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Breast Cancer Awareness Month: ‘Cancer is a word, not a sentence’ 

10 Oct 2021

By Dr. Charuni Kohombange  Breast cancer is every woman’s nightmare and in fact it is a serious disease that affects millions of people each year. It is recorded as the most common form of cancer in women across the globe and was identified as the most commonly diagnosed cancer type during last year. The International Agency for Research on Cancer (IARC) has estimated over 2.26 million new cases of breast cancer and almost 685,000 deaths from breast cancer worldwide in 2020. Further, it was the most common cause of cancer deaths in women and the fifth most common cause of cancer death in general. Although, the prognosis of patients with breast cancer is generally quite favourable, like in many other diseases there are disparities in survival between different socioeconomic groups. In low and middle-income countries, barriers to diagnosis and treatment lead to poor prognosis in comparison to high-income countries. According to IARC, in 2020 half a million women in low and middle-income countries died of breast cancer and almost three quarters of global deaths from the disease occurred in these countries.  Breast Cancer Awareness Month (BCAM), was launched in October 1985 as a collaborative effort of the American Cancer Society and Imperial Chemical Industries (now part of AstraZeneca). It was originally intended to encourage women to get regular mammograms as the most effective investigation in the fight against breast cancer. While the momentum around breast cancer awareness continued, in the early 1990s the pink ribbon was established as its symbol.  Following is an excerpt of an interview with Batticaloa Teaching Hospital Consultant Oncologist Dr. Nuradh Joseph, to raise awareness on breast cancer during breast cancer awareness month of October:  Why is it important to be aware of breast cancer?  Breast cancer is the most common form of cancer among females in Sri Lanka. Early breast cancer can be cured completely in a vast majority of cases. It is lethal only  when it spreads outside the breast and lymph glands to other organs such as the lung, liver, brain, and bone. So increasing awareness is pivotal to ensuring that it is diagnosed and treated before this happens.  Are there any categories of women who are at high risk to develop breast cancer in their lifetime?  I think your question recognises two of the most significant risk factors – being a woman and getting older – which you really can’t do anything about. But apart from these, having a family member with breast cancer, early menarche and late menopause can also increase your risk. The oral contraceptive pill and certain hormonal treatment may also place you at a higher risk.  Are there any modifiable risk factors in breast cancer?  This is a very good question. Regular exercise, weight control and cutting down on alcohol will reduce the risk of getting breast cancer and a number of other illnesses such as strokes, heart attacks, and diabetes. Pregnancy before 30 years and breastfeeding will also reduce the risk.  How can someone suspect that they are having breast cancer – what are the signs and symptoms?  A lump in the breast is the most common feature of breast cancer. In addition, lumps in the armpit and changes in the skin overlying the breast can also be signs of cancer. Nipple discharge is another feature, although not very common. It is important to mention that only about 10% of breast lumps turn out to be cancer, but women should be familiar with how their breasts normally look and feel and should report any changes to a doctor immediately.  When should women start screening for breast cancer and what are the facilities available in the healthcare system of Sri Lanka for breast cancer screening?  Screening means catching the cancer before it develops to a lump that can be felt. The most effective method of screening is mammography. Mammograms are low-dose X-Rays of the breast. Women between 50-74 years should have a mammogram every two years, while those at higher risk should start screening earlier. Mammography facilities are available in all Provincial Hospitals in the country and steps are underway to establish units in each district.  In general, what is the prognosis of breast cancer? What are the factors affecting the prognosis? Early breast cancer can be cured in more than 80-90% of cases. However, delays in seeking treatment will give the cancer time to spread to other organs and when that happens the cancer turns incurable. Larger tumours and those that have spread to lymph glands increase the risk of it spreading to these organs. In addition, there are certain features of cancer cells detected when observed under the microscope which indicate how aggressive the cancer is.  What are the treatment options available for breast cancer and for how long should patients receive treatments?  The primary treatment of breast cancer is surgery. Previously it was thought that the whole breast and all the lymph glands in the armpit have to be removed completely to cure it, but now it has been shown that removing only the lump and just the draining lymph gland (called the sentinel lymph node) is enough for most patients. In fact, latest research shows that women who have had only their lump removed live longer than those who have had the whole breast taken out. This is somewhat counter-intuitive, but we have always known that removing the whole breast and all the lymph glands triggers a reaction from the body which we call inflammation and this may help cancer cells to spread to other organs. So unless absolutely necessary, the whole breast should not be removed.  Apart from surgery, radiotherapy is another treatment that reduces the risk of the cancer coming back. There are lots of myths on radiotherapy – some think that it is an obnoxious form of “burning” of cells, but actually it is just a very small dose of high energy X-Rays that is aimed at the breast and lymph glands. It is entirely safe and has very minimal side effects.   Along with surgery and radiotherapy, chemotherapy, hormonal therapy and certain novel drugs called monoclonal antibodies that target breast cancer cells with precision are also used in the treatment of breast cancer.  Are we having all required treatment options in Sri Lanka and are they distributed across the country to ensure equitable access?  Indeed, we are very fortunate to be blessed with a high quality state healthcare system which is free at the point of delivery. Every treatment for breast cancer be it surgery, radiotherapy, chemotherapy, hormonal therapy or the more expensive novel targeted drugs are available for free in Government hospitals throughout the country. So there is no necessity for any patient to spend any money out of pocket. The Health Ministry is also expanding radiotherapy and surgical facilities to further improve the quality of care. Recently, the National Cancer Control Programme and the Sri Lanka College of Oncologists published guidelines on treatment of breast cancer to ensure greater equity and consistency of care. The main factor that determines the outcome of  your cancer is not where you live or how affluent you are but only how soon you seek treatment.    What are the commonest side effects of these treatments and are they reversible?    With the shift toward removing only the lump and draining lymph glands (sentinel lymph node biopsy), side effects of surgery such as arm swelling have reduced substantially. As mentioned before, radiotherapy is very safe. Chemotherapy has some side effects such as hair loss, nausea and risk of infection. Hair loss is probably the most devastating side effect for the patient – but this is reversible and the hair does grow back. Recently the Indira Cancer Trust, initiated a very innovative programme which provides natural hair wigs free to all cancer patients.  What is your message for the public on this ‘breast cancer awareness month’?  Breast cancer is eminently curable. You just need to catch it and treat it early.  (The writer is a Medical Officer at the Directorate of Healthcare Quality and Safety, Ministry of Health) The views and opinions expressed in this column are those of the author, and do not necessarily reflect those of this publication.


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