Sylvia Thompson outlines why Irish women need to be more vigilant about breast cancer.
Just about every adult in Ireland knows someone who has been diagnosed with breast cancer. This anecdotal knowledge about what is Ireland's second most common cancer among women (following skin cancer) is coupled with constant information bulletins on being breast aware and who can or can't access screening programmes for breast cancer.
Yet, in spite of this, or perhaps because of such information overload, the important messages about breast cancer aren't always getting through to the right people. For instance, BreastCheck, the national breast screening programme, is still attracting only 75 per cent of its target population of women between the ages of 50 and 64.
And many, many women in younger age groups never or rarely check their breasts for fear of finding a lump.
Martha Reilly (57), a survivor of breast cancer, says: "I think there is a lot of awareness about breast cancer but not as much vigilance as there should be.
"A lot of women don't want to know about it and many women don't check their breasts regularly."
For the fourth year running, the Irish Cancer Society is hosting a breast cancer awareness month in October in the hope that more women will carry out self-examinations or routinely request their GPs to do so and that older women will avail of the free breast screening available in the midlands and east of the country.
Encouraging women to take preventative action to reduce their risk of getting breast cancer is another aim of the awareness month. This is much more complex, however, partly because the established view of what are the most significant factors in the onset of breast cancer is changing.
For instance, the importance of a family history of breast cancer seems less significant than hithertofore.
"Only about 5 per cent of women with breast cancer will have a strong family history of the disease," says Dr John Kennedy, medical oncologist at St James's Hospital, Dublin.
Lifestyle factors are now believed to be the most significant cause of the rise in breast cancer in the western world.
Of these, the changing levels of oestrogen in women throughout their lives is perhaps the most important.
"Because girls weigh more, they menstruate earlier, often don't have children until they are in their 30s and live until they are in their 80s. This creates a totally different internal environment in terms of the levels of oestrogen," Dr Kennedy says.
Having babies in your 20s and breastfeeding are recognised ways of reducing your risk of getting breast cancer.
An estimated 75 per cent of breast cancer tumours are situated in the milk ducts. These ducts are less likely to harbour tumour cells when brought to full maturation through pregnancy and breastfeeding.
The rising levels of obesity in women is another causal factor, and various studies of pre-menopausal and post-menopausal women are throwing up interesting findings.
"Post-menopausal women who are overweight have more oestrogen in their bloodstream which increases their risk of breast cancer," says Dr Patricia Fitzpatrick, senior lecturer in the Department of Public Health Medicine & Epidemiology, UCD, and epidemiologist with BreastCheck.
This heightened risk is due to oestrogen receptors in the breast soaking up excess oestrogen in the blood, thus increasing the potential for cancerous growth.
Results last year from a large study of pre-menopausal women in the US also pointed to an association between the dietary intake of animal fat - in particular red meat and high-fat dairy foods - and an increased risk of breast cancer.
Other recent studies have also pointed to HRT as a risk factor for breast cancer. Women on HRT who receive a diagnosis of breast cancer are almost always taken off the treatment.
Such studies call into question the long-term impact of prolonged use of the contraceptive pill on breast tissue.
"Women are now only advised to take HRT for symptomatic relief rather than as a lifestyle option. The long-term use of the contraceptive pill may have a slight impact on breast cancer but women have to weigh up the advantages and disadvantages when they take this form of contraceptive," says Dr Fitzpatrick.
Leaving aside the influence of lifestyle factors on the chances of developing breast cancer, there is widespread agreement that screening programmes are a sure-fire way of reducing death rates from breast cancer - even if there is an increased incidence of the disease while such a screening programme becomes established.
"Early detection through screening programmes will reduce the death rate in that age group by about 20 per cent and we will see such a reduction between eight and 12 years in Ireland," Dr Kennedy says.
The all-Ireland cancer statistics, published earlier this month, showed how breast cancer deaths are falling by 4 per cent a year in Northern Ireland, where there has been a breast cancer screening programme since 1993.
The proper application of therapies - including newer hormone therapies combined with radiotherapy and chemotherapy - will also have an impact on death rates, according to Dr Kennedy.
And, since treatments are less effective when women are diagnosed with breast cancer in the late stages of the disease, the rolling-out of BreastCheck screening programmes to the west and south of Ireland remains the most crucial step to reducing the death rates of breast cancer in this country.
Breast Cancer Awareness Month takes place during October. Contact the Irish Cancer Society helpline on tel: 1800-309040 for a free information pack on breast cancer or to discuss any aspect of breast cancer with a specialist nurse.
Warning signs of breast cancer
• A new lump or thickening of tissue felt in the breast.
• Changed size, shape or contour of one breast or nipple.
• Inversion (drawing in) or scaling (flaking) of the nipple.
• Lump or swelling in the armpit.
• Dimpling/puckering of the breast skin.
(Adapted from The Complete Breast Book by June Engel, Newleaf €12.99)