Breast Cancer Awareness Month —What you Need to Know

By Dr. Attia Anwar

October is celebrated globally as a breast cancer awareness month. A thirty-one-day days awareness campaign against breast cancer is done every year. The aim of the campaign is to inform people about methods of early detection of breast cancer and its importance. This year the is ‘Keeping Her in the Picture,’ a plea to everyone to keep an eye on the well-being of the significant women in their lives.

Early detection of breast cancer is important because it can be done very easily. It is a cancer of the external organ, if you know how to examine your breast, you can detect cancer at a very early stage and can get rid of it. So there is a difference between life and death. Number two, breast cancer is a cancer that is very prevalent and affects younger age groups of women. About 1 in 9 women is at risk of breast cancer in her lifetime. It is most prevalent in women above 50 years of age. But it also affects the women in their fourth decade of life. Breast cancer is the most prevalent cancer in the world for women.

When we talk about health promotion, early detection, and prevention of a disease, there are certain scientific criteria.

• A disease that is prevented should have an early stage.
• Treatment or effective intervention should be available in the early stage.
• There should be suitable and acceptable ways to detect early stages.
• The outcome of the disease should be improved by early detection.
• The natural history of the disease should be clearly understood.
• The benefit should be more than the harm.

As far as breast cancer is concerned, it fulfills all criteria of early diagnosis. We can detect the disease in stage one and prevent it from spreading. The most important tool that is used for early detection is breast self-examination. Every woman should do it after the end of the menstrual cycle on a monthly basis. Healthcare providers at every level should help the women to learn breast self-examination. The second thing that can be done is yearly or two yearly examinations by a gynecologist or doctor. The third way of prevention is regular mammography after the age of forty. It has its own merits and demerits. But it can be done in countries where affordability is not a problem. For Pakistan breast self-examination and examination by the doctor are the most important preventive measures we can take. It is an easy, least harmful, and very practical way for early detection. Mammography is important in carefully considered cases.

Then there is a question can we prevent breast cancer altogether? What are ways to prevent the disease primarily?  There are certain risk factors associated with breast cancer. They are risk factors and do not have a cause-effect relationship.  Risk factors are non-modifiable, you cannot do anything about them. These are female sex, age, family history, and genetics. Then there are modifiable risk factors like smoking, drinking alcohol, obesity, radiation exposure, harmful chemicals in food, and no breastfeeding. You can educate people to avoid smoking and alcohol, eat nutritious food, maintain a healthy weight, be physically active and eat minimally processed food. That can help in promoting health and prevention of breast and other cancers. According to WHO half of breast cancers occur in women with no risk factors.

So preventive strategies available are

• Avoid smoking and alcohol.
• Eat a healthy diet.
• Get a healthy weight and try to maintain it.
• Have regular physical activity or be active throughout waking hours.
• Do monthly self-examination.
• Get screened if required by mammography.

When you do breast self-examination or you note some changes in your breast. Following are the signs and symptoms that can be due to early-stage of cancer and you should go to the doctor immediately

• Swelling of breast or lump in the breast.
• Skin dimpling or feeling like orange peel.
• Inward retraction of the nipple.
• Breast skin or nipple red, dry flaky, or thickened at any place.
• Any discharge from the nipple that is not milk.

Once somebody is diagnosed with breast cancer other things you need to know are the stage of your cancer, its hormone responsiveness, and survival rate. Cancer can be local in that it is confined to the breast. Then it can be regional, that it has spread to nearby tissue and lymph nodes. The most dangerous stage is distant in which cancer has spread to other organs of the body like the liver and bones. Chances of survival are measured as a year’s survival rate. They are overall statistics but individual survival depends on many factors.

Patients with early stages are sometimes considered cured after treatment. But breast cancer can come back and is usually spread in the body when it reoccurs.

When someone is diagnosed with breast cancer they should ask the following questions from their health care provider.

• What is the size, stage, and grade of my cancer?
• What is the type?
• What is my estrogen progesterone receptor status?
• What about my HER2 status?
• What are the treatment options available for me?
• Do I have to get surgery?
• If it is advanced can I be enrolled in some clinical trial?

Treatment available for breast cancers are surgical and others. Usually, patients have a combination of treatments. These are as follows.

• Surgeries like mastectomy, lumpectomy, and reconstruction of breast.
• Chemotherapy with drugs that kill cancer cells.
• In Radiotherapy, cancer cells are killed with radiation.
• Hormone therapy for hormone-responsive cancers.
• Immunotherapy targeted biological therapy with medicines.

The aim of awareness about breast cancer is that women and their families should know about the early signs and symptoms of cancer. So they can go to the doctor and cancer is diagnosed before it is spread. This is possible even in the absence of mammography screening which is impractical for many socioeconomic groups. Health workers should refer the women to diagnostic services and it should be linked with effective treatment, if cancer is present.

The author Dr. Attia Anwar is a consultant family physician with a postgraduate degree from the Royal College of GP UK. She is a strong advocate of health and well-being and wants patient participation in decision-making regarding health.