October is Breast Cancer Awareness Month
Breast cancer is one of the leading cancers in women. The stage at which the cancer is diagnosed varies greatly between races and populations (rural vs urban), influenced by availability of medical centres, socio-economic status and culture. These factors may also impact on obtaining early medical help and complying with treatment.
There are a number of factors that increase the risk of developing breast cancer: age; a family history of breast cancer; previous benign breast disease such as proliferative changes (normal) and atypical hyperplasia (abnormal); internal endocrine factors such as early onset menstruation, late menopause, long duration of periods, and never having been pregnant or first pregnancy at an older age. External hormones, such as oral contraception and hormone replacement therapy, might also put you at risk.
Examine Your Breast
Thorough breast examinations remain a critical component in diagnosis. Evidence shows that breast examinations and screening mammography decrease breast cancer deaths by 25% in women 40-69 years of age.
Signs that are worrisome and should be investigated include a palpable lump, abnormal nipple discharge, skin colour changes, nipple retraction, enlarged lymph nodes in the armpit, significant difference in the size of one breast to the other and one-sided arm swelling. If you believe you have an increased genetic risk factor (mostly found in Jewish and Afrikaans women)
Self breast examination:
Examine your breasts monthly at the same time in the menstrual cycle when the breasts are not engorged or tender. A postmenopausal woman may pick the same date each month (ie: 15th).
First sit in front of a mirror with your hands at your sides. Look for changes in the shape, size or appearance of your breasts e.g. dimpling, rash or puckering of the nipple skin, nipple discharge or any change from normal. Inspect your breasts in four ways: arms at your side, holding arms over your head, pressing hands on your hips and tightening chest muscles and finally, leaning forward with your hands on your hips. If you have problems lifting your arms you can get someone to help you.
The next step, feeling for any change in your breast tissue e.g. thickening or hard lumps, can be done lying down or in the shower or bath. Put your right hand behind your head and use the pads of the three middle fingers of your left hand to examine your right breast (soapy water makes this easier.) Press using light, medium and firm pressure in a circular motion, then up and down. Feel for changes in your breast, above and below your collarbone and in your armpit area. Repeat these steps with you left breast. Doing this in the morning provides time to consult a doctor the same day instead of spending a sleepless night.
Women with hand limitations should ask a partner, care giver or relative to assist. A breast clinic would also be able to teach carers on appropriate methods.
There is general agreement that mammography screening in women 50-74 years of age has decreased breast cancer mortality. It is the most accurate for detecting early-stage cancer, and ultrasound has improved this even further. Screening Mammography does not replace self breast examinations. Women with increased risk should start screening from age 40-45 and, if services allow, every two years thereafter. A fine needle aspiration should be performed on any palpable mass irrespective of whether the mammogram is suspicious or not.
The key is early detection and treatment including surgery, chemotherapy and radiotherapy. Breast cancer survival is directly linked to stage at presentation, the type of cancer and the age of the patient.
Men can also get breast cancer and it is known to be more aggressive, so - please men - examine your own breasts as well as your wife’s!