October is the only month in the year when adults are swathed in pink – from pink ribbons, sweaters and candles to pink marathons and monuments to pink shopping sales and dining deals. In fact, pink ceases to be just a colour; it becomes a verb, a groundswell of hope.
‘Pinkifying’ our favourite things in life during Breast Cancer Awareness Month – which first began in the United States in October 1985 – not only puts the disease on the map, but also pledges a percentage of profits towards cancer research. Since more than two million women are diagnosed with breast cancer annually, the reality is hardly rosy, but early detection saves lives – survival rates over the last three decades have steadily improved.
No one wants to hear the words, ‘You have cancer’; yet out of eight women worldwide, one will receive the distressing diagnosis of breast cancer at some point in her life. According to the World Cancer Research Fund, it has become the most common cancer in women globally, and the second most prevalent overall, thus it’s important we act to reduce the risk.
The Real Picture
The big myth about breast cancer is that it only affects women. Men get it too, though the male count of breast cancer is only a fraction of the total number of cases diagnosed per year, “because their breast duct cells are less developed, and they have lower levels of female hormones that affect the growth of breast cells”, according to Dr Senthil Sundaram, Chief Clinical Officer of the leading genetics and diagnostic health testing company Prenetics.
In reality, anyone with the breast tissue can get cancer – female, male, transgender, cisgender. Dr Sundaram further adds, ” A man’s lifetime risk of breast cancer is about 1 in 833. There are several known factors for breast cancer but lack of sleep, especially shift work, night shift for 30 years or more is said to increase the risk.” Research is still ongoing to establish the overall link between the graveyard shift and breast cancer, but it could be down to the exposure to electric lights at night which messes up the body’s circadian rhythm.
Given the alarming rate of breast cancer in women, you might look around at a playground and mentally scan seven young girls, then feel sorry for the eighth… but hold that thought for a couple of decades. It would be very rare for that girl on the swings to be diagnosed with breast cancer in her teens or twenties. The disease is much more likely to strike her in middle age or by the time she’s a grandmother at 70.
Another dominant myth is that breast-cancer is mostly genetic. Mutations in the BRCA1 and BRCA2 genes do raise the odds of breast cancer – boosting the norm of a 13 percent chance of contracting the disease during your lifetime to highs of up to 72 percent and 69 percent respectively, according to the US National Cancer Institute. Yet, more than 75 percent of women who are diagnosed have no family history of the disease, and less than 10 percent have a known gene mutation that increases risk.
While genetic makeup is a known risk factor, poor lifestyle, obesity, smoking, alcohol use or abuse and environmental circumstances all contribute to the likelihood of the disease. Age is the biggest reason, however, which is why many countries offer regular screening to women from the age of 50.
“While genetic makeup is one of the considerations [in getting breast cancer] … age is the biggest risk factor”
Know Your Normal
All breasts are different. They are uneven, bumpy masses, but once you start examining them regularly at the same point in your menstrual cycle, you will become aware of what’s normal for you. Doctors suggest doing a self-exam in the shower, or while moisturising, to check for any noticeable changes.
The classic lump is not always a tell-tale sign; in fact, 80 percent of tumours are non-cancerous, so also look out for droopy boobs, changes in breast shape or size, nipple discharge, puckering of the skin, redness, inflammation in the lymph nodes, and dimpling around the areola. In a nutshell, anything unusual from the breast to armpit area should be reported to your doctor and medically examined.
Ethnic Divide
It does not strike everyone equally. African-American women are more likely to develop breast cancer at a younger age – and get a more aggressive type of breast cancer called triple negative – than their white counterparts in the US. They’re also often diagnosed at late stages where little or no treatment options are available.
Rates among women in Hong Kong are less alarming, though the disease is on a steady upswing. The Hong Kong Breast Cancer Foundation states that the lifetime risk of being diagnosed with breast cancer is one in 14 for local Chinese women (compared to one in eight in the US and the UK). In 2008, it was one in 21, and if you review the annual figures from 1993, there has been a worrying threefold upsurge in breast-cancer patients in the city.
“The classic lump is not always a tell-tale sign; in fact, 80 percent of tumours are non-cancerous”
Mass Screening Concern
Unlike the West, where regular mammograms are recommended for women in high-risk groups – designed to achieve early diagnosis and thus better prognosis – the Hong Kong government hasn’t yet implemented a mass breast screening programme. Perhaps worryingly, local medical experts charged with studying cancer prevention and screening made this conclusion in 2018: “There is insufficient evidence to recommend for or against population-based mammography screening for asymptomatic women at average risk in Hong Kong.”
In their view, the public health success of conducting widespread mammograms remains debatable. Citing evidence from some Western countries, they went so far as to write: “Disadvantages such as false-positive or false-negative results, over diagnosis, overtreatment and potential complications arising from subsequent invasive investigations or treatment may outweigh the benefits.”
This does not imply that you should shy away from regular screening, especially if you are a woman with a family history of the disease or a smoker. Having frequent mammograms should be considered, and regular self-checks are essential. Importantly, if you do detect a noticeable change in your breast health, don’t dither: bring it to your doctor’s attention immediately. It may turn out to be nothing serious, but better swift than sorry. And in this month of thinking pink, awareness trumps complacency.
(Written By: Nikita Mishra)