Clinical breast examination facilities available islandwide | Sunday Observer
Breast Cancer prevention:

Clinical breast examination facilities available islandwide

26 September, 2021

Breast Cancer cases in Sri Lanka have leaped by a massive 85 percent in the past decade, rising from 2401 cases in 2010 to 4447 in 2019 new data from the National Cancer Registry of the National Cancer Control Program (NCCP) has revealed. The fact that the vast majority of these cases could have been treated early and even cured had they been detected early and treated promptly makes it these untimely deaths even more tragic.

Since Breast Cancer Awareness month begins next month, the Sunday Observer sought the help of Consultant Community Physician, National Cancer Control Program (NCCP) Dr. Suraj Perera what had led to this rapid rise in breast cancer cases and how they could be reduced.


Q: October has been dedicated to Breast Cancer Awareness raising. What was the need to devote a whole month to only breast cancer when there are so many other cancers as well?

A: Because Breast Cancer is the commonest cancer among women in more than 160 countries, overtaking lung cancer. Also, one-sixth of cancer deaths among women are due to breast cancer, according to the global estimates of 2020 of the International Agency for Research on Cancer (IARC) of the World Health Organization. As the majority of breast cancers can be treated successfully and even cured if diagnosed early and treated promptly, it was decided that a whole month be dedicated to spreading the message of detecting the disease as early as possible. 

Q: Define Breast Cancer.

A: Occurrence of uncontrolled, purposeless abnormal cell growth initiated at the ducts or lobules of the breast tissue is called Breast Cancer. This abnormal cell growth of the breast tissues can spread to the nipple and skin of the breast, to adjacent organs or may enter into blood vessels or lymph vessels and may spread (metastasis) into distant organs such as liver, lung, brain and bone and initiate a secondary cancer.  

Q: Do you see an increase in the number of Breast Cancer cases in recent years?

A: According to the National Cancer Registry of the National Cancer Control Program (NCCP) in Sri Lanka, 2,401 breast cancers were detected among women in 2010, while the figures lept to 4,447 breast cancers in 2019.This is an  85 percent increase in just 10 years. The actual numbers may be more since some of the breast cancers which were detected and totally managed at the private sector may not have been counted since still some of the private sector cancer incidence data are not reported to the National Cancer Registry.

The NCCP in collaboration with the Private Medical Institution Regulatory Council are communicating with private sector hospitals to get down the information on newly detected cancers at the private sector. To facilitate reporting, it is essential to explore the possibilities of declaring cancer as a disease for mandatory reporting.

Q: At what age does Breast Cancer develop in women usually and what age group is at the highest risk of developing it?

A: Breast Cancers are reported in Sri Lanka from year 20-24 onwards. But the majority of Breast Cancers are detected from 45-49 year onwards. In summary, one-third (1/3) of Breast Cancers are detected before 50 years of age (pre-menopausal breast cancers) and two-thirds (2/3) of breast cancers are detected 50 years and above of age groups (Post-menopausal breast cancers).  

Q: Can you get Breast Cancer when you are past 65 years of age?

A: Yes. Breast Cancers may be detected even after 65 years of age due to delay in diagnosis of Breast Cancer or due to late initiation of Breast Cancer. However, the highest number of Breast Cancers are detected in the  50-54 or 55-59 year age group.   

Q: Why? 

A: Most of the breast cancers are sensitive to estrogen hormones. The longer time period breasts are exposed to estrogen hormones the higher the risk of initiation of breast cancer.

Q: Causes – Since the majority of breast cancer cases are preventable as you mentioned  what are the commonest ( preventable )  risk factors  and how can they be prevented?

 A: Knowledge of prevention is still limited. However, evidence shows that increasing physical activity, maintaining optimal body weight without developing obesity, avoiding alcohol and smoking and eating healthy diets may help prevent it. Also avoiding having the first child after 35 years, continuing breast feeding for more than 2 years, avoiding exposure to radiation, not taking contraceptive pills for more than 5 years without medical advice, not taking hormone replacement therapy without medical advice may reduce the chance of initiation of breast cancer. 

Q: Symptoms - What are the early signs to look out for?

A: Change of shape of the breasts, change of symmetry of the breasts, thickening of the skin over the breast, lump in the breast or in the armpit (axilla), dimpling of the breast, change of nipple size or recent inversion of nipple, abnormal nipple discharge, abnormal breast pain. Breast ulceration, induration of the breast or orange peel appearance of breast skin may be late changes of breast cancer.

Q: What happens if she delays getting herself examined by a doctor?

