The month of October saw the world shining the torch on the world’s most commonly occurring cancer among women, namely, Breast Cancer, with an entire month being devoted to raising awareness on this issue that has raised concern among health authorities due to its sharp rise in recent years.
 Dr Nayana de Alwis |
The Sunday Observer spoke to Consultant Community Physician, National Cancer Control Programme , (NCCP),Ministry of Health, Dr Nayana de Alwis on why breast cancer is considered so important that a whole month is devoted to raising awareness about it across the world, and how if detected early, it can be controlled and even cured in some instances, and most importantly how to detect it with easy exercises that any woman can do at home.
Excerpts :
Q. Last month was Breast Cancer Awareness month. Why is an entire month devoted to discussing this subject by countries across the globe?
A. Breast cancer is the most common cancer among women in 140 of 184 countries worldwide including Sri Lanka where 27% of cancers in women are breast cancers. Over the last several decades, the incidence of breast cancer has risen globally. Considering the huge burden of the disease worldwide, the month of October each year is declared as ‘World Breast Cancer Awareness Month’ to conduct an annual campaign that supports and helps all aspects of breast cancer including prevention, early detection treatment and palliative care.
Q. Has the number of breast cancer patients increased or decreased in recent years going by the latest statistics? What is the estimated percentage of women with breast cancer in Sri Lanka today? Compared to the figures quoted in the recent five years by the Census and Statistics report do you see an upward curve?
A. The number of breast cancer patients in Sri Lanka has gone up gradually over the years. In 2010, the total number was approximately 2,500 and currently there are 3,500 – 4,000 new breast cancer patients diagnosed annually. During the past 10 years the number of patients increased by around 40%. On average one in 38 women will develop breast cancer during her lifetime.
Q. Males too can get breast cancer. What is the percentage of males compared to females?
A. According to the cancer incidence data published by the NCCP in Sri Lanka around 50 -100 men are diagnosed with breast cancer every year – i.e. 50 to 70 times less than that of women.
Q. Age wise, at what age are women in Sri Lanka most at risk of developing breast cancer? Why?
A. Around 90% of breast cancer patients diagnosed in Sri Lanka are above the age of 40. However, the peak age range is 50 – 70 years.
Q. Since we now see more cases of younger women in their thirties and forties getting breast cancer what is the best age for a woman to be examined for breast cancer today?
A. The risk of getting breast cancer exists for women from the age of 20 but the risk increases when women get older. Therefore, all women since the age of 20 should be attentive to the health of their breasts. The national guideline for breast cancer recommends women over 20 years to carry out the following on a regular basis to detect breast cancer early.
• Be breast aware – whenever you get a chance to look and feel your breasts
• Self-breast examination – monthly self-examination by all women since the age of 20
• Clinical Breast Examination – by a trained health care provider in the following frequencies:
Women of 20 -40 years – once in 3 years and those after 40 years – annually
Q .Is breast cancer due to one factor or is it a multifactorial disease?
A. The exact cause for breast cancer is still unknown and it could be multifactorial (Combination of factors). Studies have shown that there are risk factors which increase one’s chance of getting the cancer. The two main factors that influence the risk of breast cancer are, being a woman and getting older. The following risk factors alone or in combination can enhance the chance of developing breast cancer. Some risk factors can be modified but others not. Risk factors proven by researches are:
• Having blood relatives with breast / ovarian cancers (either mother’s side, father’s side or both), this could be due to hereditary or sharing common risk factors
• Hereditary (runs through families) abnormalities in genes (about 5 -10% of breast cancers are due to hereditary causes) examples of most common gene abnormalities for breast cancer are BRCA 1 and BRCA 2 gene abnormalities
• Reproductive factors
1 Women not having children (not undergone full term pregnancies)
2 Attain menarche (starting menstruation) at early age (before 12)
3 Late menopause (stopping menstruation after 55)
4 First child birth after 30
5 Breast feeding which is a protective factor (Risk of breast cancer reduce by 4% for each 12 months of breastfeeding)
• Obesity or overweight (especially after menopause)
• Lack of regular physical exercise
• Long term use of hormone containing tablets (eg: Birth control pills or hormone replacement therapy)
• Exposure to high energy radiation
• Heavy alcohol use
• Smoking
Q, Why are women more vulnerable to breast cancer? Is it due to the reduction of hormones after menopause or the shape of their bodies?
A. Women have more breast tissue (cells) than men and also their breast cells are constantly exposing to the growth promoting effects of the female hormones namely estrogen and progesterone which men don’t have.
Q. Myths - e.g. is having too many babies too soon a cause for breast cancer?
A. No, the risk of breast cancer decreases with the number of full-term pregnancies and years of breast feeding.
Q. Diet - what about women who do not get enough fibre, eat too much red meat, consume saturated fats and not eat fruits and vegetables? Are they more prone to breast cancer?
