“Let Us Eat And Drink For Tomorrow We Die”: Unspoken Risk Factors Of Breast Cancer

We wish for a world that is without pain and trouble. As we gaze toward a horizon of health and vitality, today's reality speaks otherwise, sadly. However, we have a part to play in the architecture of our lives, however meagre it may be, to make it a house not only of pain and decay, but one of fortitude in a day in which our mortality shows its ugly face. So, we have a call not to be carefree. We must not live just for pleasure, as is advanced in the philosophy of ancient Greek philosophers, including, but not limited to, Aristippus and Epicurus, a concept that is generally termed “hedonism.”

This brings to light one of the leading causes of death globally: breast cancer. This disease, with its accompanying morbidity and mortality, continues to ravage lives and pester health systems. In a work published in 2022 by the International Agency for Research on Cancer under the World Health Organization, breast cancer is the leading form of cancer globally. We see a similar picture in the various regional blocs, including Latin America, Europe, Asia, and Africa. It also leads in the causes of death from cancer, coming only second to lung cancer globally.

In Ghana, among women, breast cancer has the highest incidence considering all types of cancers. It is also the leading cause of death from cancer among women in Ghana. Meanwhile, it is usually diagnosed late in Ghana. Consequently, prognosis becomes poor.

The average age of breast cancer diagnosis in Africa is 48 years. The age at diagnosis in Caucasians (Whites) is higher compared to people belonging to the black race. This implies that our part of the world must be more intentional about breast cancer screening since it occurs at an earlier age in blacks, so that it is diagnosed earlier and the requisite management is initiated. Integral to this is the need to be acutely aware of the risk factors of breast cancer.

A risk factor for breast cancer is any entity that potentiates the possibility of breast cancer occurring. For some of these risk factors, although there is evidence of their association with breast cancer, they are not given the necessary publicity that will make them common knowledge; they have become unspoken!

Older age is a fairly well-known risk factor. However, when breast cancer occurs in young females, it is more aggressive. Older age is a risk factor due to menopause occurring at older ages, especially when it occurs late. This is because late menopause means that the breast will be overly exposed to these hormones: estrogen and progesterone. They stimulate the growth of breast tissues. Prolonged exposure increases the likelihood of gene mutation, leading to breast cancer. Talking about genetic mutation, another well-known risk factor for breast cancer is a family history of breast cancer. The main reason is that, just like the physical traits that close families share, certain mutated genes that increase the likelihood of breast cancer can be inherited, thus increasing the chance of breast cancer occurring.

Cigarette smoking is one risk factor for breast cancer that is less known. Tobacco smoking exposes the smoker to harmful substances that are cancer-causing agents, thus increasing the probability of breast cancer. There has been a significant reduction in cigarette smoking in Ghana. However, shisha smoking has raised its ugly head. Like cigarettes, shisha also contains harmful substances, some of which are cancer-causing. Interestingly, in certain areas, shisha smoking is more prevalent among females than males. Many people smoke it for pleasure, not thinking of its implications. Such a hedonistic tendency is not helpful to the fight against breast cancer.

Another risk factor, less spoken about, is oral contraceptive use. Today, the use of oral contraceptives has skyrocketed among girls and young women. It is arguably being abused. This also suggests that more of the population in question is having unprotected sex. Considering the prolonged exposure to the hormones estrogen and progesterone discussed above, oral contraceptives also contain these hormones. These hormones in oral contraceptives will increase breast tissue growth, increasing the possibility of certain gene mutations and hence breast cancer. When the use of oral contraceptives is stopped, the risk of breast cancer also decreases significantly.

The contention for oral contraceptive use as a risk factor ebbs into another risk factor less spoken of: hormone replacement therapy. This therapy is done to replace reduced estrogen and progesterone (in another form called progestin) that we see in menopausal women. People also undergo this treatment for cosmetic appearance. Hormone replacement therapy also increases exposure to the hormones in question, raising the probability of breast cancer occurring.

Furthermore, alcohol consumption is a less-known risk factor for breast cancer. This is also linked to hormonal discourse. The behavior of alcohol in the body raises the levels of estrogen in the body. This is because the liver metabolizes (breaks down) estrogen as well as alcohol. However, when the level of alcohol is high in the body, the liver prioritizes the metabolism of the alcohol, thus leading to high levels of estrogen. As mentioned earlier, estrogen stimulates the growth of breast tissue, which can lead to certain gene mutations and possibly breast cancer. Besides, alcohol breakdown produces aldehyde, an agent that is harmful to DNA, thus playing a role in the development of cancer.

It is a point to belabor that whilst the world continues to battle breast cancer, we are duty-bound to be aware of the things that increase its likelihood and contribute our “window’s mite” to protecting ourselves and others. This must be heralded by everyone to protect sisters, mothers, aunties, friends, grandmothers, and everyone, since breast cancer does not even respect the fact that the breasts are less developed in men. Some of the unspoken risk factors are things people do for pleasure. Being self-conscious, surmounting this hedonistic lifestyle can contribute immensely to this battle against breast cancer. Even Epicurus was mindful of excesses in living for pleasure. Let us not just die tomorrow; let us add quality and purpose to our existence. This goes beyond the subject of breast cancer.