Q: I am 23 years old. My mother had been diagnosed with breast cancer 10 years ago. She had her breast removed and is fine now. I am working in a garment washing (for denim jeans) factory. The environment is very dangerous as we use chemicals, which are very hazardous like sodium metabisulphite and ferro sulfate (some chemicals in powder form, others in liquid form). I stay in the chemical room for around 5 minutes or longer per day. I use a facial mask to cover my nose most of the time. Is it enough? My cousin died lately due to some accident, and when the autopsy was done, they found that his lungs are very hard and there was a hole in his brain. The cause being long term contact with the chemicals. Please advise.

A:There is no published report of the relation of breast cancer to occupational exposure with sodium metabisulphite, and ferro sulfate. These risks of occupational carcinogenesis (cancer related to occupational exposure) are generally reported in laboratory animals and even an occasional exposure to some chemical does not mean that the person will suffer from cancer. You are most likely to suffer from occupational lung cancer due to the nature of your job. The examples of chemical exposures associated with some increased risk of breast cancer are as follows: Acid mists, Benzene, Carbon Tetrachloride, Etylene oxide, Formaldehyde, Lead oxide, Methylene chloride and Styrene. Since your mother had breast cancer, your chances of inheriting it are high. The cause of breast cancer is a combination of factors like environmental, hormonal etc. Your genetic make-up could also be involved. About 1 in 20 women are likely to carry a faulty gene that increases their risk of developing breast cancer. You inherit half of your genes from your mother and half from your father. So, if you carry a faulty gene there is a 50:50 chance that you will pass it on to each child you have. Because of these faulty genes, breast cancer occurs more often in some families. This is called familial or hereditary breast cancer. Several faulty genes have been particularly associated breast cancer. These include BRCA1, BRCA2 and TP53. If you carry any one of these, you have an increased risk of developing breast cancer (and certain other cancers). Cancer tends to develop at an earlier age than usual. There are probably other genes, which carry a slight risk, but have not been identified. Not all women with these develop breast cancer. But the risk increases with them. Breast cancer is common, hence many of us will have a relative who has been diagnosed with it. This is not due to any of the faulty genes, but is more often by chance. Most women with a family history of breast cancer do not have an increased risk of developing breast cancer as compared to the normal risk of general population. However, the risk becomes greater:

• The more blood relatives you have who have been diagnosed with breast cancer.
• The closer the blood relationship is to you.
• How young your relative was, when they were first diagnosed with breast cancer. Especially if they were under 50.
• If both the breasts of a relative were affected.
• If a male relative developed breast cancer.
• If both breast and ovarian cancer runs in the family.
• If certain other uncommon cancers have developed in the family e.g. ovarian cancer, sarcoma under the age of 45, glioma or childhood adrenal cancer.
• If you come from certain ethnic backgrounds. For example, Ashkenazi jewish community have a higher incidence of genes which increases the risk of breast cancer.
• If your risk is assessed as normal or near normal.

Most women have nearly a normal risk of developing breast cancer. (That is about a 1 in 9 chance of developing breast cancer before the age of 85 - most commonly after the age of 50.) If your risk is nearly you should consider the usual advice to women. That is:

• Be breast aware. Know how your breasts normally look and feel and report any changes to a doctor.
• Go for routine breast screening. All women between 50-70 are invited to have a routine mammography every three years. Mammography detects breast cancer at an early stage, when treatment is most likely to be curative.
• Consider altering other factors which may affect your risk of breast cancer.
• If you are past menopause and overweight, losing some weight will reduce your risk.
• Exercise regularly.
• Alcohol incvreases the risk. Reduce your drinking.
• The risk increases slightly if you use the combined contraceptive pills or HRT (hormone replacement therapy). Consider other options if you use them.
• Women who breast feed have a reduced risk as compared to those who bottle feed.
• See your doctor if there is a change in your family history.

If your risk is assessed as moderate or high You will be offered a referral to see a specialist. He or she will make a detailed assessment of your risk on the basis of family history. If your risk is moderately high You are likely to be offered mammography screening to commence at the age of 40 (rather than the usual age of 50). Also, mammography is likely to be every year rather than the usual three yearly. If your risk is high You are likely to be offered genetic testing and counselling. This sinvolve tests to see if you carry one or more of the faulty genes mentioned above. Depending on the outcome of the tests and assessment of the risk, some women are offered regular mammography screening from an early age. Women, whose risk is very high, surgery to remove the breasts and/or ovaries may be an option. This only done after full risk assessment and counselling.