Be in touch with your breasts

By Dr.Nnandawula Kanyerezi Mutema, M.D.

Early detection improves breast cancer survival and remains the cornerstone of breast cancer control

October is National Breast Cancer Awareness Month world over. It is an annual campaign dedicated to increase the awareness of the deadly disease.

According to the World Health Organisation breast cancer is the top cancer in women both in the developed and the developing world.

Breast cancer is a malignant tumour that originates in the cells of the breast. The breast is mostly made up of a collection of fat cells called adipose tissue. Each breast has ten to twenty lobes with multiple lobules which are the glands that produce milk in lactating women. The lobes and lobules are connected by milk ducts which carry the milk to the nipple. Within the adipose tissue is a network of fibrous connective tissue, blood and lymph vessels as well as nerves.

Throughout the body, cells multiply in an orderly and well controlled manner. Aging cells die and are replaced by new cells. For reasons not clearly known, but related to damage in the cell DNA, cancer cells grow in a disorderly and uncontrolled manner which leads to development of tumours.

It is not clear why one woman would develop breast cancer and another would not. Even when diagnosed, most women and their doctors never get to know what might have caused it.

However it is known that women and indeed men with certain risk factors are more likely to develop breast cancer. This does not mean that if one has a risk factor they will definitely get breast cancer, neither does it mean that if you have more than one risk factor you will definitely get breast cancer.

The unavoidable risk factors include gender, with women at a higher risk than men, having dense breasts,  family history of breast or ovarian cancer, personal history of breast cancer in one breast, early menstruation before the age of twelve and late menopause after the age of fifty-five. Predisposing genetic mutations like BRCA1 and BRCA2 are unavoidable risk factors as well.

Research done by the World Health Organisation warns that the incidence of breast cancer is increasing in the developing world due to increased life expectancy, increased urbanisation and adoption of western lifestyles.

Some avoidable risk factors for breast cancer are related to this urbanisation and adoption of western lifestyles such as lack of physical activity and poor diet which lead to obesity. Excessive alcohol intake, radiation to the chest before age thirty and combined hormone replacement therapy are all included in the list of avoidable risk factors.

Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries where breast cancer is diagnosed in very late stages. But even when cancer is detected, it doesn’t mean the end of the world.

Early detection improves breast cancer outcome and survival and remains the cornerstone of breast cancer control.

And that is why you need to be in touch with your breasts.

How can you start? First of all schedule a mammogram every year. Mammography is a specialised form of x-ray which has the ability to find abnormalities in breast tissue way before they are palpable.All women over the age of 40 years should have annual or biennial mammograms.

Secondly in situations where a lump is felt or an abnormality is noted on mammography, ultrasound is the next step. This helps differentiate a solid lump from a fluid filled cyst which is usually nonthreatening and can be monitored.  It also helps further qualify the solid lump to determine whether it is suspicious for cancer. A solid lump with characteristics of cancer ought to undergo a biopsy for definitive diagnosis and grading by a qualified pathologist.

Thirdly management of breast cancer is based on the tumour type, size, grade and stage at diagnosis. The grades Low, Intermediate or High are based on how closely the cancer cells resemble normal breast cells. Staging is based on tumour size and how far it has spread in the body.

Surgery is usually the first line of treatment. It may involve a lumpectomy where just the lump is removed, mastectomy where the whole breast is removed or even bilateral mastectomy in those women who have a genetic mutation. Radiation therapy and chemotherapy are additional treatments used as well as hormonal treatment.

Breast cancer does not have to be a death sentence. If detected early and managed well many women can survive. Examination by a medical practitioner, coupled with Mammography and Ultrasound are the beginning of your survival.

Take sometime out this October and get screened for breast cancer.

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Dr. Nandawula Kanyerezi Mutema M.D. is the Executive Director and Physician at The Clinic At The Mall, Village Mall, Bugolobi. She is a Diplomate in Internal Medicine, certified by the American Board of Internal Medicine.  She is passionate about health issues and women empowerment.