HEALTH TIPS – BREAST CANCER

Dr Tariq Jagnarine

Fam Medicine/ Endocrinology and Diabetes

October is Breast Cancer Awareness Month, an annual campaign to increase awareness of the disease.
In Guyana, breast cancer is the most commonly diagnosed cancer and the second leading cause of death due to cancer in women.(WHO 2020 Report)
• Research indicates that 50% of newly diagnosed breast cancers are explained by known risk factors.
• 1 in 10 women with new breast lump have cancer while 85% of these cases occur in women with no family history of breast cancer.
• 98% of Breast Cancer patients survives when diagnose early with timely interventions.
• About 1 in 8 women are diagnosed with breast cancer during their lifetime.
For these reason, it is vital that women check their breasts regularly for any changes and always have any changes examined by a doctor. In rare cases, men can also be diagnosed with breast cancer.

SYMPTOMS OF BREAST CANCER
Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue. Most breast lumps are not cancerous, but it is always best to have them checked by a doctor especially if presenting along with the following:
• A change in the size or shape of one or both breasts
• Discharge from either of the nipples, which may be streaked with blood
• A lump or swelling in either of the armpits
• Dimpling on the skin of the breasts
• A rash on or around the nipples
• A change in the appearance of the nipple, such as becoming inverted
Breast pain is not usually a symptom of breast cancer.

CAUSES OF BREAST CANCER
The exact causes of breast cancer are not fully understood. However, there are certain factors known to increase the risk of breast cancer. These include:
• Age – the risk increases as persons become older
• A direct family history of breast cancer
• A previous diagnosis of breast cancer
• A previous non-cancerous (benign) breast lump
• Being tall, overweight or obese
• Drinking alcohol
• Smoking
• Night Shift Workers
• Previous Radiation therapy
• Early menstruation or late menopause
• Giving birth at an older age
• Women who choose hormone therapy
• And genetics may also play a role

DIAGNOSING BREAST CANCER
A thorough clinical history along with a physical exam helps doctors to access patients for breast cancer, after examining the breasts; patients may be referred to breast screening by ultrasound, mammography or taking a small sample of breast tissue to be examined under a microscope (a biopsy).
Types of breast cancer
There are several different types of breast cancer, which develop in different parts of the breast.
Breast cancer is often divided into either:
• NON-INVASIVE BREAST CANCER (carcinoma in situ) – found in the ducts of the breast (ductal carcinoma in situ, or DCIS) which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually found during a mammogram and rarely shows as a breast lump.
• INVASIVE BREAST CANCER – where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue. This is the most common type of breast cancer.
Other, less common types of breast cancer include:
• INVASIVE (AND PRE-INVASIVE) LOBULAR BREAST CANCER
• INFLAMMATORY BREAST CANCER
• PAGET’S DISEASE OF THE BREAST
It is possible for breast cancer to spread to other parts of the body, usually through the blood or the axillary lymph nodes. These are small lymphatic glands that filter bacteria and cells from the mammary gland. If this happens, it is known as secondary, or metastatic, breast cancer.

BREAST CANCER SCREENING
Mammographic screening, where X-ray images of the breast are taken, is the most commonly available way of finding a change in the breast tissue (lesion) at an early stage. However, in some cases a mammogram might fail to detect some breast cancers increasing the chances of having extra tests and interventions, including surgery, even if a person is not affected by breast cancer.
Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.
• Women less than 30 years should have diagnostic ultrasound as initial investigation followed by a Mammography if the Ultrasound is questionable.
• Women above 30 years old a Diagnostic mammography and ultrasound is indicated both for initial investigation.
• Women of any age who are pregnant/lactating ultrasound is recommended as the initial investigation.
• As the risk of breast cancer increases with age, all women who are 50 to 70 years old are invited for breast cancer screening every 3 years.
• Women over the age of 70 are also entitled to screening and can arrange an appointment through health facility.

TREATING BREAST CANCER
If cancer is detected at an early stage, it can be treated before it spreads to other parts of the body. Breast cancer is treated using a combination of:
• Surgery
• Chemotherapy
• Radiotherapy
Surgery is usually the first type of treatment, followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted treatments. The type of surgery and the treatment will depend on the type of breast cancer patients presents with.
In a small proportion of women, breast cancer is discovered after it is spread to other parts of the body (metastatic breast cancer). Secondary cancer is not curable, so the aim of treatment is to relieve symptoms.

LIVING WITH BREAST CANCER
Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it is at and the treatment options available. Coping with the diagnosis and treatment varies from person to person. There are several forms of support available including:
• Family and friends, who can be a powerful support system
• communicating with other people in the same situation
• Finding out as much as possible about breast cancer
• Not trying to do too much or overexerting
• Self-Care/ Mindfulness

PREVENTING BREAST CANCER
As the causes of breast cancer are not fully understood, at the moment it’s not possible to know if it can be prevented. In persons with an increased risk of developing the condition, some treatments are available to reduce the risk. Studies have looked at the link between breast cancer and diet. Although there are no definite conclusions, there are benefits for women who:
• Maintain a healthy weight
• Exercise regularly
• Have a low intake of saturated fat
• Avoid drinking alcohol
• Avoid/ Quit Smoking
• Breastfeeding
It’s been suggested that regular exercise can reduce the risk of breast cancer by almost as much as a third. Regular exercise and a healthy lifestyle can also improve the outlook for people affected by breast cancer.
The year 2020 has been a powerful reminder that we are all in this together, and our choices and actions have the power to protect the most vulnerable among us in a big way. The same holds true when it comes to breast cancer. With our support, we can show every woman that her life is important. By working together, we can inspire hope and become a force for good “to get her” access to the care she needs.