I have a confession to make: I do not do regular breast self-exams. I know, I know, you’re supposed to, and it can save your life, and that’s the way so-and-so found hers, etc., etc., etc. But I just don’t understand the idea of looking for something you don’t want to find. When I search for my keys, I am hoping they will materialize. When I scan a room for a friend, I am hoping I will see her. Even when I am not supposed to be looking for trouble, I am still secretly hoping to find it. But looking for something bad? It is like opening up the refrigerator and digging around for something gross to eat. I do not want to find a moldy turnip, I do not want to find a moldy turnip… oh crap! I just found the moldy turnip.
Do not get me wrong, I think early detection of breast cancer, or any cancer for that matter, is extremely important. Life-saving even. But I guess I am at the age (thirty) where I am still swimming upstream, trying to prevent the oh-no-that’s-a-pea-sized-lump-under-my-left-areola from ever happening in the first place. In graduate school, I studied epidemiology, and learned that distribution of disease and health in a population is not random; risk factors can increase a person’s chance of getting an illness. Minimizing my risk factors always seemed easier than going downstream.
However, risk factors are based on statistics, and statistics have outliers. That means those with very little risk may still get cancer and those with very high risk may not. We still do not know exactly what causes breast cancer or who will get it. We do know that breast cancer is the second most common cancer in women (after skin cancer) and the second leading cause of cancer death (after lung cancer). How can we try to avoid it?
Risk Factors You Cannot Change
Hormones. Damn them. Not only do they turn us into crazed carbo-loading fatsos once a month, they go hand in hand with our biggest breast cancer risk factor: being a woman (men get breast cancer too, though it is very rare). The prevailing theory is that breast cancer risk is determined in large part by a woman’s cumulative exposure to estrogen and progesterone during her ovulatory menstrual cycles. This means the longer the intervals of regular menstrual cycling, the higher the risk. So, women that have had early menstruation (before age eleven) and/or late menopause (after age fifty-five), have a higher risk of breast cancer.
Age. There is a saying, “if you live long enough, you’ll get cancer.” Breast cancer risk significantly increases with age. About 78 percent of women are diagnosed with breast cancer after the age of fifty.
Genetics. Two genetic mutations, BRCA1 and BRCA2, greatly increase the risk of getting breast cancer. However, these mutations are very rare in the population and account for about 5 to 10 percent of all breast cancers. Other inherited genetic mutations play a role in breast cancer, and in many cancers, but none are as clearly defined as these two.
Family history. If you have a first-degree relative (mother, sister, or daughter) who has breast cancer, you have about double the risk of developing it yourself. The more relatives you have with breast cancer and the earlier the age at which they were diagnosed increases risk. In addition, your own history of breast cancer or benign breast condition increases your chance of getting breast cancer.
Previous chest radiation. Radiation can be a good thing when treating a cancer, but also has some negative long-term effects. Women who as children or young adults had radiation therapy to the chest area as treatment for another cancer (such as non-Hodgkin lymphoma) are at significantly increased risk for breast cancer.
Kids. Remember the Sex and the City episode where Samantha is diagnosed with breast cancer? Her doctor tells her not having children has put her at risk, an idea she balks at before storming out of the exam room to find a new physician. Contrary to what our high school advisors told us, having multiple kids at a young age is actually a good thing, for our breasts at least. Again, it all comes back to hormones: levels of estrogen drop after a first full-term birth and during pregnancy and lactation. Women who never have children or who have their first child after the age of thirty-five have a higher risk of breast cancer than a woman who had her first kid before age twenty. The more children a woman has and the longer she breast-feeds reduces her breast cancer risk. (Note: I am putting kids in the unmodifiable risk factors section. Yes, you can decide when to have kids, how many to have, and how long to breast feed, but some of us—the thirty-somethings whose clocks are ticking with no husband or virile penis in sight—cannot.)
