The truth about breast can­cer: ex­perts sort the facts from the fic­tion.

Are all lumps can­cer­ous? Is eczema on your breast nor­mal? Can men get breast can­cer? We ask ex­perts to sep­a­rate fact from fic­tion. Chris­tine Field­house re­ports

Friday - - Contents -

Most women as­sume that a lump in the breast is the only in­di­ca­tion of breast can­cer. Or that all lumps are can­cer­ous. Or if none of their close fam­ily mem­bers had can­cer, they are risk-free and needn’t worry.

There are so many myths about breast can­cer that it’s some­times hard to sep­a­rate fact from fic­tion. We put some of the most com­mon myths sur­round­ing breast can­cer to the ex­perts.

MYTH: You can’t have breast can­cer if there’s no lump

While in most breast can­cer cases, the first in­di­ca­tion is a no­tice­able lump, there are sev­eral other tell­tale signs to look out for when check­ing your breasts, says Dr Si­mon Smith, a UK-based con­sul­tant on­coplas­tic breast sur­geon. For one, skin puck­er­ing – which may look like a small dent in the breast – could also be a sign of can­cer.

‘The tu­mour in­side the breast causes the lig­a­ments to shorten, which pulls the tis­sue and skin in­wards,’ ex­plains Dr Smith. ‘This gives the breast a puck­ered ap­pear­ance, which is known as teth­er­ing.’

Other symp­toms to look out for are an in­verted nip­ple, dis­charge from the nip­ple and a swelling un­der your arm or around the col­lar bone. Or­ange peel skin on the breast could also be a sign of a more ag­gres­sive, though rarer form, of can­cer called in­flam­ma­tory breast can­cer.

MYTH: If your mum didn’t have breast can­cer, you won’t get it

Some breast can­cer is hered­i­tary, ad­mits Dubai-based Dr San­jay Parashar, a con­sul­tant plas­tic and re­con­struc­tive sur­geon. ‘Yet up to 80 per cent of women who get breast can­cer do not have a fam­ily history of it.

‘Hered­i­tary breast can­cer oc­curs due to a mu­ta­tion in genes BRCA1 and 2. How­ever, breast can­cer can oc­cur with­out a fam­ily history,’ says Dr Parashar, head of plas­tic surgery unit at Co­coona day care hos­pi­tal in Dubai.

A cell needs to have a num­ber of mis­takes in its ge­netic code be­fore it be­comes can­cer­ous, but it usu­ally takes years to gather enough ge­netic mis­takes and most ab­nor­mal cells die or are killed off by our im­mune sys­tem. But hav­ing the gene fault – which is the case for 1 per cent of the pop­u­la­tion would in­crease our risk of get­ting can­cer.

MYTH: Eczema on your breast is nor­mal

Eczema is a dry-skin con­di­tion, which can cause scaly, red and itchy skin, and at its worst, it can cre­ate sores that weep, crust and bleed. Nip­ple eczema can oc­cur in preg­nancy and when women breast-

feed. It also af­fects jog­gers whose breasts chafe against their cloth­ing while they run.

But Lester Barr, a con­sul­tant sur­geon spe­cial­is­ing in breast can­cer at the Christie Hos­pi­tal in Manch­ester, UK, says any itchy red rash on the nip­ple must be checked out by a doc­tor.

‘Paget’s Dis­ease of the nip­ple mim­ics eczema and it’s usu­ally a sign that breast can­cer is in tis­sue be­hind the nip­ple,’ says Dr Barr, who is also chair of Ge­n­e­sis Breast

Can­cer Preven­tion in Manch­ester.

MYTH: Men can’t get breast can­cer

‘That’s a huge myth,’ says Dr Parashar. ‘Men do get breast can­cer, de­spite them hav­ing very lit­tle breast tis­sue com­pared to women. Fig­ures from the Amer­i­can Can­cer So­ci­ety re­veal that men have a life­time risk for breast can­cer of one in 1,000. How­ever, Dr Parashar points out that a high per­cent­age of men in the UAE have gy­nae­co­mas­tia, an en­large­ment of the male breast tis­sue. These ‘man boobs’ as they are also called, could be caused by obe­sity and a high-fat diet, both of which are risk fac­tors in breast can­cer. The bad news is breast can­cer is likely to have spread be­fore it’s picked up in men, and it’s more com­mon in men over 60 and men who have a fam­ily history of breast can­cer.

