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Risk factors for Breast Cancer

Identification of factors responsible for in causing an individual's chance of having Breast Cancer in important not only to the epidemiologist but also in clinical practice. There are two types of risk factors:

• major risk factors

• minor risk factors

(1) Major risk factors:

they are

• sex

• age

• family history

• Personal History

• Non-Invasive carcinoma

• Benign proliferative changes c atypia

Sex:

More in female than male. Carcinoma breast also occur in male breast but females are suffering more than males.

Age:

Carcinoma breast is very rare under age of 20. The incidence of carcinoma breast continues to increase with the advancing age. Max. between 49 – 69 year.

Family history:

There is increased risk of carcinoma breast in a person who had positive family history meaning by positive of carcinoma breast in mother sisters and daughter. There is two to three times excess risk of the disease in first degree relative i.e. sisters mother, daughters and risk is much higher if affected first degree relative had premenstrual onset of bilateral breast carcinoma. In families if bilateral pre-menopausal cancer present to first degree relative the risk rises to 50%.

Personal history:

the presence of breast cancer one side increases the likelihood of a second primary cancer in Centro lateral breast. The age of onset of cancer is very important. Meaning by of patient is under 45 year the risk is five or six times that of general population.

Benign proliferative changes c atypia:

it is well known that women with fibro cystic complex and who have undergone breast biopsy are at increased risk of subsequent breast cancer. The fibrocystic complex is a spectrum of pathologic changes that may include epithelial proliferation, cyst formation and stomal sclerosis, excess risk in those whose biopsy shows abnormal breast epithelial proliferation. The relative risk of cancer in women with atypical hyperplasia was 4.4 times. The risk of developing breast cancer is a central population of women. The co- existence of a positive family history with atypia of biopsy increased the risk to nearly nine times. The general population Breast biopsy is a common surgical procedure providing important prognostic information. The pathologist should give complete pathological descriptions rather than giving report such as fibrocystic disease or cystic mastitis.

Non Invasive Carcinoma:

This is a major risk factor and about this the discussion needs more detailing. However many patients with lobular carcinoma in-situ lesions are treated by biopsy only. These patients are subjected to be followed carefully if less aggressive surgical therapy has been recommended.

(2) Minor Risk Factors:

has relevance clinically

• Early Menarche: First Menarche starts at very early age

• Late Menopause:

• Obesity: obese female have more chances of getting carcinoma Breast.

• How dose radiation:

When to suspect Breast Cancer:

for patient’s suspicion of having cancer, the history directly aids. In making diagnosis after a detail history about all risk factors the examination should be in detail and methodical. The examination begins with careful visual inspection for various masses, asymmetries and slim changes in breast.

The points to be looked carefully are,

• Breast should always be examine first in sitting upright position with stretched both arm up head

• Nipple retractions – Inversion and excoriation

• Dimpling of slim or Of Nipple is a sensitive and quite specific sign of under lying carcinoma. Stretched arms over head may accelerate the under lying carcinoma, even very small

• co edema of slim i.e. plauds orange when combined c tenderness and warmth. These signs and symptoms are the hallmark of inflammatory carcinoma and may be mistaken with acute mastitis. The duration of problem may help to differentiate between two.

• Involvement of nipple and areola- is a common histo breast removed for carcinoma. Unilateral retraction or retraction developing over weeks or months is more suggestive of carcinoma.

• Palpation of breast- is in sitting position is insensitive and in accurate. It should always be done in supine position i.e. lying on bercu.

• The benign tumor such as fibroadenomas and cysts can be as firm as carcinoma. How ever these tumors are usually quite distinct well circumscribed and movable. Carcinoma is typically firm but less circumscribed and its movement produces a drag of adjacent tissue.

• 75% of carcinoma breast produce palpable masses and most of the time discovered by patient by her self.

Diagnostic facilities help in confirmation of clinical diagnosis:

1. Mammography

2. Ultra sound

3. FNAC
 

(1) Mammography

imaging of breast can extent the capability of physical examination either to detect small abnormalities or to provide more information about palpable masses. Mammography is clearly the most sensitive and specific diagnostic modalities which can be used for knowing the health of breast, or as screening test to finiad any abnormality in breast. The mammography can be-

I. Diagnostic

II. Screening

(I) Diagnostic mammography.

Two types are popular.

a. Xero mammography

b. Film/ screen mammography.

In both techniques there is very little difference between the sensitivity and specificity. The mammographic factures of malignancy can be broadly divided in to-

• Density abnormalities

• Masses

• Asymmetries

• Architectural

• Distortion

• Microcalcification

Each mammogram also should be assessed for the presence of abnormalities in auxiliary modes and for the presence of skin or nipple changes such as thickening or retraction. These mammographic abnormalities may exit c presence or absence of physical finding. In fact it is the integration of each of the radiographic features and the physical findings.

The mammographic abnormalities that can’t be detected by physical examination are classified in three broad categories.

Lesions are consisting of microcalcification only.
Density lesions- masses, architectural distortion and asymmetries.
These c both calcification and density abnormalities.

Lesions c both microcalcifications and a mass effect, speculated masses and linear branching calcification. Carry the highest probability of being malignant. However, well defined densities can be malignant. It is very certain that every abnormality should not biopsied and the recommendation could be made by consultation between surgeon and radiologist. But one thing is recommended that those patients not undergoing biopsy, interval mammograms must be done to assure stability of the abnormality. If a biopsy is performed, it is usually done after mammographic placement of a needle or hook wire and prior to fixation; it should be determined whether material needs to be retrieved for hormone receptor assays.

(II) Screening mammography-

screening studies seek to identify and abnormality, maximizing sensitivity and cost effectiveness. The different studies shows that over all mortality in screened population reduced in patients above 50 year, it was about 50%. As a result of these studies the American cancer society recommended annual mammograms for women of 50 years and older. In younger population most studies failed to show a conclusive advantage for screening. The conclusion is that mammography should be made available to women who understand the limits of its benefits, who understand its risks, and who are willing to pay its costs.
Ultrasound of breast- for lisions 7.5 cm.

(2) FNAC –

The FNAC become a routine part of the physical diagnosis of breast masses. Its main utility is the differentiation of solid masses from cystic lisions. This simple procedure is postponed if mammography is necessary. In younger pt mammography is not really required and FNAC is choice of investigation. By using FNAC in a routine examination of breast masses, make easy to understand the criteria for open biopsy is helpful. Carcinoma will not be missed if a formal biopsy is done when,

(1) Needle aspiration produces no cyst fluid and a solid mass in diagnosed.

(2) The cyst fluid produced is thica and blood tinge.

(3) Fluid is produced but mass fails to resolve completely

(4) The mass reappearance in the same area after more than to aspiration

Conclusion:

The over all conclusion of above discussion is that the incidence of Breast Carcinoma is increasing day by day. The diagnosis of this cancer at very early stage give a good long term survival so that the female should be aware of the self examination of breast, should a new when to consult a doctor, it is possible by various public awareness program and keeping all the risk factors in view the physician should investigate the patient when require and consult to surgeon. As screening program are not well developed in our country so it becomes our responsibility to suspect and diagnose this cancer at early stage and also create awareness in general public. As the cost, effectiveness in our limitation so we have to depend more on clinical criteria and go for various investigations in a risk group patient.