CTT Breast Cancer Awareness Month
Breast Awareness and NF1
Caitríona Plunkett (Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University)
October is Breast Cancer Awareness Month. Early detection of breast cancer is vital for better treatment outcomes. Screening programmes to detect cancer at an early stage, healthy lifestyle choices such as regularly exercising, not smoking, and eating a balanced diet, all contribute to reducing our risk of developing breast cancer. Being breast aware also plays an important role in improving the outcomes of many women that receive a diagnosis of breast cancer, by helping in the detection of breast cancers at an earlier stage. There are certain conditions particularly those associated with a genetic mutation that increase the risk of developing breast cancer. Women with neurofibromatosis type 1 are at an increased risk, with those under the age of 50 at an up to five-fold increased risk of developing the disease. It has been found that there is an increased susceptibility particularly in those aged between 30 and 40 years. After the age of 50 the risk of developing breast cancer becomes similar to that of the general population. Recent research places the risk of developing breast cancer in women with NF1 between that of a woman in the general population and of a woman with a BRCA-related risk which is an inherited genetic mutation that contributes to breast and ovarian cancers.
Women with NF1 are often diagnosed with hormone negative breast cancers, with HER2 reported most commonly. These hormone negative breast cancers tend to be of a higher grade which means that they behave more aggressively and grow at a faster rate. Women with NF1 that are found to have breast cancer, often present with later stage cancers which results in a poorer prognosis. Some research has attributed neurofibromas around the breast tissue with the delayed clinical diagnosis of breast cancer, often misdiagnosed as a benign growth. Despite these findings and particularly that of breast cancer appearing from an earlier age in women with NF1, in the UK the National Institute for Health and Care Excellence’s (NICE) guidance recommends women with NF1 to attend annual mammograms from the age of 40 as per the guidelines for those at moderate risk of developing cancer. However, the National Comprehensive Cancer Network (NCCN) of North America has suggested that women with genetic disorders including women with NF1 should attend screening from an earlier age of 30. A recent paper published in the journal Genetics in Medicine by Professor Gareth Evans and colleagues, recommends the inclusion of women with NF1 gene defects in national high-risk screening protocols, so as to ensure earlier diagnosis and therefore better outcomes for those that are diagnosed with breast cancer.
It is clear that the earlier a cancer is found the better the outcome. It is therefore important for all women of all ages to be breast aware, particularly those with an increased risk of developing breast cancer. As there is not a national screening programme in place for women with NF1 from the age of 30, it is crucial for these young women to be proactive in identifying anything that is unusual about their breasts. Many women in the population, including those who are in routine screening programmes, find a lump themselves or notice something that appears different. However, it is important to state that in the vast majority of cases a lump in the breast is usually nothing serious and is often attributed to other factors that are not cancer. It is normal for the feel of your breasts to change at different times. Hormones, your menstrual cycle, non-cancerous cysts and fibromas and also just the natural feel of breast tissue, are mostly the underlying reasons for lumps and bumps that develop and are felt.
That is why it is so important to become breast aware. Being breast aware should be a natural process, of knowing what is normal for you and being confident in seeking help from a health care professional if you notice a change in your breasts. But what does it mean to be breast aware? The NHS Breast Screening Programme has produced a 5-point plan for being breast aware. These are:
⦁ know what is normal for you
⦁ look at your breasts and feel them
⦁ know what changes to look for
⦁ report any changes without delay
⦁ attend routine screening
When feeling or looking for changes remember not to forget your armpits and to feel right up to your collarbone. This useful infographic from Breast Cancer Now shows what to look out for:
Being breast aware can help you spot cancer at an earlier stage which has been shown to improve outcomes. This is the bottom line for all women whether you are at an increased risk of developing breast cancer or not. It is important to be proactive and report any changes that you notice to a healthcare professional or to somebody that you trust that can organise an appointment for you. Being breast aware goes beyond just the month of October. It is something that we can all take action on and incorporate into our routines.
Being breast aware is in our hands.