Fridae

Like a thief in the night, it can happen without you noticing. It is invisible, sometimes painless and often goes unnoticed until it is in its later stage.
Breast cancer is the most commonly diagnosed cancer in women worldwide. In 1964, the lifetime risk was 1 in 20. Today it's 1 in 8. It is estimated that 1.2 million new cases will be diagnosed and 500,000 deaths from breast cancer will occur worldwide this year (The Breast Cancer Fund, US).

While breast cancer research to date has not represented the full cultural diversity, race, class and age of lesbians, there have been suggestions that lesbians may have increased risk of developing breast cancer based on known and suspected risk factors.

There is also a higher risk of breast cancer as well as cervical and ovarian cancers because they are less likely to have children by age 30, if at all.

"Breast cancer is generally a tumour that is thought to be estrogen dependant, estrogen being the predominant female hormone that is produced mostly by the ovaries in a woman's reproductive years. Pregnancy appears to confer some protective effect because the predominant hormone in pregnancy is progesterone, and not estrogen. Estrogen is also produced by fat tissue in the body and so women who are obese generally have more estrogen floating around their system," says Dr Quek Swee Chong, a gynecologist at KK Women's And Children's Hospital in Singapore.

Lesbians appear to be less likely than their heterosexual sisters to seek healthcare and may therefore be at risk of increased morbidity and mortality resulting from delayed diagnosis for treatment.

Since most lesbians do not require pre-natal and birth control care, they do not visit nor receive regular screenings for breast cancer at their healthcare providers. Lesbians may also intentionally avoid seeking healthcare due to the discomfort of coming out to healthcare professionals, and the fear of painful, unknown and embarrassing procedures, as well as past negative experiences with homophobic practitioners.

Elizabeth Rankow from the Duke University Medical Center reported that these experiences have been well documented within medical literature and may include patronizing treatment, intimidation, attempts to change the patient's orientation, hostility, invasive and inappropriate personal questioning, undue roughness in physical exams and even sexual assault.

Lesbians may not be able to afford routine check-ups, as they do not have adequate health insurance, especially in developing countries.

Additionally, lesbians who are estranged from their families because of their orientation may not have access to their family's medical records and breast cancer history.

What puts you at risk? "Generally the highest risk women are those that have a strong family history of breast cancer or ovarian cancer. A gene mutation has been identified which puts a woman at risk of both ovarian and breast cancer," says Dr Quek.

---

Research has shown that the following conditions place a woman at increased risk for breast cancer:

Personal history - if you have had breast cancer, you may face an increased risk of getting breast cancer again.

Heredity - your risk for developing breast cancer increases if your mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer, especially at a young age.

Smoking and exposure to second-hand cigarette smoke (also increases risk for other types of cancer).

Reproductive history - earlier onset of menstruation (<12 years), late first-term pregnancy (>30 years), no children or breast-feeding, later menopause (>55 years), early use of oral contraceptives, long-term use of hormonal replacement therapy (HRT), however, this has to be weighed against the benefits of HRT on the heart and osteoporosis.

Diet that is high in fat, lack of exercise and high alcohol consumption. Breast cancer rates are the highest in industrialized countries that may be caused by lifestyle changes such as a fat-rich diet and smoking. A report in The Straits Times, a Singapore daily reported that the figure of women contracting breast cancer is one in 10 in developed countries such as the US and Britain; and one in 30 in developing countries such as Thailand.

Exposure to radiation - the use of radiation therapy to kill cancer cells and shrink tumors. (Source: The Breast Cancer Fund, US) However, studies have shown that routine diagnostic chest x-rays or screening mammograms will not cause increased risk.

Studies have also shown that women who develop breast cancer may have none of the risk factors listed above, other than the risk that comes with growing older.

Actions to take
"Regular self breast examinations are the best way to detect an early tumour. I would not recommend mammograms for younger women but certainly women 45 and over should have regular mammograms. There is also some evidence that ultrasound examinations are more sensitive for younger women because the breast tissue is less dense and ultrasound is more likely to pick up the changes. This advice is not specific to only single childless women but all women. It is important to establish a good relationship with a doctor who will be able to facilitate the necessary investigations," says Dr Quek.

- Have an annual mammogram after age 45
- Establish an open relationship with your health care provide
- Stop or reduce smoking and have a balanced diet
- Perform a monthly breast self-examination (or BSE). The best time is 10 days after the start of your period. Report any changes or irregularities to your doctor

Besides breast lumps, other warning signs to look out for are:
- skin changes over the breasts
- pain or discomfort lasting for more than a few weeks
- changes in the shape or size of either breast - nipple changes
- nipple discharge

How to do a breast examination:

Standing up:
Stand in front of a mirror that lets you see your breasts clearly. Place your hands at your sides and check breasts. Placing hands on hips - pressing shoulders and elbows forward to flex chest muscles. Check again raising hands and clasping behind head.

In the shower:
Raise your left arm. With the flat part of the fingers of your right hand, carefully examine your left breast. In a circular pattern, start from the outer top, pressing firmly enough to feel the tissue beneath. After one full circle, move an inch and circle again, continuing until you reach the nipple. Check the area above the breast, especially the armpit area for lumps or hard knots. Repeat on right breast.

Lying down:
Lie flat on your back, with your right hand behind your head and a pillow or folded towel under your right shoulder. With your left hand, examine the right breast and area around it very carefully. Then switch hands and repeat the procedure for the left breast. Also gently squeeze each nipple to check for discharge.

The most effective weapon against breast cancer is early detection. The aim of screening is to detect the disease at an early stage where the tumour is small and the survival rate is high. If found early, about 90% of all breast cancers are curable.

This report has been written with help from the Breast Cancer Foundation (Singapore), The Breast Cancer Fund (US) and the National Breast Cancer Coalition (US).