Breast cancer is the commonest cancer in women both in the developed and the developing world. The incidence of breast cancer is increasing in the developing world due to increasing life expectancy, urbanisation and adoption of western lifestyles. Early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control.
What can I do to reduce my risk of breast cancer?
• Limit alcohol: The more alcohol you drink, the greater your risk of developing breast cancer. The general recommendation, based on research on the effect of alcohol on breast cancer risk, is to limit yourself to less than 1 drink per day as even small amounts increase risk.
• Don’t smoke. Accumulating evidence suggests a link between smoking and breast cancer risk, particularly in premenopausal women.
• Control your weight. Being overweight or obese increases the risk of breast cancer. This is especially true if obesity occurs later in life, particularly after menopause.
• Be physically active. Physical activity (at least 4 hours per week) can help you maintain a healthy weight, which, in turn, helps prevent breast cancer.
• Breast-feed. Breastfeeding might play a role in breast cancer prevention. The longer you breastfeed, the greater the protective effect.
• Limit dose and duration of hormone therapy. Combination hormone therapy for more than three to five years increases the risk of breast cancer. If you’re taking hormone therapy for menopausal symptoms, ask your doctor about other options.
Early detection and screening:
Early detection through mammography is still the most widely available tool we have to fight breast cancer. It can detect breast cancer up to two years before the tumor can be felt by you or your doctor. The American Cancer Society guidelines for women at average risk for breast cancer (defined as women without a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase the risk of breast cancer e.g. BRCA), are as follows:
• Women between 40 and 44 have the option to start screening with a mammogram every year.
• Women 45 to 54 should get mammograms every year.
• Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
What do I do if I feel a lump?
There’s little that scares women more than finding a breast lump, especially if you know you’re at risk for breast cancer because of family history or for other reasons. But if it happens to you, the first thing to do is take a deep breath and try to stay calm. Most breast lumps (90%) aren’t cancerous, but it’s always best to have them checked by your doctor. You should visit your doctor if you notice any of the following:
• a new lump or area of thickened tissue in either breast that was not there before
• a change in the size or shape of one or both breasts
• bloodstained discharge from either nipple
• a lump or swelling in either of your armpits
• dimpling on the skin of your breasts
• a rash on or around your nipple
• a change in the appearance of your nipple, such as becoming sunken into your breast
Breast pain isn’t usually a symptom of breast cancer
Your expert team of healthcare professionals will do the necessary investigations which usually entails having a breast ultrasound and mammogram. A needle biopsy will be arranged if there is a high index of suspicion of a cancerous lump. The pathologist will analyse the biopsy sample, and if breast cancer is confirmed, your multidisciplinary breast cancer team will decide on the best management.
Stage of cancer remains one of the most important prognostic factors. Generally, the earlier breast cancer is diagnosed and treated, the higher the chances for long-term survival. Treatment is individualised based on many factors including the stage and molecular subtype of the disease. Common treatments modalities used are surgery, radiotherapy, chemotherapy, hormonal therapy and targeted therapy (Herceptin®).
While the diagnosis of breast cancer still instills fear in the hearts of women, we can draw courage and hope from improving survival rates in patients diagnosed with breast cancer thanks to earlier diagnosis, innovative drugs, and better treatments. In the words of Christopher Reeve, “Once you choose hope, anything’s possible.”