Breast Cancer Awareness: Give support, save lives – Dr Shivannie Persaud

Dr Shivannie Vanada Persaud is a bi-lingual, Cuban-trained Medical Doctor who recently started her very own clinical practice at Medical Arts Centre Ltd. She currently offers free clinical breast exams at the clinic – Dr Shivannie V Persaud Family Health & Wellness Clinic.
Apart from her medical practice, Dr Persaud dreams of becoming a medical diagnostic imaging specialist or radiologist. She is currently a General Medical Practitioner within the department of Radiology at the Georgetown Public Hospital Corporation.
When she is not saving lives, Dr Persaud is an Executive Member and player at the Guyana Badminton Association.
With October designated at Breast Cancer Awareness Month, Dr Persaud wrote the following piece, in an effort to educate and create awareness on breast cancer. She is encouraging everyone to give support to breast cancer patients and survivors while also encouraging others to get examined in an effort to save their lives.
Breast cancer is a disease which causes abnormal cell growth which invades healthy cells in the breast, the surrounding tissue and which may spread to other areas of the body. These cancer cells usually grow out of control and form a tumour which is most commonly felt as a lump. Having said this, it is important to understand that some breast lumps can be non-cancerous or not life-threatening but may increase one’s risk of getting breast cancer.
Breast cancer can affect anyone, including men. However, it is more common in women. It is important to note that your doctor does not necessarily think you have breast cancer if he/she suggests a screening test. The goal of breast cancer screening is to find the cancer at the earliest stage before presenting with symptoms due to the fact that treatment options are more numerous, more effective, less toxic and generally leads to better outcomes than late-stage cancers.

Risk factors for women
• Age. Women’s risks for developing breast cancer increases with age.
• Menstruation at an early age (usually before 11 years old)
• Never having giving birth or giving birth at an older age. (Pregnancy after 35 years of age is considered high risk.)
• Menopause at a late age. After 55 years of age.
• Dense breast tissue
• A family history of breast cancer. This accounts for 20- 25 per cent which includes both mother’s and father’s side of the family.
• Use of hormones such as estrogen and progesterone
• Obesity
• Excess alcohol consumption
• Having had radiation therapy to the chest before age 30
• Gene mutation known as BRCA 1 OR BRCA 2

Risk factors for men include:
• Age
• Family history. Which includes blood relatives, male or female.
• Gene mutations. BRCA 1 affects men more than BRCA 2
• Klinefelter syndrome. A birth condition which leaves men infertile due to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones) and they often develop male breast growth known as Gynecomastia.
• Radiation exposure. A man who has been treated with radiation therapy.
• Obesity. Causes a hormonal imbalance
• Liver disease.
• Alcohol. Excessive alcohol drinking leads to damage of the liver
• Estrogen treatment. Men who received this treatment for prostate cancer. As well as transgender individuals who take high doses as part of sex reassignment
• Testicular conditions. Undescended testicles, having mumps as an adult or having one or both testicles surgically removed (Orchiectomy)
One should be familiar with how their breasts normally look and feel and should report any changes to a health care provider immediately.

Common signs and symptoms include:
• The appearance of a new lump or mass on the breast which is painless, hard or has irregular edges. However, it is not uncommon for them to be painful, soft or round.
• Swelling of the breast even if no lump is felt.
• Swelling of the nipples.
• Pain to breast or nipple.
• Breast skin or nipple that is seen red, dry, flaking, thickened or hardened.
• Nipple retraction (turning inward of the nipple) or unusual secretions (watery, milky, yellow or bloody) from the nipple.
• Small swollen lumps called lymph nodes under the collar bone or under the arm.

Screening recommendations
Screening is key to early detection and leads to a more favourable prognosis.
● Women who are considered average risk. Those are women who have no specific risk factors for breast cancer such as no known personal or family history, has not had chest radiation therapy before 30 years of age or a genetic mutation are recommended to have a clinical breast examination (CBE) every 1 to 3 years.
● Women who are considered as high risk, such as those with certain gene changes, such as changes in the BRCA 1 or BRCA 2 genes, a family history (a relative, such as a mother, daughter or sister) with breast cancer or certain genetic syndromes, such as Li-Fraumeni or Cowden syndrome are recommended to have screening done with Magnetic Resonance Imaging (MRI)
● Women between 40 and 54 should have a mammogram annually.
● Women 55 and older may have a mammogram every two years, or they can continue yearly mammograms.
● Recommendations for men. Clinical Breast Examination is recommended for men with a strong personal history or family history of breast cancer semiannually/once every 6 months starting at age 35. This is due to the fact that breast cancer in men presents at more advance stages than in women.
CBE is an exam done by your doctor to check for physical changes and lumps in your breast with the aim to detect cancer at the earliest stage of progression.
It is usually done in your doctor’s office or medical examination room which guarantees you privacy since you would be required to take your shirt off. It is comprised of a visual check of your skin looking for differences in the size and shape of your breasts, abnormal skin colour, texture, temperature, dimpling, redness, rashes, visible lumps or changes in the nipples. You may be asked to lift your arms over your head, hang them loosely or rest them on your hips during this procedure.
Next, your doctor will perform a manual examination of your breast. This is done with you lying down which enables the breast tissue to flatten over the chest walls. Your doctor will then use the pads of his/her fingers using firm pressure to assess deeper tissue to feel for lumps including assessment of their size, shape, whether or not they move within the tissue or to assess the presence of pain or soreness.
Usually, a lump which appears soft, round, smooth and movable are likely to be non-cancerous tumours or cysts. A lump which is more likely to be cancerous is described as hard, firmly attached within the breast and oddly shaped.
Your healthcare professional will also check under your arm and above and below your collar bone to look for lumps called lymph nodes.
If there are any abnormal findings, you will then be oriented towards further diagnostic measures.

Other screening tests
Screening tests help to find early-stage cancers which increases chances of survival.
● Mammography. Mammography is an X-ray picture of the breast and is used to find tumours which may be too small to feel. It is the most common screening test used to detect breast cancer.
● Breast Self-examinations. Recommended to be done monthly.
● Breast Ultrasound. Uses sound waves sent to a computer to give a visual of the inside of the breast. It is useful to check for lumps in women with dense breast tissue which a mammogram may not have detected. It can be used to differentiate between a lump or a fluid-filled cyst and is also useful to guide a biopsy needle.
● Breast MRI. This machine uses strong magnets and radio waves to give a picture of the breast. It is used to screen women who are at high risk and not usually recommended alone as a screening test since it can miss some cancers.
● Thermography. This is done with a special camera which senses heat to record the temperature of the skin which covers the breast. The presence of tumours can show temperature changes.

Early detection is key to saving your life.
Get examined!