QI am really worried about developing breast cancer. I am 45 and have three children under the age of six. I had a lot of fertility treatment to have my children and I have heard that it can increase the risk of certain breast cancers. My mother and grandmother both had breast cancer: my mother in her 60s and my grandmother died in her 30s. Is it worth my while paying for a mammogram to put my mind at rest? Are there other tests I can do?
A Breast cancer is the most frequent cause of cancer death in women worldwide. Most breast cancers are sporadic genetic mutations. Approximately 6pc of breast cancer cases are caused by genetic mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 and an even smaller percentage are due to other inherited genetic mutations. Overall less than 10pc of breast cancers are the result of an inherited genetic mutation from one of your parents. Ideally, genetic testing of any surviving family members (previously diagnosed with breast cancer) should be performed first.
In the absence of this known breast cancer genetics, certain criteria can be used to assess an individual for hereditary cancer risk. In your case, I assume you are a female who has never been diagnosed with breast or any other type of cancer. I also assume the two family members you mentioned are on the same side of the family. In other words, it was your maternal grandmother (second-degree relative) who passed away in her 30s due to breast cancer.
This being the case, you hit a key criterion for possible hereditary breast cancer risk which is: At least two individuals with breast cancer primaries on the same side of the family with at least one diagnosed at 50 years old or younger.
Expanding this key criterion, a first (parent, sibling or child) or second-degree relative with any of the following: Breast cancer diagnosed at 45 years old or younger, ovarian cancer, male with breast cancer, pancreatic cancer, metastatic prostate cancer, or two or more breast cancer primaries in a single individual or on the same side of the family with at least one diagnosed at 50 years old or younger.
Your risk of developing breast cancer increases with age. The probability of developing breast cancer is about one in 51 women under 49 years old and rises to one in 15 at age 70 or older. Other risk factors include obesity in post-menopausal women, particularly for oestrogen-receptor positive breast cancer. In vitro fertilisation (IVF) does not appear to increase the long-term risk of breast cancer, even in women with BRCA 1 and 2 mutations. There are several other reproductive factors including early age of menarche (onset of first menstrual cycle), late onset of menopause, having no children or multiple children depending on your age at first birth. Smoking and alcohol consumption are also associated with a dose dependent increased risk of developing breast cancer. Having a high breast or high bone density is also linked to your risk of breast cancer.
All women are best advised to have breast awareness, that is to know how their own breasts look (in a mirror) and feel in order to be able to detect a change. You should perform regular breast self-examination once per month. Changes include new onset nipple inversion, a change in size or shape of one or both breasts, dimpling/puckering of the skin, a rash around your nipple, as well as brown/blood-stained nipple discharge. The second part involves feeling with your three finger pulps (not tips) for a lump or mass in the breast or in the armpits. In general, painless lumps that are fixed, or more difficult to move, are more concerning. Be reassured by the fact that over 90pc of breast lumps are benign (not a cancer).
Breast screening aims to reduce deaths from cancer, by finding and treating the disease at an early stage, in women who are symptom-free. You must be 50 years old to qualify for your first free HSE mammogram (a special kind of breast X-ray). Your first invitation will depend on the availability in your area. You are guaranteed to have your first mammogram within two years of your 50th birthday. Over 80pc of breast cancers occur age over 50. Screening with mammogram every two years has proven effective in reducing mortality.
There are limitations to screening including a missed diagnosis or 'false positive' when a mammogram is suggestive of cancer but further investigations (breast ultrasound, biopsy, or MRI scan) reveal no evidence of cancer. The Gail Model is a free online tool (bcrisktool.cancer.gov) to help assess your risk of developing breast cancer by answering a few simple questions.
I suggest you attend your doctor to engage in a shared decision-making process as there is a lot to take into consideration. But given your age, family history and the fact that you were 39 years old having your first child, I think it is worthwhile starting early screening with a mammogram in a private hospital.
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