Demystifying breast cancer

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This coming October is breast cancer awareness month, an annual international health campaign organized every October to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure.

Unfortunately breast cancer cases are on the rise (second commonest cancer in Namibia after skin cancer). In 2005 there were 179 cases of breast cancer reported in Namibia, but by 2013 the number had steadily increased to 300 (data from Cancer association of Namibia). Yet myriads of women remain unaware or ill-informed about prevention and screening of this deadly condition. Traditionally breast cancer is common in menopausal women, but lately there has been an increase in the number of young women diagnosed with the cancer. One notable young breast cancer activist was the late brave Chi-Chi. A variant of the cancer found in men tends to be more aggressive than the female type while presenting with the same symptoms and signs.

Symptoms

Oftentimes people with early cancer are asymptomatic. The following symptoms are associated with breast cancer.
• Lump in the breast or underarm (armpit).
• Thickening or swelling of part of the breast.
• Irritation or dimpling of breast skin.
• Redness or flaky skin in the nipple area or the breast.
• Pulling in of the nipple or pain in the nipple area.
• Nipple discharge other than breast milk, including blood.
• Any change in the size or the shape of the breast.
• Pain in any area of the breast
• Inverted nipple where the nipple, instead of pointing outward, is retracted into the breast.
Keep in mind that some of these warning signs can happen with other conditions that are not cancer, but experiencing such symptoms warrants a cautionary visit to the doctor.

Risk factors

Usually it’s impossible to know exactly why one person develops cancer and another doesn’t. Research has shown that certain factors, called risk factors, may increase a person’s chances. The increase in risk factor exposure partially explains the surging breast cancer numbers.

• Female sex is more predisposed to the cancer because of the female hormone oestrogen.
• Previous breast cancer history.
• Family history of breast or ovarian cancer especially in first degree relatives i.e. your mother or sister.
• Nulliparity or never falling pregnant. (Women are less likely to develop breast cancer if they have their first child at an earlier age. Their risk also goes down the more children they have and the longer they spend breastfeeding.)
• Alcohol – The Million Women Study found drinking more than 1 unit of alcohol every day (there are two units in a medium sized glass of wine) can increase the risk of breast cancer by around 10 per cent.
• Tobacco use is associated with breast carcinoma.
• Obesity (being overweight).
• Benign breast disease.
• HRT (hormone replacement therapy): Discuss with your doctor the risk involved. Radiation exposure, especially X-rays, CT scans – as more women reach old age their cancer risk increases.

Screening

Breast cancer screening activities are done to detect cancer early before any symptoms show and ideally before the cancer has spread to other parts of the body. Early treatment gives the best treatment outcome.
1. Weekly self-breast examination should be done by all women starting in their 20s. Women should know how their breasts normally look and feel and report any breast changes to a health care provider right away.
2. Yearly breast exam by a medical professional from your 20’s.
3. Yearly mammogram from the age of 40. A mammogram is an X-ray of the breast. It is the best way to detect breast cancer early before it becomes symptomatic or more difficult to treat. Mammograms work best when comparing different X-rays taken at different times. Whenever possible bring your old mammograms for comparison.
4. Ultrasound/sonar: Your doctor may recommend ultrasound before mammography if you’re under age 30 because young women’s breasts are dense and full of milk glands making mammogram interpretation difficult.
5. BRCA 1 and 2 gene test: BRCA stands for breast cancer 1, early onset. The faulty genes are inherited and account for only 5 % breast cancer and 10% ovarian cancers. This genetic testing is offered to people with a strong family history of early onset breast and ovarian cancer and relatives of men with breast cancer. Extensive genetic counselling is offered. Contact your health provider for more information on the above screening tests. In 2013 and 2015 Angelina Jolie had both her breasts and ovaries removed because she carried a faulty BRCA 1 gene. Her mother, grandmother and aunt all died from ovarian cancer.
Although breast cancer screening cannot prevent breast cancer, it can help detect breast cancer early, when it is easier to treat. Early screening and awareness remain our best option. This year take that step to practise regular self-breast examination and get screened. Exercise regularly, reduce fatty foods and remember there is a CAN in cancer.

• Dr Brian Chaka can be contacted on 065 251373 or email bchaka2000@yahoo.co.uk

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