Breast cancer is the second most common cancer in South Africa. According to the National cancer Registry (2007) the lifetime risk of all females in South Africa for developing breast cancer is 1 in 35. The lifetime risk of females in first world countries such as the UK is 1 in 9.
Dr Nuraan Abdurahman educates us on Breast Cancer Awareness
WHAT IS BREAST CANCER?
Breast cancer refers to an uncontrolled growth of abnormal cells in the breast. Breast cancer can either begin in the lobules (the milk-producing glands) or the ducts (which drain milk from the lobules to the nipple).
WHAT CAUSES BREAST CANCER?
Most women will never be able to find the exact cause. However, we do know that women with certain risk factors have an increased chance of getting breast cancer. Risk factors are divided into genetic and environmental factors.
Genetic factors include the following:
- age: breast cancer risk is greater after age 50.
- gender: it is more common in women. The lifetime risk for all males is 1 in 788.
- family history: a first-degree relative with breast or ovarian cancer increases your risk.
- Genetic factors: Mutations in certain genes such as BRA1 and BRA2 increases your risk.
- Menstrual and reproductive history: early menstruation(before 12), late menopause(after 55),having your first child after age 30 or never having given birth increases your risk.
- Dense breast tissue: research has shown that dense breasts can be 6 times more likely to develop cancer
- Personal history of breast cancer:if you have been diagnosed with breast cancer, you are 4 times more likely to develop a new cancer in a different part of the same breast or the other breast.
- race/ethnicity:Caucasian women are more likely to develop breast cancer.
- radiation to the chest before age 30.
- combined Hormone Replacement Therapy(HRT)
- lack of exercise
- being overweight
- alcohol consumption
- poor diet
- no breastfeeding: breastfeeding is a protective factor
WHAT ARE THE SYMPTOMS AND SIGNS OF BREAST CANCER?
Every woman should know the symptoms and signs of breast cancer. Once an abnormality is detected then it is important to consult a healthcare professional such as a general practitioner, gynaecologist or nurse.
It is also important to remember that the presence of any of these symptoms or signs does not mean that you have breast cancer.
The symptoms may include:
- a breast lump
- a change in the skin texture or enlargement of the pores resembling the skin of an orange
- unexplained swelling of the breast or underarm area
- change in the size or shape of the breast
- dimpling or puckering on the breast
- a nipple that has recently inverted
- any spontaneous nipple discharge, particularly bloody or clear discharge
- a change in the skin around the nipple
- unexplained asymmetry of the breast
HOW CAN ONE DETECT BREAST CANCER EARLY?
There are different methods of detecting breast cancer.
- Breast self examination: all women are encouraged to perform monthly breast examinations. This can be performed in the shower, in front of a mirror or lying down.
- Clinical breast exam: this is performed by a healthcare professional such as your gp or gynaecologist
- Mammogram: this is an xray that allows a radiologist to examine the breast tissue for any suspicious areas.Mammograms often show a lump before it is palpable.It can also show calcium deposits which may be an early sign of breast cancer.
WHAT ARE THE RECOMMENDATIONS FOR SCREENING ?
- All women 40 and older are encouraged to have a mammogram annually
- Women between 35 and 39 may have at least 1 mammogram
- Women under 35 do not have mammograms unless there are risk factors and it has been recommended by a radiologist or breast surgeon.
WHERE CAN YOU HAVE A MAMMOGRAM?
You can have a mammogram at most tertiary centres in the public health sector and also at private hospitals if you have a medical aid.
DO I HAVE ACCESS TO A BREAST UNIT IF I DO NOT HAVE A MEDICAL AID?
Most tertiary public health hospitals such as Groote Schuur Hospital have a one-stop breast clinic which have breast surgeons who will examine you and send you for a mammogram if there are any signs that are worrying.
Health tips to reduce breast cancer risk.
- maintain a healthy weight
- healthy diet
- exercise and active lifestyle
- limit alcohol intake
- stop smoking
- breastfeeding. This can lower one’s breast cancer risk, especially if a women breastfeeds for more than a year.
HOW IS BREAST CANCER DIAGNOSED?
Breast cancer is diagnosed in the following way:
- Mammogram: special x-ray of the breast
- Tomosynthesis: this is an advanced type of mammogram that produces a 3-dimensional image of the breast allowing radiologists to see through layers of breast tissue and examine areas of concern from all angles.
- ultrasound: this uses sound waves that do not damage the breast tissue
- MRI: this uses magnetic energy and radiowaves to create detailed images of the breast. This is used mainly in high risk patients or younger women who may have denser breast tissue.
- Biopsy: this is a special test that is performed by a radiologist or breast surgeon.It removes tissue from the suspicious lump or area which is examined under a microscope.
WHAT ARE THE STAGES OF BREAST CANCER?
By staging breast cancer, the breast team can decide the best way to contain and eliminate the breast cancer. It also gives a reasonable indication of prognosis.
The stage is determined by the following factors:
- size of the tumour
- the number of lymph nodes affected
- whether there is spread to organs such as the bone, liver, lungs or brain.
There are 5 stages:
- Stage 0 and 1: the cancer cells are confined to a limited area in the breast
- Stage 2: this is still an early stage but there are signs that the cancer has grown or has begun to spread. This is still confined to the breast.
- Stage 3: this is advanced cancer, which is invading the tissue near the breast
- Stage 4: the cancer has spread to other areas of the body
WHAT KIND OF SUPPORT CAN ONE OFFER A PERSON WITH BREAST CANCER?
When a woman has been diagnosed with breast cancer the initial reaction is one of shock, denial, helplessness and grief. It is a very stressful time for the person and also for the family. This is the time to provide support and understanding. There are several organizations that provide support groups and contact with breast cancer survivors.Organisations such as CANSA, Bosom Buddies, Reach for Recovery and online forums such as Breast Buddies offer invaluable support and information to breast cancer patients and their families.