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The most common question I am asked by my patients is “Why me?” Typically, my patients say, “I have never smoked, I have kept pretty fit, I have tried to do the right thing, why me?” The first idea to dispense with is the notion that it somehow your fault, that had you done something different, or taken a different job, or lived somewhere else, or drunk more tea, or drunk less tea, or eaten more dairy-foods, or eaten less meat, or been a vegetarian, or taken soy products, or whatever, that you could have avoided this. Getting breast cancer is not your fault! Breast cancer is common. Nearly one-in-ten Australian women get the disease at some point in their lives (and more than one-in-eight US women!) Cancer itself is very common, affecting nearly one-in-three people. Almost half of all cases occur in women over the age of 65. The breast is particularly susceptible to cancer because cancer is a disease primarily due to the loss of control over the division and normal death of cells, and breast tissue is actively dividing and dying throughout life. With each menstrual cycle the gland tissue in the breast prepares itself for possible pregnancy, by cell division and proliferation of the duct tissue. When no pregnancy eventuates, the duct tissue returns to normal size by a process of regulated cell death, called apoptosis. Subtle, and perhaps even very minor alterations in the computer programs of the cell that regulate this constant process of cellular proliferation and death can result in one rogue cell beginning to behave abnormally. It may divide more rapidly than it should. It may divide in the absence of the normal stimuli that are present during the early stages of the menstrual cycle. It may fail to die when these stimuli are withdrawn. There are many, many duct cells, so there are many, many opportunities for such minor abnormalities to occur. Once one rogue cell has escaped from this tightly-regulated system of control, it is on the path to malignancy. It may accumulate more and more abnormalities in its computer program (“mutations”), each one giving it growth advantages and independence from the normal regulatory processes of the body until a fully developed tumour is present. Some of these mutations permit the cell to escape from normal tissue boundaries and circulate through the blood stream, lodging in distant organs where it may “seed” and cause secondary tumours, or metastases. Breast cancer cells particularly like to “seed” to the lymph nodes (or lymph glands), bone, liver and lungs. Fortunately, the majority of breast cancers are detected well before such metastases occur, and chemotherapy and hormone therapy provide a backup means of destroying these “seeds” before they have a chance to grow and cause problems in later life. 
Breast cancer is extremely uncommon in men, and it does not occur in women deprived of the female sex hormone oestrogen. This indicates how dependent the disease is on oestrogen. Under normal circumstances, oestrogen stimulates the duct cells of the breast to divide and proliferate in preparation for possible pregnancy and breast feeding. Let’s consider “Jungle Jane”, one of our ancestors in the earliest jungle days of homo sapiens. In their most primitive “jungle” state, human females do not start menstruating until the late teens. Shortly afterwards they fall pregnant, and newborn babies and infants are often breast-fed for as long as three years, partly for nutrition, and partly because breast-feeding acts as a natural form of contraception. As soon as Jungle Jane stopped breast feeding, she was likely to fall pregnant again, and so-on. She would have died of natural causes in her forties, probably well before her menopause. Jungle Jane may well have only had a handful of normal menstrual cycles in her whole life! The rest of the time she was either pregnant or lactating, and her breast was spared the cycles of preparation and involution that accompany the menstrual cycle. Modern women undergo twelve such cycles every year from about the age of 12 until their menopause at about the age of 50! Against this kind of background, breast cancer can be seen as one of the unfortunate penalties of modern civilisation. Modern nutrition has led to an earlier and earlier onset of menstruation. (The age has gone from around 17 to around 12 in just three generations of modern Japanese women because of nutritional changes after World War II.) Modern women, for excellent reasons, often with-hold pregnancy until their fourth decade, unlike our grandmothers, who frequently had children in their early twenties. It is rare for modern women to have more than one or two pregnancies, and periods of breast-feeding tend to be kept short, for social and economic reasons. Despite all of these changes, deaths from breast cancer in western countries are now decreasing. Contrary to popular belief, there is no great epidemic. It’s just that we are probably more aware of the disease than we were previously, we are detecting it earlier with mammography, and there is certainly much, much more that can be done about it than in our great-grandmothers’ time, when all that there was to offer was radical surgery. The following factors are linked to a slightly higher risk of breast cancer. CAUTION: These data are drawn from large population studies and it very difficult to transpose those data onto an individual person. Also, the relative increase in risk for most of these factors is slight. Factors associated with an increased breast cancer risk in reliable epidemiological studies:
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