This is compounded by the fact that most cancers are detected at an advanced stage when cure is untenable. Campaigns against cancer in the last several years and making October cancer awareness month has gone a long way in sensitizing women, especially in urban areas. However, a lot still remains to be done toward sensitization for early detection.
What is Cancer?
As highlighted in a previous article on cervical cancer, cancer cells are normal cells that for unknown reasons multiply rapidly in a peculiar way. Unfortunately, in the early stages, cancer does not cause pain and thereby denies the body the alert signal that something is wrong.
Cancer of the Breast
Breast cancer will usually begin as a NOT painful breast lump (this lump is one that has not always been there) and on rare occasions as a bloody discharge through the nipple. Only 1 out of 9-10 lumps will turn out to be cancerous. A bloody discharge may signify either infection or a wart-like growth in the milk duct. If any of these are identified, do not panic but make sure to immediately see your doctor because like all other cancers, if detected early, breast cancer can be cured.
Causes of Breast Cancer
The specific cause is unknown. There are however some factors if associated with making a woman stand a higher risk of developing breast cancer:
1. Age – Getting older puts one at a higher risk of contracting all types of cancers.
2. Family history of breast cancer.
3. Intake of high estrogen pills over a long time.
4. High dose of hormonal replacement therapy.
5. Some forms of recurrent breast lumps need to be monitored regularly.
6. High-fat diet.
7. Being overweight and obese.
8. Excessive alcohol consumption.
9. Cigarette smoking.
Not having any of the above risk factors does not mean that one is immune to breast cancer. Conversely, having any of these risk factors will not necessarily lead to the development of breast cancer.
Methods for Early Detection
Routine monthly self-examination of the breast (BSE – Breast Self-Examination).
This is the first and the mainstay of early detection of breast cancer. For women who are still receiving their monthly period, the best time to check each month is right after the period finishes. Breasts and breast lumps tend to swell during menstruation and checking just on the last day of menstrual flow will make it easier to detect even smaller lumps.
How to do BSE (Breast Self-Examination)
Look - Women, in this case, are encouraged to admire their breasts and familiarize themselves with their breasts. When looking one needs to note: any change in size, shape, position of nipples, change in the skin – especially where the breast skin changes to look like a lemon peel. On lifting both arms, the breasts should move up equally.
Feel – Lift the arm on the breast you are examining and put it on your head so as to make the axilla (armpit) prominent.
a. With your fingers of the opposite hand flat, pass the breast in small circular motions to cover the whole breast – all the way to the collar bone and to the arm-pit.
b. Check for any lumps – hard nodes like a hard pea or dry maize.
c. Check for any thickening on the skin.
d. Check for any firmness and difficulty in mobilizing the skin.
e. Finally, press the breast towards the nipple from 2 positions right-angled to each other to check for any nipple discharge.
f. Repeat the same process on the other breast. If you detect any of the above-outlined abnormalities, please consult your doctor.
Clinical breast examination once a year by your doctor. Your doctor will carry out the steps outlined in the BSE above.
Yearly ultra-sound of the breasts. This will detect any lumps in the breasts and give an indication as to whether the lump is cystic (full of water) or solid (hard through and through). An ultrasound can also detect any dilation (widening) of the milk ducts. Ultrasound depends on echoes of sound waves bounced into and back from the breast to detect these changes. There is no irradiation in an ultra-sound.
Mammography – Unless specifically requested by your doctor, mammography is indicated in women who are older than 40 years and then only once every 2 to 3 years. Mammography uses irradiation although in very small doses.
What happens when a breast lump or bloody nipple discharge is detected?
Bloody Nipple Discharge
- The doctor is likely to send you to have that discharge checked by a pathologist to determine whether there are any cancer cells.
- You might also be sent for a breast ultrasound.
- You might be sent for mammography.
Lump
Only 1 out of every 9 or 10 lumps will be cancerous, 9 out of 10 will be benign. If it is a small suspicious lump the doctor may opt to surgically remove it in totality and then send it for pathological evaluation to determine if there are any cancer cells.
Bigger Lumps
The doctor might send you for fine needle aspirate to harvest some material from within the lump which is then analyzed by a pathologist to decide whether these are features of cancer. This fine needle aspirate (FNA) involves pushing a wide bore needle into the lump and sucking out some material that is sent for analysis.
