Are you worried about…breast cancer?

Many women worry about getting breast cancer| , sometimes because one of their relatives has developed the illness. This section explains:

Why having just one, or even two, relatives with cancer
does not normally mean that there is an inherited genetic link in your family.
What we know about the causes of breast cancer.
What you can do to help yourself.
Cancer genes/family history

Genes carry the biological information we inherit from our parents. They affect the way our bodies grow, work and look. Changes (mutations) in certain genes can increase the risk of breast cancer in family members who inherit the genetic change. But only a small number of breast cancers are thought to be due to an inherited altered gene running in the family.

Two gene changes – called BRCA1 and BRCA2 mutations – can run in a family and increase the breast and ovarian| cancer risk of those family members who inherit the genetic change. But they are not common.

How does my family history affect my risk of developing breast cancer?

It is only likely that a genetic mutation that can increase your breast cancer risk is present in your family, if you have:

three close relatives from the same side of the family (your mother’s or your father’s family) who developed breast cancer at any age
two close relatives from the same side of the family who developed breast cancer under 60
one close relative who developed breast cancer at the age of 40 or under
breast and ovarian cancer on the same side of the family, or a male relative with breast cancer, or a close relative with cancer in both breasts.

Your close relatives are your mother, sisters or daughters. They are sometimes called your first degree relatives.

If your family is like this, and you are worried about developing breast cancer yourself, you might want to talk to your GP. They will ask you questions about your family history. If you have a family history of any unusual cancers/childhood cancers or you have Jewish ancestry or other ethnic background (where a faulty breast cancer gene is more common), you should mention that to your GP. If your GP thinks there’s a chance that you might have an increased risk of developing breast cancer because of your family history, they will refer you to a genetic counsellor, family cancer clinic or a cancer specialist.

All women, when they are 50, are invited to join the NHS Breast Screening Programme| and offered three yearly mammograms until they reach 70. Women who seem to have inherited an increased risk of getting breast cancer may be offered yearly mammograms, and sometimes MRI scans, from an earlier age.

If you only have one middle-aged or elderly relative who has developed breast cancer, or one case of breast cancer on each side of your family, this does not significantly increase your risk. If you had one of the ovarian or breast cancer genes in your family, then it is likely that more than one relative on the same side of the family would have developed ovarian or breast cancer.

If you are worried about the occurrence of breast and/or ovarian cancer in your family and whether there might be an inherited genetic link, OPERA| is an online interactive software program that will offer you personalised information and support in the comfort of your own home.

If you are still worried

It can be a normal reaction to severe illness in the family, or to bereavement, to feel more vulnerable to the same disease. If you can’t stop worrying, you may find it helpful to see a counsellor, who can help you get things back into perspective. You can ask your GP, or call our nurses| for details of a local service. You could also call the Cancer Counselling Trust| to speak to a counsellor.

Mind| , the mental health charity, has published a leaflet called ‘How to Stop Worrying’.

Cancer risk

The cause of most breast cancers is not known. But we do know that some things – called risk factors – can increase our chances of developing cancer. Some risk factors are very likely to cause cancer, whereas others will only very slightly increase our likelihood of getting it.

Having a particular risk factor for cancer, or being exposed to one, doesn’t mean that we will definitely get cancer, just as not having it doesn’t mean that we won’t. Smoking is a good example of this. If you smoke, it isn’t certain that you will get lung cancer , just as if you don’t smoke, it’s not certain that you won’t. But smoking will greatly increase your risk of getting lung cancer. Nine out of ten people who develop lung cancer are smokers.

Cancer is very common and nearly 1 in 3 of us will develop it at some time during our lives. This means that most of us will have relatives who have had cancer. Surveys have shown that many people are worried that a history of cancer in their family greatly increases their risk. People often worry that an increased risk of cancer can be inherited, or passed on from one generation to another. In fact less than 1 in 10 cases of cancer (between 5 and 10%) have been shown to be due to a family history of the disease.