Dr Parashar’s mes­sage to men is clear – get all breast lumps checked out im­me­di­ately.

MYTH: An­tiper­spi­rants cause breast can­cer

There’s a school of thought that an­tiper­spi­rants stop our bod­ies from sweat­ing out poi­sons, which then build up in the lymph glands un­der the arm and cause breast can­cer.

Dr Sally Nor­ton, a UK-based weight loss con­sul­tant and health ex­pert, says some stud­ies have sug­gested that there may be an in­creased risk due to the use of alu­minium com­pounds in an­tiper­spi­rants. ‘These com­pounds tem­po­rar­ily block sweat glands, but can build up in breast tis­sue and pro­duce some oe­stro­gen-like ef­fects,’ she says.

‘There is a pos­si­ble link but if the risk was very high, we would know about it by now. How­ever, the in­creas­ing use of chem­i­cal prod­ucts on our­selves, around the home and in our wider en­vi­ron­ment is al­most cer­tainly caus­ing some harm­ful ef­fects and we should try to re­duce them wher­ever pos­si­ble.’

MYTH: All breast lumps are can­cer

A breast lump is a swelling or thick­en­ing in your breast, yet nine out of 10 lumps are be­nign (non can­cer­ous).

The most com­mon form of breast lumps are fi­broade­noma, which oc­cur in teenagers and young women. They’re formed when the tis­sue and ducts around a milk-pro­duc­ing lobe grow over it and thicken.

‘Breast lumps can be due to many things – gen­eral lumpi­ness around pe­riod time, cysts or in­fec­tion,’ says Dr Sally. ‘These lumps can get quite large and may be ten­der.

‘Be­nign breast lumps can be re­moved if nec­es­sary, but may of­ten im­prove with lit­tle, if any, treat­ment. How­ever, any lump should be checked out by your doc­tor – par­tic­u­larly if it is hard and ir­reg­u­lar and doesn’t im­prove af­ter your pe­riod.’

MYTH: Only over­weight women get breast can­cer

Re­search sug­gests that about five out

There may be an in­creased risk due to AN­TIPER­SPI­RANTS, as alu­minium com­pounds in them tem­po­rar­ily BLOCKS WEAT glands but can buildup in breast tis­sue and pro­duce OE­STRO­GEN-LIKE ef­fects

of 100 can­cers could be avoided by main­tain­ing a healthy body weight. A study pub­lished in the med­i­cal jour­nal,

The Lancet, in 2014 looked at the med­i­cal records of 5.24 mil­lion peo­ple in the UK, where the doc­tor had recorded their height and weight.

The re­searchers found that post­menopausal women who were over­weight or obese had a higher risk of breast can­cer.

Dr Nor­ton says: ‘Be­ing over­weight can in­crease your chances of breast can­cer, and other types of can­cers too. Fat isn’t just stuff that spills over your waist­band and sends your scales in the wrong di­rec­tion. It’s also an or­gan of the body that pro­duces chem­i­cal mes­sen­gers (hor­mones), one of which is oe­stro­gen.

‘Oe­stro­gen is thought to be a ma­jor part of the path­way lead­ing to breast can­cer so it fol­lows that the more over­weight you are, the greater your risk of breast can­cer, es­pe­cially af­ter the menopause when fat is a more im­por­tant source of oe­stro­gen than the ovaries.’

MYTH: Your fa­ther’s fam­ily history doesn’t count re­gard­ing breast can­cer as much as your mother’s

We tend to look at our mother’s med­i­cal history to gauge our can­cer risk, but the genes we get from our fa­ther’s side of the fam­ily are just as im­por­tant.