A. Unhealthy diet is a risk for the development of many cancers including breast cancer, colorectal cancer, etc. In addition to the direct effect of the unhealthy diet, they indirectly increase the risk of cancers by contributing to obesity, also a known risk factor for many cancers.
Q. Are there different types of breast cancers? If so, what is the commonest form?
A. The breast is made up of glands which produce milk, ducts which bring milk up to the nipple and connective tissues. Wherever cells are present cancer can occur. However, the most common type of breast cancer is cancers originating from the cells lining the milk ducts.
Q. What are the earliest symptoms or signs to look out for?
A. Most commonly found signs and symptoms are:
• Lumps – lump, swelling or thickened area in the breast or axillae
• Recent changes in the shape/ size or appearance of the breast, visible depression in any part of the breast
• Change in skin texture or colour of the breast
• Continuous pain or discomfort in the breast which is unrelated to pain associated with menstrual cycles
• Changes in the nipple
1 Abnormal secretions (especially blood stained)
2 Reddish, wet and non-healing eczematous rash or wound around the nipple
3 Change in position or direction of nipple (inverted nipple, pointing differently) when it is recent onset
Q. How do you diagnose breast cancer? Screening? Mammogram?
A. Screening is to detect early disease in individuals without symptoms whereas early diagnosis is in patients with symptoms suggestive of breast cancer.
The methods of screening were explained in the previous question. The diagnosis of breast cancer in patients with symptoms suggestive of breast cancer is done by triple assessment which include:
• Clinical examination
• Imaging – Mammogram/Ultrasound
• Biopsy – taking small sample from the lesion
Q. Are they available free of charge to patients in state hospitals with cancer prevention units?
A. Yes, currently there are 24 cancer treatment centres in Sri Lanka, of which there are 9 major cancer treatment centres, one per province with many of the cancer treatment modalities. In addition to these 24 centers, diagnosis of breast cancer and surgical management facilities are available in any hospital where consultant surgeons are present.
Q. Treatment- when a patient is diagnosed with breast cancer what is the initial treatment procedure to control the disease if it has not advanced? Drugs? Chemotherapy?
A. If the breast cancer is not advanced, initial treatment of choice is mostly surgery but there are different levels of surgery and different modes of treatments including chemotherapy, radiotherapy, hormone therapy, etc.. The treatment modalities needed for each patient is decided by the treating clinician based on several factors including the type of breast cancer, hormone status, age of the patient, etc..
Q . How effective are these procedures according to the feedback you have received in controlling breast cancer?
A. Around two-thirds of breast cancer patients seek treatment at an early stage which is a very good achievement compared to the past and also with the modern treatment modalities available for cancer including breast cancer in the country, many patients survive probably a near normal life compared to the past.
Q. What are the late symptoms of breast cancer and complications caused by them?
A. Breast cancer can be spread to other organs in the late stages of the disease through blood and lymphatics similar to many other cancers. Usually, breast cancer spreads to lungs, liver, bones, brain etc.. Depending on the site affected, patients have different kinds of symptoms. For example, if lungs are affected the patient may have a cough, difficulty in breathing etc, and if it spreads to the bones it would cause bone pain (especially spine)
Q. What are the latest interventions set up by the Health Ministry in collaboration with the NCCP program to make Sri Lanka a cancer free country?
A. Cancer is a group of diseases occurring as a result of abnormal, purposeless and uncontrollable division of cells due to the presence of mutated (not normal) genes within the cells which are the basic building blocks of the body.
These gene abnormalities can be present from the time of birth or in most cases later on in life due to lifestyle and exposure to various environmental factors.
It is not possible to make a cancer free country anywhere in the world. But one-third of cancers can be prevented by healthy life choices (eg: cervical cancers, mouth cancers, lung cancers etc.), while another one-third of cancers can be cured by early detection eg: breast cancer, colorectal cancers, etc.
The NCCP program of the Ministry of Health is carrying out several interventions to prevent and detect cancers early, improve diagnosis, treatments and care for cancer survivors and terminally ill cancer patients (Palliative care)
Q. Briefly state the goal and objectives of the NCCP?
A. The vision of the National Cancer Control Programme is:
‘A country with low incidence of preventable cancers and high survival rates, with good quality and minimal disabilities/suffering from the effects of cancers’.
Q. Your message to our readers?
A. “Early detection saves lives. You definitely have the power to save your own life”. Detecting breast cancer early, prompt diagnosis and effective treatment will improve survival, quality of life and reduce the cost of care. The best way to control breast cancer is to find it early – when it’s small, has not spread, and is easier to treat.
To do that all women should know how their breasts normally look and feel and actively look for any recent changes and report to a health care provider right away.