Other risk factors

Other risk factors in the development of breast cancer can play a bigger role than family history.

Age

Breast cancer is mainly a disease of older women and is rare in women under 50. Only 1 in 9 women will get breast cancer in their lifetime, but the older you are the more likely it is that you will develop the disease. In the UK more than half of breast cancers occur in women over 65. Women under 50 are at far lower risk of getting breast cancer than older women, and women under 40 have an even lower risk.

Hormone levels

There is some evidence that the more years a woman has had periods, and is therefore exposed to the female hormone, oestrogen, the more prone she is to breast cancer. This means that you may have an increased risk of developing breast cancer if you:

started your periods at an early age (under 12)
had a late menopause (after 50)
have not had any children, or had children after you were 30
have not breastfed or breastfed for less than 12 months in total.
The contraceptive pill

Taking the Pill slightly increases a woman’s risk of getting breast cancer. The risk decreases again after stopping the Pill.

Hormone replacement therapy (HRT)

There is evidence that women over 50 who take HRT increase their risk of developing breast cancer. The risk begins to increase after 1–2 years of HRT use, and then goes on increasing the longer HRT is used. Combined HRT increases risk more than oestrogen-only HRT. Risk begins to decrease when HRT is stopped and is thought to be back to normal around five years after stopping.

Obesity

Being overweight, particularly after the menopause, is a risk factor for breast cancer. This seems to be because overweight people have different hormone levels compared to people who are of normal weight.

Lack of exercise

There is evidence that regular exercise reduces women’s breast cancer risk. This might be because physical activity regulates women’s hormone levels.

Alcohol

Drinking excessive amounts of alcohol seems to increase women’s breast cancer risk. The European Code Against Cancer recommends that to reduce their risk of developing cancer women should drink no more than one unit of alcohol per day. A unit is half a pint of ordinary strength beer, lager or cider or one small glass (125ml) of wine or a single measure (25ml) of spirits.

Other possible risk factors

It has been suggested that particular diets, some dietary supplements and deodorants can increase the risk of developing breast cancer. However, there is no good evidence to support these claims. Scientists are studying many different possible factors, but so far the risk factors listed in this leaflet are the only ones where there is good evidence.

Reducing your risk

Although many of the known breast cancer risks are beyond our control there are other risk factors, known as lifestyle risk factors that you can control. It has been estimated that about one half (50%) of all cancers diagnosed in the UK could be avoided if people made changes to their lifestyles. These changes don’t mean that you definitely won’t get cancer – but they make it less likely. So here are some things that you might want to consider:

Take up some regular exercise

You don’t need to go to the gym – walking, cycling or gardening, done regularly, can be enough.

Try to maintain a healthy weight

Eating a balanced diet| , which contains plenty of fruit and vegetables, can help. Your GP can give you more advice.

Avoid smoking and drinking excessive amounts of alcohol

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Although making these changes may reduce your risk of developing breast cancer, they do not guarantee that you won’t get cancer. But all of the above strategies will improve your health generally.

Signs and symptoms

Breast cancer, when it is found early, can be treated successfully. Unfortunately, the early signs of breast cancer can be hard to detect and are often unclear. You should see your GP if you have:

a change to the outline or shape of the breast
lumps or bumpy areas
nipple discharge that is new for you and not milky
feelings of discomfort or pain in one breast that are different from normal (many women say that their breasts are more tender or a bit lumpy just before they have their period).

In most cases, changes to your breast do not mean that you have cancer. But it is worth seeing your doctor. There is no reason for you to feel that you are wasting your doctor’s time if you have discovered a change in your breasts.

Regular checks and screening for breast cancer

Women over 50 years are invited to join the national screening programme and have a mammogram (x-ray of the breasts) once every three years until they reach 70. Women of 70 and over can continue to have regular mammograms by contacting their GP, who will arrange an appointment in a breast screening clinic. From 2010 all women aged between 47 and 73 will be called for regular breast screening.

Mammography can help to detect breast cancer early, when it is easier to treat.

We have further information on breast screening.