Cancer Vijay

RISK FACTORS : Take home messages
Most Important :

1.  Breast cancer can also occur in women who have no identifiable risk factors.
2.  many women with risk factors never develop breast cancer
3. Most risk factors are not reversible, but some can be modified.
   1.  risk factors help to identify women who may benefit most from screening or other preventive measures.  .
      1. Individual women should work with their clinicians to determine  personal risk 
4. To calculate an individual woman’s estimated risk is very difficult then  probabilities  for the whole population. Real risk  may be higher or lower depending on a number of known and unknown factors 
5.   one out of every eight women born today will be diagnosed with breast cancer at some time during her life.

List of risk factors

1. The strongest risk factors for breast cancer
   1.  Risk  increases as age increase.  - Very  Strong
   2. Being female - Very Strong
   3. BRCA1 or BRCA2 gene mutation  -5–14 times greater
   4. Family history 
      1. 2 immediate family members - 3–4 times greater
      2. Mother diagnosed before age 60  - 2–3 times greater
      3. Mother diagnosed after age 60 -  1 times greater
   5. High breast density
   6. Atypical Hyperplasia (benign breast condition) -  2–4 times greater
   7. Lobular carcinoma in situ (LCIS) -  7–10 times greater
   8. Personal history of cancer  --2–6 times greater
      1. invasive breast cancer,
      2. DCIS,
      3. Hodgkin's disease and
      4. other cancers
   9. Radiation treatment or frequent X-rays  before the age of 30  ----
2. Risk for breast cancer diagnosed at age 40 ---11 times greater
3. Risk for breast cancer diagnosed at age 60----3.5 times greater 
4. Increased estrogen exposure

Reproductive Risk Factors

1. First menstrual period.before 12 --1–1.5 times greater
2. Starting menopause at a later age.
   1. 1. Age 55 or older at menopause --2 times greater
3. Being older at the birth of your first child.
4. Never giving birth. compared with a woman who has her first child before 35- 1.5 times greater
5. Not breastfeeding.- 1 times greater
6. Long-term use of hormone-replacement therapy.- 1.5–2 times greater
7. Other
   1. In utero exposure to diethystilbestrol
   2. Menopausal hormonal therapy - 1.5–2 times greater
   3. Using birth control pills (current or recent use)-- ​1–1.5 times greater
   4.  

Other Risk Factors

1. Getting older.
   1. Age 30 . . . . . .  1 in 227
   2. Age 40 . . . . . .  1 in 68
   3. Age 50 . . . . . .  1 in 42
   4. Age 60 . . . . . .  1 in 28
   5. Age 70 . . . . . .  1 in 26
       
2. Personal history of breast cancer or some non-cancerous breast diseases.
   1. who have had breast cancer are more likely to develop a second breast cancer
3. Family history of breast cancer (mother, father, sister, brother, daughter, or son).
   1.     a strong family history of the breast cancer  who has inherited one of the genes that predispose  to breast cancer is over 50 percent
   2. Other cancer in family- Ovary, Cervix ,Uterus, Colon
4. Biopsy report: Changes that are associated with an increased risk of breast cancer include
   1. Atypical hyperplasia- --2–4 times greater
      1. a noncancerous condition in which cells have abnormal features and are increased in number
   2. Lobular carcinoma in situ (LCIS) -- 7-10 times greater
      1.  abnormal cells are found in the lobules of the breast
      2. monitored carefully
   3.  Ductal carcinoma in situ (DCIS;
      1.  abnormal cells are found in the lining of breast ducts).
         1. some cases of DCIS will eventually become cancer
            1. Need ,  active treatment.

1. Breast density by mammogram.
   1. The milk-producing and connective tissue of the breast are dense ( white on a mammogram)
   2. In contrast, fatty tissue of the breast is not   dense and appears dark.
   3. As density increase risk increase
   4.  tumors, in dense breasts can be difficult to detect   because tumors often  appear white.
2. Obesity
   1. increases risk  after menopause -- 1–1.5 times greater
3. Inherited changes in  breast cancer-related genes BRCA1 or BRCA2 and other.
   1. no more than about 10 percent of all breast cancers.
   2. However, women who carry changes in these genes have a much higher risk of breast cancer than women who do not carry these changes.
   3.  
4. Alcohol (2–4 drinks per day) -- 1.5 times greater
5. Physical inactivity .-
   1. Lack of exercise 1 times greater
6. Socioeconomic status
   1. ​High socioeconomic status---​1–2 times greater
7. Urban/ Rural
8. Race/ethnicity
   1. Ashekenazi Jewish heritage --- 1 times greater
9. Dietary pattern — 
   1.  diet composed predominantly of fruits and vegetables resulted in a lower risk
   2. Dietary fat intake - increase risk
10. Treatment with radiation therapy to the breast/chest.
    1.  before age 30 have an increased risk  throughout their lives.
    2. younger a woman, the higher her risk
11. Height: Tallness   increased risk   in postmenopausal women---1 times greater
12. High bone density-- 2 times greater

REDUCING   RISK of breast cancer
Screening mammography does not reduce the risk of developing breast cancer, but it decreases the risk of dying from breast cancer
Lifestyle changes — A number of lifestyle changes may reduce breast cancer risk:

1. • Planning for first child  before the age of 30
   • Breastfeeding for at least six months or more
   • Avoidance or limited  use of  Hormone replacement therapy (postmenopausal hormone therapy)
   •  Radiation -Avoidance of unnecessary exposure (eg, inappropriate use of computed tomography)
   • Healthy weight
   • Smoking- Avoidance or cessation
   • Limiting nocturnal shift work
   • Alcohol- Limiting intake
   • Physically active lifestyle.
   • Limiting sedentary behavior
   • Moderate intensity activity,- at least 150 minutes of weekly
   • Vigorous intensity activity,75 minutes of weekly
   • Some physical activity above one’s usual routine,