Breast cancer is one of the most commonly diagnosed cancers in Indian women—and often the most misunderstood. Like many illnesses with no obvious symptoms, the mystery around its manifestation feeds the fear.

“If I were to ask ten people to stand before you and if I told you that one of these people is a terrorist, would you be able to identify which one?” says Dr. Sumeet Shah, a consultant surgical oncologist in Mumbai. “Of course you couldn’t. A terrorist looks exactly like anyone else—he eats and breathes in the same way. The only difference is that his thinking is different. He’s been designed to kill. A cancer cell is exactly like that: It appears normal, but there are differences.”

One of these differences is that a cancer cell multiplies rapidly and uncontrollably into a colony of rogue cells, which, if undiagnosed, can spread to other parts of your body. Once cancer has spread – or metastasized – it is much more difficult to treat. This is why timely diagnosis and treatment is so integral to fighting the disease. Unfortunately, there’s no surefire way to prevent the disease. One of the scariest parts of cancer is that it often comes down to bad luck, especially in the case of breast cancer. However, your genetics, environment, and lifestyle can all play a role.

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Genetic risk factors

Breast cancer affected almost 145,000 Indians – yes, men can get breast cancer, too – in 2012. Of these, roughly 10 percent were due to genetic reasons, says Dr. Selvi Radhakrishnan, an oncoplastic breast surgeon at the Chennai Breast Centre. If you’ve got the wrong end of the genetic lottery, then your two tumour-suppressing genes, known as BRCA 1 and 2, will show mutations. Other genetic factors may also increase the risk of developing breast cancer, but their link to the disease is less clear.

When Hollywood A-lister Angelina Jolie revealed in May 2013 that she had a double mastectomy – a surgical procedure to remove both breasts – because she had tested positive for a harmful BRCA 1 mutation, Indian oncologists were not prepared for the onslaught of women requesting the tests in urban centres. The ‘Jolie Effect’ created a great deal of breast cancer awareness in urban India and, around the world, sent women in droves to health centres. But genetic testing is not recommended for everyone; since genes are inherited from parents, BRCA mutations tend to run in families.

“An average person, with no family history of the disease does not need to undergo genetic testing,” explains Dr. Shah. “It is best meant for those with a strong family history of both breast and ovarian cancers, with multiple relatives suffering from th[ose cancers] at a young age.”

Such was the case for Jolie, whose mother died of breast cancer in 2007. She took the decision to have preemptive surgery that dropped her chances, according to her, from 87 to under 5 percent. A preventative mastectomy is one option after testing positive for a harmful BRCA mutation. Others involve increased monitoring and exams. The test itself is nothing more than a simple blood test, but adequate counselling during this process is crucial and often isn’t available in India. If you do have a family history of breast cancer, discuss a genetic test with your doctor.

Lifestyle risk factors

Lifestyle choices have also been linked to cancer, including breast cancer.

“A sedentary lifestyle; obesity; eating excessively processed, fatty, or adulterated foods; consuming too much alcohol; constant stress; smoking—all these are risk factors,” says Dr. Uttam Soni, an oncoplastic breast surgeon at Jaipur Breast and Cancer Research Institute. “That’s why men can contract breast cancer, too.”

Giving birth at a later age (35+) can also increase women’s risk, Dr. Soni says.

“This is because breastfeeding at an earlier age has a protective effect,” he says. “When you breastfeed scantily or have a baby when you’re older (or not at all in cases when women don’t give birth), then you’re at higher risk.”

Environmental risk factors

The most risky environmental factor is passive, or second-hand, smoking, which leads to high levels of cadmium and polycyclic aromatic hydrocarbons—known carcinogens specific to breast cancer risk. Other environmental factors have been linked to breast cancer, but the truth is doctors don’t know enough about the disease’s cause to make a definitive connection. Some research suggests that synthetic chemicals – found in almost every aspect of daily life – contribute to breast cancer, but more study is needed. Regardless, if you have a family history, it might be best to be conscious of the substances around you.

Pesticides from food, parabens from cosmetics and shampoo, and powerful chemicals in items from household cleaners to plastic cutlery can have a cumulative effect, creating a condition in your body called endocrine disruption. Endocrine disruption occurs when the body’s hormonal balance is disrupted, causing a subsequent rise in the hormone estrogen—excessive amounts of which are known to trigger breast cancer.

Regardless, in the search to make sense of such a mysterious disease, many myths have popped up around breast cancer’s cause. Underwire bras, implants, deodorants or anti-perspirants, caffeine, microwaves, and cell phones are not environmental risk factors for breast cancer. Nor are mammograms; in fact, this life-saving technology identifies breast cancer at the earliest possible point, but more on that below.

Symptoms and diagnosis

Timely diagnosis and treatment is the most effective way to manage breast cancer. Learning to examine your own breasts and to be alert to changes in breast tissue can save your life. This video can teach you how to do a self-breast exam—just don’t watch it at work.

“The single, most important symptom of more than 90 percent of breast cancers is a painless, hard knot or lump in the breast,” says Dr. Shah. “It can be as small as two centimeters in size. It feels hard or firm, in contrast to the rest of the breast tissue, which is soft like dough.”

Other symptoms include: bloody or blood-stained nipple discharge, a recent nipple retraction (i.e. the nipple area, instead of pointing outwards, appears as though it has dipped into the breast), changes to the skin of the breast (e.g. an orange-peel or leathery appearance) with prominent dots.

In addition to self-examination, regular mammograms are also a must. Dr Selvi Radhakrishnan, an oncoplastic breast surgeon at the Chennai Breast Centre, credits high breast cancer survival rates in developed countries to early detection by mammography.

“To date, we have no cure for breast cancer or any method in which to prevent its occurrence,” Dr. Radhakrishnan says. “Early detection is the only way to save lives.”

Mammography is a lifesaving technology that involves a low-radiation X-ray of the breast tissue, which can detect breast cancer about two years before a lump even materializes. This is why women with a family history of breast cancer, who have known risk factors, and/or who are above the age of 35 should have a mammogram each year. If you don’t have a family history, you can wait until you’re 40 to get your first mammogram.

Detecting breast cancer early can help you avoid chemotherapy, radiation therapy, and surgery. It can save your breast(s)—and your life.

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This is the first in a series on breast cancer. The next installment will examine how Indian women experience the disease in the unique context of our culture.