Ma’am, are you at risk of breast cancer?

DEARreaders, especially the ladies, our apologies for the rather frank, intimidating and possibly scary question. However, considering that the Philippines has one of the highest incidence of breast cancer not only in Southeast Asia but in the entire world, it might as well that we Filipinos, take the issue like taking the bull by its horn. It is a sad reality so we must face it. As the saying goes, “forewarned is forearmed."

After having an extensive and in depth conversation with my former students who are now specialists in the field of OB-Gyne, surgery and endocrinology who shared with your columnist their experiences and clinical encounters with the breast cancer, the following items must be taken in consideration.

Like most cancers, there are non-modifiable factors in the causation of malignancy. For one, the risk of cancer increases with age. After 60, the risk of a woman having breast cancer is 60 percent, with the highest risk at 75 years and after.

Family history is like sword of Damocles always threatening the clan especially among first degree relatives-mother, daughter, sister- although the risk decreases as the blood relationship gets farther but still, once a relative has had it, prudent monitoring as well as cursory individual self-examination of the breast must be encouraged.

A recent study, although small has shown that two particular genes have been identified among women who have had a rather high incidence of breast cancer, which all bolstered the observation that breast cancer, like prostate cancer, has a very strong genetic connection. The other disturbing finding is that, women who have had an earlier ovarian tumor seem to be more likely victims of breast cancer later in life.

The reproductive profile of a woman is also a factor. Girls who had their menarche-first menstrual flow- earlier than 12 years, elderly ladies who had their menopausestoppage or cessation of ovulation later than 56 years, or being a primigravida-pregnant for the first time after 30 years old- all these have, by statistical data are more likely to be at risk of developing breast cancer. Nulliparity or having no pregnancy at all, explains why nuns - if they develop cancer at all, it's more likely to be that of the breast.

We all know by now that breast cancer is hormone-connectedthe word connected is used in a rather safe term- if just to emphasize that , women who may have used contraceptive pills in the past, are NOT automatically breast cancer victims. Experts in family planning using pills have come up with a wide range of contraceptive pills with varying amounts of estrogen and progesterone in order to individualize the choice for a particular woman depending on her history-family, menstrual/ovulatory cycles, pregnancy . Even HRT or hormone replacement therapy- usually given by OB-Gyne and endocrinologists to women after their menopause(usual is 48-52 years) is a very individualized, patientcentered choice, the duration of treatment is again much to the discretion and clinical judgment of the attending physician.