that women who took letro­zole for up to five years fol­low­ing 5 years of ta­mox­ifen ther­apy ex­pe­ri­enced a sig­nif­i­cantly re­duced risk of cancer re­cur­rence. The clin­i­cal trial was co­or­di­nated by the Na­tional Cancer In­sti­tute of Canada Clin­i­cal Tri­als group and was funded in part by the Cana­dian Cancer So­ci­ety. Rou­tine use of mam­mog­ra­phy and im­proved treat­ment for breast cancer will mean that more women will sur­vive breast cancer at older ages, at which time they might have a higher risk of death from causes other than breast cancer, says Dr Ju­dith-Anne Chap­man, lead au­thor of the study. “The study find­ings show that we are suc­cess­fully treat­ing women with breast cancer. How­ever, the study also un­der­scores the need to pay more at­ten­tion es­pe­cially to older women and the po­ten­tial for death from other causes,” Dr Chap­man says.

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