Many are aware of the risk factors ? such as smoking, lack of exercise, and a diet high in cholesterol ? but fewer are aware of the genetic predisposition factor.
Awareness the key to battling breast cancer
Cancer is the third leading cause of death in the UAE after cardiovascular diseases and accidents. Data from the UAE Ministry of Health indicate that cancer accounts for approximately 500 deaths per year. Breast cancer is the world's leading cause of cancer-related deaths for women aged 15-64, and is the most common cancer in women after skin cancer.
Every one of us has had a friend or relative concerned about their family history of breast cancer. This is compounded by the media's emphasis on a woman's chances - one in eight - of developing the disease during her lifetime. On a positive note, however, there is constant development of new diagnostic tools, accompanied by a vast range of new cures being tested even as you read this article. Many of us are aware of the risk factors associated with breast cancer, such as smoking, lack of exercise, a diet high in cholesterol, the choice not to breast feed and various types of chemicals and radiation we face every day. However, fewer of us are aware of the genetic predisposition of breast cancer. About 10 per cent of breast cancers are associated with specific inherited mutations (errors in your genetic make-up). If several members of your family have had a particular type of cancer, then you may have an increased risk of developing breast cancer.
The National Institute or Health and Clinical Excellence (NICE) in the United Kingdom has guidelines that help identify family histories that could increase the risk of breast cancer. These include tracing mothers or sisters with breast cancer before the age of 40, three close relatives diagnosed with breast cancer at any age, or a father or brother diagnosed with breast cancer at any age. If a woman is then identified as being at risk, MRI scans for screening are recommended.
In cases where a strong family history is evident, then a multitude of genes may be faulty. We are able to test for only two of them, however: the breast cancer associated genes 1 and 2, also known as BRCA1 and BRCA2. BRCA1, discovered in 1994, works to reduce cell growth and replication, and studies have shown low expression in breast cancer tissues. BRCA2 was discovered in 1995. The presence of a fault in either is likely to increase the development of breast cancer by 85 per cent.
Various issues complicate gene testing. First, little is known about the interaction between these genes and other identified risk factors. Second, the cost of performing such tests and the impact this may have on health insurance policies. Finally, the consideration of what the information from testing might mean and what effect it might have on the woman and her family. Remember, expert counselling is crucial whenever genetic testing is undertaken.
So the question that we have to ask ourselves is: do the benefits of genetic testing for breast cancer outweigh the psychosocial impact it may have on the individual in question and their family? To complicate matters further, breast cancer is polygenic in its nature. That means a variety of genetic faults and mutations may be responsible for its development. Many genes come to mind such as the p53 and CCND1. Once again, research into the interaction between these genes and the BRCA1 and BRCA2 genes is still in its preliminary stages.
With current dilemmas in the field of breast cancer genetics, we must turn our attention to awareness campaigns. We have recently seen some very successful campaigns to raise awareness of breast cancer in the UAE. I was involved in organising one recently with students from the Department of Natural Science and Public Health at Zayed University. It was refreshing to see the enthusiasm expressed by the participants. What was an eye opener, however, was the lack of knowledge that breast cancer can be genetic.
With gene testing still in its early days, one must turn to more conventional methods of detection, and breast self-examination is one of them. Be safe, examine your breasts regularly, and if you suspect something, do not try to deny it. Remember, breast cancer can be treated successfully if detected at an early stage. Dr Usama Al Alami is an associate professor at Zayed University