Kampala — THE Ministry of Health recently announced that there is an increase in the cases of breast cancer among women less than 40 years of age. Reports show that the age trend of breast cancer has changed from 40-50 years to 30-40 years of age, compared to the Western world, where the diagnosis is still among the old - 50-plus years.

Mugisha adds that since breast cancer screening is something new in Uganda, majority of patients present late and those who do not seek treatment die out of hospital. However Mugisha notes that basing on the patients that go to hospital, the median age of women with breast cancer is about 45 years. "The youngest patient with breast cancer we have treated was a 19-year-old and unfortunately she died," says Mugisha. However, he affirms that the danger of getting breast cancer goes up as a woman gets older.

According to Noleb Mugisha, a medical officer at the Cancer Institute Mulago Hospital, there is a general increase in the prevalence of cancer worldwide. Though the causes are not clearly known, environment changes like global warming and pollution may increase the associated cancer risk factors.

Dr. Jacinto Amadua, the commissioner clinical services, Ministry of Health, says: "The increase of breast cancer among the young is simply attributed to the increased number of awareness among the people."

He explains that breast cancer among the young women has been there. It is only that over the years, more people are have realised the need to go for testing, unlike before where only the older women did testing."

On the other hand, many young women assume they are too young to get breast cancer. They tend to assume a lump is a harmless cyst or other growth. Some health care providers also dismiss breast lumps in young women as cysts and adopt a "wait and see" approach.

Lifestyle and breast cancer

Mugisha argues that in pursuit of academic qualification, good jobs and financial stability, many career women delay to give birth. Mugisha affirms that women who have not had children or who have their first pregnancy after the age of 40 have a slightly higher risk of developing breast cancer.

"Generally, pregnancy reduces a woman's total period of exposure to high levels of estrogen which is believed to lower the risk of developing breast cancer. During pregnancy, the estrogen levels are low and it is believed this decreases a woman's risk," explains Mugisha.

He, however, notes that pregnancy is not a guarantee of protection against breast cancer, it is possible to be diagnosed with breast cancer during pregnancy.

Young mothers today do not breastfeed their babies for long, most stopping before the baby is one-year-old. Many claim that they do not want their breasts to sag, or that their busy work-home schedule does not allow for them to breastfeed for long. The recommended length of time to breastfeed an infant is up to two years old, according to World Health Organisation.

Mugisha says breastfeeding for a longer time, for example a year or longer, is one way to protect oneself against breast cancer. According to a UK cancer report, breast cancer risk is reduced by 4.3% for each additional year that a mother spends breastfeeding her baby. Studies from 50,302 women with breast cancer and 96,973 healthy women from 30 countries, showed that breast cancer was low compared to the women who did not breastfeed at all.

Amadua concurs. "Mothers these days do not have time because they spend most of their time at work and by the time they return home they are rather tired and they not any position to breastfeed their child, yet breast feeding has an added advantage to reducing breast cancer."

Murokora says breastfeeding helps by reducing the oestrogen levels in the body. Oestrogen increases a person's risk of developing breast cancer. Breastfeeding also changes the make-up of a mother's breast cells, making them more resistant to cancer. Breastfeeding will also rid the breast toxins like carcinogens that are likely to cause cancer in the future.

Poor diets and sedentary lifestyles are also among the factors that increase breast cancer risk. Mugisha explains that being overweight or obese increases the risk of breast and colon cancer, endometrial, and other organs.

He advises women to watch how much and what they eat to control their weight. The other key thing is to increase the amount of physical activity one does. Being active helps reduce breast cancer risk, by helping with weight control and also reduces a woman's risk by influencing hormonal levels and the immune system.

Link with contraceptives Mugisha says there are some pills that lower the risk while others increase the risk. He stresses that the combined pill; an oral contraceptive which is recommended and is given by the family planning clinic is safe.

However, Dr. Dan Murotora, from the Uganda Women's Health Initiative, says: "Young people today do use a lot of drugs from contraceptives like pills that do contain oestrogen hormones in them yet, high levels of oestrogen increases the risk of breast cancer."

An extended use of oral contraceptives (the pill) later in life is also sometimes considered a risk factor for developing breast cancer. However, this is still subject to much debate.

Misconceptions & myths

Mugisha notes that there are a number of misconceptions about what can cause breast cancer. These include using deodorants or anti-perspirants, wearing a tight bra, bumping or bruising breast tissue. None of these factors has been shown to increase a woman's risk of developing breast cancer.

Besides, breast cancer is not contagious; it does not spread through contact with another person, it develops in one's own breast tissues.

Screening for breast cancer

Mugisha says breast cancer screening is still a relatively new phenomenon in Uganda. There are only two screening places - on site at the Uganda Cancer Institute, Mulago and Breast Clinic (surgical outpatients' clinic, New Mulago Hospital).

However, the institute carries out community outreach activities with the mobile Mammo Van. "With the mobile mammography machine, the institute is able to take screening services near to people. We have gone as far as Mayuge," Mugisha notes, adding that the institute plans to train more health workers so that screening is available at every health centre.

Other factors that increase risk

Mugisha says a woman's risk of developing breast cancer also depends on her natural genetic make-up. The risk is higher among women with a family history of breast cancer.

"Women whose immediate relatives suffered breast cancer, are at a higher risk of developing it themselves," says Mugisha. The risk is also higher, he adds, if there has been a history of other cancers such as ovarian and uterine cancers, and cancer of the colon.

Personal history is another factor. "A woman with cancer in one breast is at greater risk of developing another cancer in the second breast or in another part of the same breast," says Mugisha.

He adds that hormonal factors that may increase the risk of breast cancer include conditions that may allow long periods of exposure to high levels of the hormone in one's life time, such as beginning menstruation at an early age, for example before the age of 11, and experiencing menopause at a late age (after age 55). This means that the body produces the oestrogen hormone for a longer period than is usually expected and this is thought to increase one's risk of developing breast cancer.