EACH YEAR, THE MONTH OF OCTOBER IS CONSIDERED AS THE WORLD BREAST CANCER AWARENESS MONTH. THIS BEING THE MOST COMMON CANCER AMONG FEMALES WORLDWIDE, MILLIONS ARE DIAGNOSED WITH BREAST CANCER EACH YEAR, WHILE THOUSANDS SUCCUMB TO THE DISEASE ANNUALLY. THE INCIDENCE OF BREAST CANCER IN SRI LANKA IS AROUND 8 PER 100,000 PEOPLE. RESEARCH REVEALED THAT EARLY DIAGNOSIS REMAINS THE KEY TO SURVIVAL IN BREAST CANCER; THUS JUSTIFYING THE ALLOCATION OF AN ENTIRE MONTH FOR AWARENESS OF BREAST CANCER. THIS WEEK, HEALTH CAPSULE FOCUSES ON THE IMPORTANCE OF SPREADING AWARENESS OF BREAST CANCER, ITS DIAGNOSIS, PREVENTION, TREATMENT AND BEYOND.

Who are at risk?  
It is said that being female, aeging and having a family history of breast cancer are the biggest risk factors. In addition, estrogen is considered to have some influence in development of breast cancer and therefore women who have an early menarche and a late menopause, women who are on hormone replacement therapy, women who don’t have children or have children late in their lives are considered to have a higher risk when compared with other women, based on the theory that they are exposed to more estrogen. Lifestyle also affects the causing of breast cancer with obese women, smokers and those who consume excessive alcohol being at a higher risk for breast cancers. Interestingly, breastfeeding is supposed to reduce the risk, therefore women who breastfeed longer, have a lower chance of getting the disease. However, it should be noted that many women who are diagnosed with the disease may have none of these risk factors, while women who have many or most risk factors never develop breast cancer.  

Types of breast cancers  
The type of cancer depends on the cell type that the mutation has occurred in and its invasiveness. There is a group of cancers that does not go beyond the duct or area it originated from and therefore has a very little or no effect on the body. There are however other types that spread to the lymph nodes and other organs around, which makes treatment a challenge.  

Recognising risks  
The National Cancer Control Programme (NCCP) advises all women above twenty years of age to perform a self-examination of breasts once a month to detect any change occurring during early stages. The test is best performed a week after menstrual period starts, and in women who do not have menstrual periods, in a fixed date every month.  

What to look for
Change or wrinkling of the skin of the breast, the appearance similar to an orange peel, recent onset asymmetry of one breast, recent onset nipple changes, ulceration of the breast-lump in the breast or in the armpits, unusual discharge from the nipple are the usual symptoms.

In addition, women who are between the ages of 20 and 40 are advised to go for a clinical check-up of breasts once every three years, while women above 40 should get a clinical breast examination annually. If a woman has a family history of breast cancer, meaning that she has a close relative who had breast or ovarian cancer before the age of 40, she is advised to start her check-ups even earlier in life.  

Ideally, a breast cancer is identified through a method called ‘triple assessment,’ which has three steps; A good history and examination, imaging and tissue biopsies.  

Imaging can be done through mammography or Ultra-Sound Scanning of the breast. Mammography is preferred in older women while Ultra-Sound Scan yields better results in younger women.  

Treatment  
The main treatment method is to remove the malignant parts, in combination with chemotherapy and radiotherapy as needed. Surgery may involve removing just the tumour or removal of one or both breasts, depending on the spread of the cancer.  

In the minority where the disease is too advanced, palliative treatment would be started to keep the patient comfortable while prolonging life as much as possible.  

Prognosis is quite high in breast cancers if detected early. It also depends on the type of cancer. Some cancers have a better chance of cure than the others.  

After treatment ends  
It is extremely-important to attend regular check-ups as decided by the doctor, even after your treatment course is finished, since even one or two cells which may have gone undetected may insidiously row into a tumour again.  

Depression and anxiety are common but significant problems that a person goes through. Having a supportive group of friends and family around her can make a huge difference.  

Even if the cancer is cured, losing a breast can be devastating for a female no matter her age. With the cleavage she took for granted gone, she may not be able to wear her usual clothes, and may feel that her identity and sexuality is removed along with the breast. There are reconstructive surgeries available with the remaining breast tissues and implants. Prosthetic breasts are also available. Use of prosthesis is not a reason to be ashamed of as some women believe since its equivalent of any other prosthetic device used in other parts of the body.  

Most importantly, breast cancers are not exclusively female. From Sri Lankan statistics, an average of 2% of patients diagnosed with breast cancers are male. Unfortunately, it’s also been observed that males usually wait until the disease is quite advanced to seek treatment, reducing their chance of complete cure. Therefore any male who observes a change in his nipples or chest should seek immediate medical care, since you are not safe contrary to the belief ‘breast cancer is a female cancer.’  

Finally, if a loved one of yours is going through a battle with breast cancer; or any cancer for that matter, always be supportive, holding their hands when they need the most, while reminding them to not let a group of mutated cells to keep them from leading a full and a happy life.