Breast cancer risk real without family history

By RON TAYLOR

Women should not be lulled by the popular misconception that if there is no history of breast cancer in their family they are not at risk, says a Hamilton specialist.

Surgical oncologist Ian Campbell says 85 per cent of women who get breast cancer have no family history of the disease.

"Yet so many women think because there's no family history they don't need to bother sorting out any breast lump or going along for [breast screening] mammography.

"This dangerous misconception has got to be dispelled," he says.

"However, it is also true that for a minority of women, inheriting a breast cancer gene puts them at high risk of developing breast cancer, and in some cases other cancers."

Breast cancer is the single biggest cause of death among New Zealand women aged 55 and under. About 600 women die of it each year. The incidence of the disease here - and of even more concern, the death rate - is among the highest in the world.

The reason for this is not known because of a 15-year shortage of Government money to analyse the problem, says Dr Campbell. The result is that doctors do not have accurate information about when women are diagnosed with cancer or the long-term survival rates.

"We can't even compare ourselves with other countries as far as our treatment processes go.

"As clinicians we're pretty much up to date, we know what the best treatments are and we do our best to get them within the [limited] hospital resources ...

"But I do have my own suspicions as to why mortality rates are so bad and it's not because we treat women badly.

"I believe our public health services are under-resourced. The result is that women with breast symptoms referred to the public health system often wait a long time for a diagnostic assessment," says Dr Campbell.

"In Britain they've passed legislation which requires a woman with a suspicious lump to be offered assessment [by a public hospital specialist clinic] within two weeks of a referral from her GP who suspects there may be a cancer.

'There's no way we can achieve such a prompt assessment here without a special request in person from a woman's GP."

Reproductive factors influence the risk of getting breast cancer, says Dr Campbell. Research shows that women who start menstruation early and finish late are at greater risk.

Conversely, those who start late and finish early have less risk, as do women who go through pregnancy at a young age, especially before 20.

Women over the age of 30 or those who have not given birth have nearly double the risk of developing breast cancer.

Dr Campbell says that menopausal women who take hormone replacement therapy for a long time - on average for 10 or more years - have a small increase in risk, as do women who have taken oral contraceptives for a long time.

But the slight increase is not enough reason to abandon either HRT or the pill.

The risk goes away within a few years of stopping oral contraception.

The evidence is growing that exercise is beneficial not only in lowering the risk of breast cancer but many other cancers and heart disease along with other complaints, says Dr Campbell.

Exercise does not have to be strenuous. A daily walk is enough to make a significant difference.

Auckland surgeon Belinda Scott, who chairs the medical advisory committee of the Breast Cancer Foundation, says the mortality rate has been dropping overseas.

Breast awareness and screening programmes have helped, with the resulting quicker remedial action, as have endocrine treatments such as Tamoxifen or chemotherapy.

Screening has been available throughout New Zealand for only 18 months although pilot studies were done for eight years.

The screening has detected an average of seven women per 1000 with breast cancer, which confirms the previously estimated rate.

"What we are hoping is that we find a cancer earlier."