Cancer

Sometimes in lonely nights I wonder why there aren't more starsigns named after deadly illnesses, but then after I while the fact occurs to me, that nobody died of cancer when they named them back then. Nobody was old enough in those days.

I'd still love to hear women approach each other, asking for their signs. »I'm multiple sklerosis and my friend is alzheimers« – »Oh, that's like so terrible, you just don't match«.

I tend to think, it would be a better world. And I'm not even a Cancer.

All breast cancer results from changes in genes, but not all changes in the genes
are inherited. In fact, only about 5 to 10 percent of breast cancers are thought to
be caused by inheritance. Scientists have identified some of the genetic
alterations, or mutations, that are responsible. In particular, women with
mutations in genes called BRCA 1 or BRCA 2 (for breast cancer 1 or 2) are in
greater danger of breast cancer. Statistics indicate that about 50 to 60 percent of
women with a mutation in either gene will develop breast cancer by the age of 70.
These mutations also increase a womans risk of ovarian cancer, and possibly of
colon cancer. And they tend to promote development of breast cancer at a
younger than average age.

Women with an abnormal AT (ataxia telangiectasia) gene are also thought to be
at increased risk of breast cancer. Likewise, abnormalities in the p53 tumor
suppressor gene can increase a womans risk. Theres also some evidence that
women of Ashkenazi Jewish descent may be at higher risk of carrying a genetic
mutation associated with breast cancer.

Its important to remember that a case of breast cancer in your family does not
automatically mean that you carry a gene associated with the disease. After all,
breast cancer is relatively common in women without a genetic mutation. A family
history of both breast and ovarian cancer increases the likelihood that you carry
such a mutation, but does not guarantee it.

You can find out whether you have the BRCA 1 or BRCA 2 mutation by getting
a blood test. If you have a family history of breast cancer, theres good reason to
be tested, but there are pluses and minuses to knowing for sure. Confirmation of
the abnormality can alert you to the need for lifestyle changes you might otherwise
have dismissed. It can also weigh heavily in the decision to undergo drug therapy
or a mastectomy to reduce the risk of breast cancer (see chapter 37 for more
details). On the other hand, a positive reading could result in loss of health
insurance, inability to obtain insurance, or an increase in premiums to an
unaffordable level.

For nearly 80 percent of women with breast cancer, the discovery of a mass or
lump in the breast is the first sign that something is amiss. Fortunately, 8 out of
every 10 lumps discovered and biopsied turn out to be noncancerous, but if you
do find a suspicious lump, its still best to call your doctor right away.

Most women discover breast lumps themselves, either by accident or while
performing a monthly self-examination. Because early detection is crucial for a
cure, you need to learn the right way to examine your breasts each month. Once you know the feel of a »normal« breast, youll quickly
recognize any little change.
If you do find a lump, your breast may be tender, or it may feel normal. There
could be some discomfort or a »pulling sensation.« Cysts, which are benign, tend
to move freely within the breast, so when a lump appears to be immobile, or the
skin is dimpled or puckered, doctors tend to suspect that the growth is malignant.
However, this is not a certainty.

A discharge from the nipple is another common sign of a potential problem. The
discharge may be clear, bloody, or colored. It is important to understand that a
discharge can be perfectly normal in women who are not breastfeeding. In this
case, a small amount of discharge usually comes out of several openings in both
breasts.

A spontaneous discharge that occurs without squeezing the breast is a far greater
cause for concern. A discharge coming from the same general location in one
breast may well indicate the presence of an underlying mass. Although a bloody
discharge occasionally may occur during pregnancy, it can also be a significant
warning sign of cancer. The older the woman, the greater the possibility that the
discharge is caused by cancer. The odds are even higher if she also has a lump.

Other signs of cancer include a change in the shape or size of the breast or
swelling of the skin that covers it. The breast tissue may feel thicker, even though
there is no lump. There may be pain or redness of the skin. The nipple may be
sore or retract inside the breast. You should have a skin-doctor examine any sores on
the nipples or breast that do not clear up after two weeks of treatment with a
prescribed cream or lotion. Its also important to tell a doctor about scaly skin on
the nipple, skin dimpling, and any change in the veins in the breast. In most cases,
the doctor will need to take a sample for microscopic examination (a biopsy) to
check for cancer.

As breast cancer progresses, signs and symptoms become unmistakable,
including skin ulcers and extensive swelling and redness of the breast and swelling
of the arm. The nipple may retract into the breast, and the breast may retract into
the chest.

No one understands exactly why breast cancer seems to run in some families and
not others, but physicians are getting better at predicting which of us is more
likely to be stricken. Whatever the underlying reason may be, family history
definitely does play a significant role. If your mother, sister, or daughter (known
as first-degree relatives) have had breast cancer, your estimated risk is 1.5 to 3
times higher than that of a woman whose close female relatives are breast
cancer-free. If two first-degree relatives have had breast cancer, your risk
increases five-fold.

The older you are, the greater your chance of developing this frightening disease.
Breast cancer rarely occurs before the age of 20. The odds of developing it
increase sharply with age until menopause. After that, the chances of developing
breast cancer continue to rise with age, but not as rapidly.

The longer a woman remains fertile, the greater her chances of developing breast
cancer. If you started having periods early (before the age of 12) or stop having
them late (after the age of 55) youre in the high-risk group.

Pregnancy seems to short-circuit the process under certain circumstances. The
earlier a woman completes her first full-term pregnancy, the less likelihood she
has of contracting the disease. For example, a womans lifetime risk of developing
breast cancer drops by as much as 70 percent when she has a baby before her
eighteenth birthday. This beneficial effect steadily tapers off during her 20s and
seems to vanish entirely by the time she reaches the age of 30. Women who have
their first baby after the age of 35 are twice as likely to develop breast cancer as
those who give birth while still in their teens. Abortion does not appear to
increase your risk of breast cancer, though this issue is not definitively settled.
And what of the widespread belief that breastfeeding naturally protects a nursing
mother from breast cancer? At present, its still under scientific debate.

Like early motherhood, the removal of the ovaries seems to offer some
protection against breast cancer. If a womans ovaries are surgically removed, her
chances of getting breast cancer can fall by as much as 75 percent. How much
this procedure cuts your risk depends upon your weight, your age at the time of
surgery, and whether you have had children. The greatest benefit accrues to
young, thin women who have never had children. Removing only one ovary also
reduces the risk of breast cancer, but to a lesser degree than removing both.

Other probable risk factors are harder to pinpoint. For example, breast cancer is
most common among Caucasians and occurs much less often among Asians. But
despite a very low rate of breast cancer among Japanese women who stay at
home, the risk rises sharply among those who have moved to the United States --
a phenomenon that has convinced some scientists of a link between environment
and development of the disease.

Although black women are less likely to develop breast cancer than white
women, black women are more likely to die of the disease.

For some reason, breast cancer seems to occur more often among the wealthier
and better educated. Some data suggest that alcohol use or a high-fat diet
increases risk of breast cancer, but this has not been confirmed. Smoking does
increase the risk of breast cancer for some postmenopausal white women. Other
studies suggest that vigorous exercise at certain ages may reduce the risk.

Women who have previously had cancer of one breast are at higher risk of
developing it in the other. Women with a certain type of noncancerous lesion in
the breast, called a radial scar, are more likely to develop cancer where the scars
are found.

Because the breast is extremely vulnerable to the effects of radiation, previous
exposure to radiation increases the odds of breast cancer, especially for women
exposed before the age of 30. Exposure as a young girl is a particular cause for
worry.