Doctor’s blog

Breast cancer is a hormone dependent disease. This evident from the fact those women who do not have functioning ovaries and who never receive estrogen replacement therapy do not develop breast cancer. The causes of breast cancer are not well defined and controversial. One of the causes is female sex and female to male breast cancer ratio is 150:1.

(1) The Three Dates: The three dates that has major significance in a woman’s life regarding breast cancer incidence are (i) age at menarche (first menstruation) (ii) age at first full-term pregnancy and (iii) age at menopause. Women whose gets menarche at age 16 has only 50% to 60% of the breast cancer risk of a woman having menarche at age 12 and the lower risk persists throughout life. If menopause occurs 10 years before the average age of menopause, which is 52 years, due to natural or surgically induced, reduces lifetime breast cancer risk by 35%. Similarly, women who have a first full-term pregnancy by age 18 have a 30% to 40% lower risk of breast cancer compared to who have a first full-term pregnancy by higher age or who has only one pregnancy.

Thus, length of menstrual life particularly before first full-term pregnancy is a major risk factor in development of breast cancer. These three factors i.e. menarche, age of first full term pregnancy, and menopause may be responsible for 70% to 80% of the variation in breast cancer incidences in different countries.

(2) Breast Feeding: Another important factor in the development of breast cancer is the breast feeding. The duration of breast feeding correlates with substantial risk reduction which are not related to either parity (number of children) or age at first full term pregnancy.

(3) Diet: The role of diet in the causation of breast cancer is controversial. There are links between total caloric and fat intake and breast cancer risk, though the exact role of fat in the diet is not proven. Increased caloric intake may contribute to breast cancer by inducing earlier menarche, later age at menopause, and increased postmenopausal estrogen concentrations reflecting.

(4) Alcohol: Alcohol and breast cancer are closely related. Moderate alcohol intake can also increase risk of breast cancer by an unknown mechanism. Folic acid supplementation in alcoholics reduces the risk.

(5) Exogenous Hormones: The role of oral contraceptives and postmenopausal hormone replacement therapy in causation of breast cancer is very controversial. The benefits of oral contraceptives seem to outweigh the risk of breast cancer.

(6) Radiation: If women are exposed to radiation like multiple fluoroscopies (200–300 cGy) or treatment for Hodgkin’s disease before the age of 30 years, they have substantially higher risk of breast cancer. But exposure after 30 years has minimal risk though the reason is unknown.    

Breast cancers have strong familial predisposition and runs in families. Many studies have been done in this regard. About 10% of human breast cancers can be linked directly to germline mutations. Several genes have been implicated to cause breast cancer.

Li-Fraumeni syndrome is characterized by inherited mutations in the p53 tumor-suppressor gene, that lead to an increased incidence of breast cancer, osteogenic sarcomas, and other type of cancers. Inherited mutations in PTEN have been reported to increase breast cancer.

BRCA-1, a tumor suppressor gene, has been identified at the chromosomal locus 17q21. The gene seems to be involved in gene repair. Women who inherit a mutated gene from either parent have at least a 60% to 80% lifetime chance of developing breast cancer and about a 33% chance of developing ovarian cancer. Men who inherit the gene have an increased incidence of prostate and breast cancer.

Another gene, BRCA-2, which has been identified at the chromosomal locus 13q12, is also associated with an increased incidence of breast cancer in men and women.

Mutations in BRCA-1 and BRCA-2 can be easily detected and patients should be given genetic counseling. All women with strong family histories for breast cancer are ideally sent to genetic screening programs, particularly women of Ashkenazi Jewish origin, because they have a high incidence of a specific BRCA-1 mutation. This mutation is due to deletion of adenine and guanine at position 185.

The role of these genes is more important in sporadic form of breast cancer than inherited form of breast cancer. p53 mutation is present in about 40% of human breast cancers as an acquired defect and PTEN occur in about 10%. But BRCA-1 mutation in sporadic primary breast cancer has not been reported yet.

Lots of research is still required to determine exact risk of familial predisposition of breast cancer and diseased (mutated) genes before we can say conclusively.

Few days back the big boss (the main partner of the institute where I work; the other partner is the local govt.) came here to find out the ground situation of the institute. He came here with the mission to solve the problems the college is facing as he is the best and only person who can solve the problems.

Here, I would like to mention that the local govt. is not doing the duty which it is supposed to do in trying to solve the difficulties. Govt. knows (at least everybody believes so) every thing but not taking any positive action in solving the problems. After all a democratically elected govt. has a moral duty to look after its people and their aspirations.

The big boss came and had a meeting with the faculty members first. Many of the faculty members raised many questions from the welfare of the college to the welfare of the faculty and other employees and the big boss tried to answer to them in most convincing ways. But, I think many of the faculty members were not convinced by the answers which they got. After meeting with faculty he met other employees of the institute and they had much more complains than the faculty staffs. There he reassured them but I don’t know how much they were convinced by his reassurance.

The big boss reassured every body that very soon (we hope) the problems will be solved and the Medical Council of India (MCI) will give the green signal for the admission to the new batch this academic year (though it is already late by more than 3 months). If admission for the new batch is granted it will solve the major problems, and every body is hoping and praying for that.

In the mean time during the agitation in the college for the problems many unexpected things also came to limelight. We all hope that the big boss will take concrete action to sort out all the problems the institute is facing right now. Because he is the only person who can solve the problem and he will be the largest beneficiary of that, being the main partner of the institute.

We all are eagerly waiting for the good news of Medical Council of India permission for the new admission to come. We can only wait and watch. So let’s wait and watch.