A: Not seeing a doctor and getting diagnosed and treatment early may lead to the cancer progressing to an advanced stage requiring advanced surgeries including radical mastectomies and advanced radiotherapy and chemo schedules which may have higher morbidities.

Q: Are there different stages in Breast Cancer progression?

A: Stage I, Stage II, Stage III, Stage Iv

Q: What happens to the body at the last stages? 

A: In stage IV, cancer has spread to distant body sites including lung, liver, brain and bone.

Q: If a woman suspects she has a lump that may be cancerous what is the first thing she must do? 

A: She should meet her family doctor or closest hospital primary care doctor. She will be taught on how to do self-breast examination. She will undergo clinical breast examination. If there are abnormalities, she will be referred to nearest surgical clinic or breast clinic for further investigations. After assessing, she will be directed do a surgical unit for further investigations including Ultrasound scan or breast, mammography of breast, fine needle aspiration or core biopsy of the breasts.

Q: You referred to self-breast examination. What does it mean? Are there guidelines available to women to follow?

A: They are available on the web - NCCP web site, booklets and in leaflets we are distributing. Flash cards, Mannequins are also being distributed in all districts as teaching materials. We have also trained all health care workers especially primary care doctors including Medical Officers of Health (MOH), Public Health Nursing Sisters (PHNS), Public Health Nursing Officers (PHNO), Public Health Midwives (PHM) in self-breast examinations. Facilities are also available at all Well Women Clinics and Healthy Life Style Centres throughout the country.

Q: How often does she have to do these exercises and for how long?

A: Every woman from 20 years should do monthly self-breast examinations and at least three yearly clinical breast examinations from 20-40 years. For those aged forty and upwards, yearly clinical breast examinations are recommended.

Q: What happens if she delays getting herself examined by a doctor?

A: Not seeing a doctor and getting diagnosed and treatment early may lead to the cancer progressing to an advanced stage requiring advanced surgeries including radical mastectomies and advanced radiotherapy and chemo schedules which may have higher morbidities.

Q: Who makes the diagnosis? Can an MOH diagnose Breast Cancer? Or does it require an Oncologist?

A: Diagnosis is made after completing triple assessment including history and clinical breast examination, imaging (Ultra sound scan of breasts with or without mammography) and histology (Fine Needle Aspiration Cytology or Core biopsy). Only after completing triple assessment findings, diagnosis is made. Diagnosis cannot be made at the MOH level.

Q: Treatment- How do you treat the initial stages of breast cancer?

A: It will depend on the clinical stage of breast cancer, histology type and receptor status of Breast Cancer. The treatment schedule is decided through a multi-disciplinary approach, to arrange surgery, chemotherapy, endocrine therapy, targeted therapy and radiotherapy. 

Q: Any new techniques developed abroad which are now available in Sri Lanka?

A: The breast conservation surgeries and targeted therapy using monoclonal antibody are available in Sri Lanka too.

Q: Some women who have a family history of Breast Cancer have removed their breasts ahead of any symptoms. Is this a good thing?

A: Having some genetic factors such as BRCA 1 & BRCA 2 genes, increase the risk of getting Breast Cancer in adult age. Removing breast tissue (Prophylactic mastectomy) will minimise the Breast Cancer risk among those having BRCA 1 & BRCA 2 genes

Q:  What are the recent interventions by the NCCP to reduce Breast Cancer risks?

A: Advocate for expanding breast clinic network, launch of handbook on comprehensive Breast Cancer care for health care workers, distribution of breast examination mannequins to Medical Officer of Health Offices, Launching breast cancer management guideline in collaboration with leading professional colleges.

Q: Your message to readers.

A: All women should be aware of their breasts and know what is normal or abnormal about them by self-examinations. If they suspect an abnormality, they need to seek medical advice promptly as with early detection and prompt treatment, Breast Cancer can be cured. Every woman aged 20 years need to self-breast examinations once a month. They can also undergo clinical examinations at our Well Women Clinics, Healthy Life Style Centres or their family practitioners. They can also attend the Breast Clinics at the Teaching Hospitals and Provincial General Hospitals, as well as the Early Detection Centres at Narahenpita, or the Teaching Hospital, Jaffna, if they have any doubts related to breast diseases.

Q: What is the address and telephone number of the NCCP for women who suspect symptoms of Breast Cancer to reach? 

A: The National Cancer Control Program, 555, Public Health Complex, Elivitigala Mawatha, Narahenpita, Colombo 5.  Tel. No. 011-2368627.