AETIOLOGY OF BREAST CARCINOMA

Shilpa Kathuria Shweta Dubey

Risk Factors for Breast Cancer

 Major

risk factors

Gender :- Female > Male (100 times more common) Age :- The majority of patients presenting with breast cancer are over the age of 50 years. Previous breast cancer :This risk appears greatest in young women if their initial breast cancer is diagnosed before the age of 40. Family history and genetic predisposition :The risk is greatest in patients with first-degree relatives (mother or sister) affected, especially if under the age of 50 when the disease developed .

Multiple family members with breast cancer, the existence of bilateral disease, or the identification of an affected male all indicate excessive riskespecially if in association with ovarian cancer among other relatives.
GENETIC PREDISPOSITION :1. BRCA1:- Chromosome 17q21 It accounts for up to 40% of familial breast cancer syndromes BRCA1 is a tumor suppressor oncogene inherited in an autosomal dominant fashion.

BRCA-1 associated breast cancers have :An early age of onset when compared with sporadic cases Higher prevalence of bilateral breast cancer; Presence of associated cancers in some affected individuals, specifically ovarian cancer and possibly colon and prostate cancers.

2) BRCA 2 :- chromosome 13q12 30% of familial breast cancer and is associated with increased breast cancer risk in males A higher prevalence of bilateral breast cancer.

 Intermediate

risk factors :-

Diet and alcohol intake :These factors are important as they are to an extent under the control of individual women. Nulliparity :Single and nulliparous married women have a relative risk of 1.4 compared with parous women . Age of menarche and menopause :The risk decreases as the age of onset of menstruation increases. The risk of developing breast cancer is more in those who cease to menstruate before the age of 45, compared with women who continue menstruating beyond age 55.

Oral contraceptives and hormone replacement therapy The relative risk of developing breast cancer while taking oral contraceptives is 1.24. On stopping therapy this increased risk diminishes to 1.01 over the ensuing 10 years. Hormone replacement therapy:- risk increases after 15 years of therapy Irradiation :Increased risk becomes apparent after a latent period of 10 to 15 years: the effect is most obvious in women exposed to irradiation when under the age of 35; there is little increased risk in women exposed after the age of 40.
Benign proliferative breast disease (eg. multiple papillomatosis)

Minor and controversial risk factors :-

Benign breast disease :Multiple papillomatosis and hyperplasia with gross atypia are certainly associated with an increased risk of breast cancer (3.0). Severe atypia with hyperplasia is associated with a moderately increased risk of developing breast cancer The risk is lower with lesser degrees of atypia. Body size Stress

CARCINOMA OF MALE BREAST

ETILOGY :1.

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Significantly raised serum levels of oestrogens in men with breast carcinoma . Being overweight in early adulthood is a risk factor for developing the condition. Male breast tumours are very common in patients with Klinefelter's syndrome (impaired testicular function). Increase in the ratio of oestrogen to testosterone include long-standing hypopituitarism and hypogonadism, mumps orchitis in adulthood, and testicular injury.

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Gynaecomastia. There is a positive correlation between male breast cancer and prostate cancer. Two gene defects have been associated with a predisposition to the development of male breast cancer :BRCA2 Androgen receptor (AR) gene.