The doctor may send you for an ultra-sound of the breasts or mammography.
- The doctor may send for an MRI (Magnetic Resonance Imaging) of the breasts. This will help establish if the mass is cancer and if it has invaded deeper tissues.
Management of Confirmed Cancer
1. If localized and the cancer mass is small – It is sometimes enough to remove the cancer mass surgically with a large enough margin of healthy breast tissue to make this the only treatment required. Sometimes part of the affected breast is spared and left on the body. This is if cancer has been detected very early indeed.
2. Removal of the whole breast (mastectomy) – It is sometimes necessary to surgically remove the whole breast along with any lymphatic nodes where cancer may have spread to – especially in the area of the arm-pit. Most times this surgery will be followed by irradiation of the area and by chemotherapy – with maintenance medication for about 5 years.
3. If the cancer mass is very large, sometimes irradiation of the mass is done to reduce the size. Then surgical removal is performed followed by chemotherapy and maintenance medicine for about 5 years.
4. Some cancers might be beyond surgical intervention even after irradiation and these patients would then be offered pain relief and made as comfortable as possible.
Complications and Side Effects of Treatment
Complications can be associated with: anesthetic risks, surgical risks and its sequel, irradiation risks, and chemotherapy risks. In general:- Surgical risks are mainly associated with the scarring of the tissue on the chest where the breast has been removed. This scar can be very hard and limit the movement of the affected arm. This problem is normally sorted out by several sessions of physiotherapy.
- Absence of the breast – A prosthetist has to be fitted.
- Lymphoedema – This occurs due to the interference of lymphatic drainage. Lymph is one of the fluids that bathe the cells of the body and is often the first channel through which cancer cells spread. So in dealing with breast cancer, lymph nodes in the arm-pit are removed and this interferes with the flow. The particular arm is then generally swollen – hand swelling. This state will also be eased by several sessions of physiotherapy.
- Irradiation – Associated with diarrhea, nausea, and loss of appetite.
- Chemotherapy – Nausea, diarrhea, vomiting, loss of appetite and hair loss on the whole scalp. The hair loss will normally revert once the chemotherapy is over.
Breast Cancer Awareness Month, October: Awareness vs. Action
Why there is a need for breast cancer awareness and sensitization
After skin cancer, breast cancer is the most common cancer in women.
With an average lifetime risk of developing breast cancer at 12%. There are about 300,000 cases diagnosed each year, with about 15% of those (40,000 people) dying from the disease each year.
A clearer way of looking at it and why it's so serious is that 1 in 8 women will have breast cancer, and 1 woman is diagnosed with breast cancer every 2 minutes. Additionally and contrary to what most people believe, breast cancer doesn’t just end with female folks, in fact, men can develop breast cancer as well (although it's rare).
Always keep in mind that screening for breast cancer begins at 40 years old (for average-risk women) with annual mammograms and that catching breast cancer early can save your life.
What can you do to make it meaningful?
Sure, you can pin a pink ribbon on your lapel, or share Instagram memes with breast cancer statistics. But do you honestly know anyone who isn’t ‘aware’ of breast cancer?
We have enough breast cancer awareness. We need action.
Breast Cancer Awareness Month – Take Action!
Here are some meaningful actions you can take during Breast Cancer Awareness Month.
- As the saying goes, you can’t help others if you don’t help yourself. So make sure you’re up to date on breast cancer screening mammograms and assess your risk for the disease.
- Donate to a local chemotherapy center or breast cancer organization. You don’t have to donate money – you can give many (lightly-used) household goods – from clothes to electronics. Many cancer organizations accept vehicles as a tax-deductible donation. You can donate your time by volunteering. There are so many ways you can help out and take meaningful action during Breast Cancer Awareness Month. Just ask.
- Lend an ear. Many breast cancer patients feel pressured by society to ‘be strong’ and ‘stay positive’ – don’t add to that by telling them ‘you’re a warrior, a survivor’. If you know someone affected by breast cancer – sometimes the best thing you can do is just listen.
- Help local breast cancer patients in any way that you can. Don’t ask what they need – everyone else is doing that. Tell them you’re available to run errands, clean the house, or babysit. Be specific and take the burden off them so they don’t feel like they’re asking you a favor.