‘Ge­netic sus­cep­ti­bil­ity can come from ei­ther par­ent,’ ex­plains Dr Houriya Kazim, con­sul­tant breast sur­geon at the Well Woman Clinic, Dubai. ‘We know of two main mu­ta­tions in our DNA (called BRCA 1 and 2) which make us more sus­cep­ti­ble to breast can­cer. If ei­ther par­ent has one of these mu­ta­tions, each child has a 50-50 chance of in­her­it­ing that mu­ta­tion and sus­cep­ti­bil­ity.’

MYTH: Un­der­wired bras cause breast can­cer

The sug­ges­tion that hav­ing wires so close to the breast could be dan­ger­ous has been around for many years.

Dr Nor­ton ex­plains: ‘The the­ory was that over-tight bras could re­duce the lymph drainage from the breast and there­fore cause an ac­cu­mu­la­tion of tox­ins that could then lead to can­cer. There is no proof what­so­ever that this oc­curs. A wire rub­bing against an al­ready present breast lump could make you aware of it, hence the con­cern that the pres­sure may have caused it in the first place. But fear not, it’s just co­in­ci­dence!’ The type of bra nor tight­ness pose any risk, say ex­perts.

MYTH: Breast can­cer af­fects only post­menopausal women

Dr Kazim says this is true to an ex­tent be­cause in most western coun­tries, breast can­cer is a dis­ease of menopausal women, with about 80 per cent of cases oc­cur­ring af­ter the age of 50.

‘But in the Mid­dle East, North Africa and the In­dian sub­con­ti­nent, the pat­tern is dif­fer­ent, with cases oc­cur­ring at least 10 years younger,’ she says.

There hasn’t been any re­search into why this hap­pens as yet, but some ex­perts have put the prob­lem down to a poor diet, obe­sity and a lack of reg­u­lar ex­er­cise.

MYTH: Mam­mo­grams raise our risk of breast can­cer

Most women who have had their breasts squashed into an X-ray ma­chine for a mam­mo­gram will have been left won­der­ing how safe the pro­ce­dure is. Af­ter all, X-rays con­tain ra­di­a­tion, which is a car­cino­gen.

Dr Kazim says: ‘Mam­mo­grams are X-rays and X-rays can cause can­cer. How­ever, the amount of ra­di­a­tion in a mam­mo­gram is small. You’re ex­posed to less ra­di­a­tion than you would get fly­ing to New York.’

On av­er­age the to­tal dose for a typ­i­cal mam­mo­gram with two views of each breast is about 0.4 mSv (a mSv mil­lisiev­ert is a mea­sure of ra­di­a­tion dose). To put this in per­spec­tive, the world­wide av­er­age nat­u­ral dose hu­mans re­ceive from what is called back­ground ra­di­a­tion (de­tectable amounts oc­cur nat­u­rally in soil, rocks, wa­ter, air, and veg­e­ta­tion, from which it is in­haled and ingested into the body) is about 2.4 mil­lisiev­ert (mSv) per year.

Strict guide­lines en­sure that mam­mog­ra­phy equip­ment is safe and uses the low­est dose of ra­di­a­tion pos­si­ble. Many peo­ple are con­cerned about the ex­po­sure to X-rays, but the level of ra­di­a­tion from a mam­mo­gram to­day does not sig­nif­i­cantly in­crease the breast can­cer risk for a woman who gets reg­u­lar mam­mo­grams.

The GENES we get from our FA­THER’s side of the fam­ily are just as im­por­tant as our mother’s. ‘If ei­ther par­ent has one of two MU­TA­TIONS, each child has a 50-50 chance of in­her­it­ing that, and SUS­CEP­TI­BIL­ITY’

All breast lumps don’t mean can­cer, but should still be checked out by your doc­tor – es­pe­cially if it is hard and ir­reg­u­lar

Mam­mo­grams are X-rays, but the amount of ra­di­a­tion in them is small – lesser than what you’d be ex­posed to fly­ing to New York

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