Breast Health Begins with You !!

by Dr. Rajyashree N

“Be breast aware…! Be smart! Catch cancer before it catches you”

 

Breast cancer is a growing health problem worldwide.  It is the second most common malignancy in the world, and the most frequent cancer in women.  Breast cancer ranks second among cancer death in women.  This causes great worry and concern for women.  Everyone knows at least one person who has been treated for breast cancer.

The incidence of breast cancer is on the rise and in the US, 240,000 new breast cancer patients are diagnosed every year, and approximately every 3 minutes a woman is diagnosed with breast cancer and approximately every 12 minutes breast cancer claims another life.  One out of eight woman is diagnosed with breast cancer.  Breast cancer also affects a small percentage of men, and about 1500 new cases of breast cancer are expected to be diagnosed in men next year.

In Oman, it is the most common cancer in females, that is 16.4% of all cancers in women.  The mean age is 48yrs (+/- 10), and 48% are pre-menopausal.  The patients present themselves at advanced stage and in younger age group, and therefore there is lower survival rate as compared to the western counterparts.

 

So the need for breast cancer awareness is very important, and emphasis on screening for early detection which will help in prompt treatment and better survival rate.  Today’s patients are much more likely to be able to resume a healthy and long life after treatment than women with breast cancer in their mother’s generation.

 

Women should understand that there is no need to feel shy or have a social stigma if one has a breast problem. There should not be any psychological or cultural restriction to seek advice of a family physician for clinical examination of breast.

 

Nobody knows for certain why some women develop breast cancer and others do not. One should know that all breast diseases are not cancerous and never contagious, and it is NOT caused by stress or by injury to the breast. It is not related to black magic and not your “bad past”.

70-75% women diagnosed will have breast cancer do not have any known risk factors (mentioned below).

 

It is not possible to prevent cancer from starting, but detection in its very early stage can improve breast cancer survival rate and quality of life. Every woman should be breast aware and familiar with ones own breast, to recognize and seek help if there is a problem. Changes in lifestyle (see below) can also help in reducing the risk of being affected by cancer..

 

 

Men with any lumps or abnormalities in the breast should seek medical consultation.

 

Breast self examination (BSE) especially 4-5 days after periods is a good way of keeping a check on any abnormalities in one’s breast.

It is advisable to visit your family physician or gynecologist or surgeon for clinical breast examination (CBE) once a year after 35yrs of age (Early age incidence in the Gulf).

It is mandatory to undergo yearly breast screening (clinical breast examination and mammography + ultrasound) from 40 yrs of age, or as advised by your doctor.

Breast screening by mammogram, a specialized x-ray of the breast, is the BEST available tool for early detection of breast cancer that cannot be palpable or is asymptomatic.  A mammogram is not fool proof.  And in dense, glandular breasts it is difficult to spot the changes. Mostly changes are in the form of microcalcifications, and will be assessed by the radiologist and clinician. A lump should never be ignored just because it is not visible on a mammogram (15% may not show on mammogram).

Early detection helps in better treatment, by breast conserving surgery; and better quality of life and longer life. The 5yr survival rate for woman diagnosed to have a breast cancer detected early by mammogram with no nodal metastasis is about 98%.  Earlier a tumour is identified / detected, the better the chance of cure.  95% of women with cancer less than 1 cm in size are cured.  SCREENING MAMMOGRAPHY IS THE KEY TO EARLY DETECTION.

 

Breast Self examination (BSE):

To be breast aware and become familiar with how your breasts LOOK AND FEEL. You should understand how your breasts may change at different times during the month and also as you get older.  For some women, breasts become enlarged, tender and lumpy just before a period and then return to normal once the period is over, others may have swollen breasts throughout their cycle. Age, pregnancy, Hormone Replacement Therapy (HRT) and menopause can all affect the size and feel of your breasts. The important thing is to recognise the changes that are usual and those that are not.

Look and feel your breasts at least once a month (4-5 days after periods).  Look at yourself in the mirror, with your arms elevated and behind your neck.  Look for the same with hands on the hips.

 

 

 

While standing in the shower and while lying down. right breast with the left palm and left breast with the right palm. Feel your breasts, feel for anything that is not normally there. If you find any unusual changes (mentioned earlier), and remember, if you are in any doubt visit your doctor.

Other abnormalities that need attention are:

• Any unusual appearance of an area of the skin on the breast, like dimpling, puckering, or lumps in underarms.
• Veins on the skin surface become more prominent on one breast.
• The nipple becomes inverted, develops a rash, changes in skin texture, or has abnormal discharge
• Report any changes that you find to your doctor without delay. Be sure, be safe.

Over her lifetime, a woman can encounter a wide variety of breast conditions including normal changes that occur during menstrual cycles (cyclic breast changes) as well as several types of lumps. Not all lumps are cancers.

Benin breast changes include, mastitis - inflammation, abscess - infection. Generalised breasts changes – fibrocystic disease (lumpiness), fibroadenomas (solid benign tumors), cysts (fluid filled sacs),

Nipple discharge accompanies some benign breast conditions, may occur in patients on certain medications but can sometimes be a signal for an underlying malignancy. This may vary in color and textures.

Most benign breast conditions do not increase a woman’s risk for getting cancer. However, if any abnormal changes are discovered, they should be notified to the clinician.

Other tests involved in detecting breast cancer:

Ultrasound of the breasts: A noninvasive and safe imaging procedure to evaluate the changes in the breasts, and commonly used in young patients as the first line investigation, and can be repeated as often as required..

Several other imaging techniques are used in special circumstances – Computed tomography (CT scan), Magnetic Resonance Imaging (MRI), etc.

Histopathological Examination (HPE): The only certain way to know whether an abnormality is cancerous, is a procedure where the tissue is removed and examined under microscope. Further management of the abnormality is decided as per the result of the HP report.

-FNAC:- Fine-needle aspiration cytology with a needle (has  limitations).

-Trucut biopsy: Larger bore needle is used and so more tissue obtained.

-Excision biopsy: Diagnostic or Curative excision. 

Gene testing for Breast cancer susceptibility: Genetic changes in BRCA-1 and BRCA-2 genes. (key regions within a woman’s chromosomes that control cell growth in breast tissue).

Blood tests: Tumor markers (especially for checking relapse after treatment).

If breast cancer is diagnosed by HPE, further treatment depends on the type and grade of cancer. The grade depends on the size, and the spread of the tumor. This helps predict the patient’s prognosis. Hormone receptor status (ER/PR ie estrogen and progestron receptors) and HER2 status are also tests to determine the type of treatment and hence prognosis

Treatment modalities can be in the form of surgery, chemotherapy, radiotherapy, hormonal therapy or immunotherapy and mostly a multimodal therapy.  New drugs are under research for better treatment and survival rate. 

Other tests like chest x-ray, CT scan abdomen, bone scan, tumor markers  are done to detect if there is spread of the cancer.

If a woman is diagnosed to have a breast cancer, she should have good counselling, she should be explained the treatment options and modalities, and about the importance of followup. Her family should also be counselled to give her complete support.

One cannot prevent breast cancer from occurring, but certain changes in lifestyle will surely reduce the risk of getting breast cancer and hence breast cancer mortality. Some of the factors that influence the development of cancer like – age, genetic susceptibility are beyond ones control, but there are other steps that can be taken to reduce the risk of developing cancer,and detecting the cancer early.

Take Home Message:

Regular BSE, CBE and yearly screening mammogram (40 years and above).

To be aware of risk factors.

Change lifestyle; do regular exercises, reduce fatty foods, avoid obesity, avoid smoking and limit alcohol intake.

 

At Muscat Private Hospital, we have all services under one roof with a specialised female team of Gynaecologists, Surgeon, Radiographers and Anesthetist.  We have free walk-in clinics for breast examination on Tuesday evening and Thursday morning. And  discount on the Imaging facilities for screening is offered until end of October 2005.  For further information, please contact Telephone No. 24592600 Extn. 2905.

Dr. Rajyashree N., Specialist Surgeon