Breast Cancer: Early detection saves lives

October is recognised as Breast Cancer Awareness Month and it is important for women in Ghana to recognise that early detection of breast cancer saves lives. Breast cancer is the most common diagnosed cancer in women.

In a review of all cancer cases in 2012 at the Korle Bu Teaching Hospital, breast cancer was the commonest with about 29 per cent incidence, and among all female cancers it was 40.8 per cent. Studies done in Kumasi using the Kumasi cancer registry for the year 2012 showed that the commonest cancer among females was breast cancer which accounted for a third of all cancers.

Types of breast cancers

There are many types of breast cancers, but it has been found in studies done in both USA and in Ghana at the Komfo Anokye Teaching Hospital (KATH) that black women in both places tend to get the more aggressive types of breast cancer and more importantly, it seems to occur in younger women.

Breast cancer usually occurs in women above the age of 40 years; however it has been found that more black women compared to white women below the age of 40 years are diagnosed with breast cancer. In one of the Ghana studies, breast cancer accounted for about 25 per cent of all cancers recorded at KATH, and more than a third of the women diagnosed were less than 45 years old.

Unfortunately the death rate is also high at about 80 per cent, and we have all known friends and relatives who have succumbed to breast cancer. Due to the dismal survival rate of this disease in Ghana compared to developing countries like UK and USA, there is the need for Ghanaian women to be familiar with the risk factors involved.

I would like to address the risk factors for developing breast cancer and what a woman can do to prevent having this disease, as well as what to do in order for it to be detected early when it occurs.

Risk factors

Risk factors are conditions that may increase an individual’s chance of developing an illness or disease; and so knowing about risk factors could help one avoid the condition. Some risk factors can be modified or changed, while others cannot.

Common risk factors include:

• Being a woman who is older than 50 years and postmenopausal (has stopped having periods); however this is not always the case in Ghana as discussed above

• Having a previous history of breast cancer (recurrence of previous incidence)

• Family history of breast cancer in a mother, sister or daughter

• Carrying some special genes called BRCA (Breast cancer genes) 1 and 2

• History of breast cancer in distant relatives like an aunt, grandmother or cousin.

Others risk factors include excessive alcohol intake, obesity, not having any children or having your first child after the age of 35 years, taking female hormone replacement therapy for menopause symptoms, excessive radiation exposure, early start of one’s period and late menopausal age.

There is a small increase risk in women who are current or recent (less than 10 years) users of combined oral contraceptive pills (birth control pills), but this is not seen in past users. However, the pill can also protect users against ovarian cancer, plus many other benefits.

Reducing the risk

There are many things that women as individuals can do to reduce their risk of breast cancer.

• Physical activity has been found to be protective against breast cancer because it is able to decrease circulating levels of female hormones. In women who have not reached menopause yet, regular physical activity whether walking, jogging, swimming, aerobics etc. can reduce breast cancer risk by 40 per cent.

• Decreasing alcohol intake to less than two drinks a day (equivalent to less than two 12 fluid ounces of beer, two 5 fl. oz of wine and two 1.5 fl. oz of spirit) or not drinking alcohol at all may help decrease the risk.

• Weight loss to reduce number of active fat cells in the body.

• Have your first child before age of 35 years if possible.

• Breast feeding, with its many benefits, causes a reduction in the risk of breast cancer.

Women who have dense breasts as seen on mammogram pictures (this is not the same as heavy or large breasts), have an increased risk. Dense breasts have more fibrous tissue and so on the mammograms they appear white and can easily have cancer tumours hiding behind them.

Women with dense breasts may need additional studies like diagnostic mammograms, ultrasound or MRI of the breasts. Older women may have a lot of fatty tissue replacing the breast tissue and this is rather easy to see through on mammograms compared to dense breasts.

Among women who have been through the change (postmenopausal and have stopped having menses), being overweight or obese has been found to increase risk of breast cancer because increased fat cells affect female hormones that are related to the development of breast cancer cells.

Clinical breast examination

This is a breast examination performed by a trained health worker (e.g. doctor or nurse) on women below the age of 40 years every 1-3 years. For those above 40 years, once a year is appropriate especially for women in developing countries where access to the special Xray called mammogram used to detect breast lumps is not readily available.

It is important to talk to your doctor about your risk factors and to let him/her know that you will like a clinical breast examination at some point. One has to be proactive in discussing topics like breast cancer prevention because a doctor may not bring up the topic.

Self-breast examination

This same group of women can also do self-breast examination (SBE) every month just after the end of their menses when the breasts are not tender or lumpy. One has to be taught how to do it properly.

The SBE has limitations because a breast lump or mass can only be felt with the hands when it is very large therefore some medical specialties do not recommend it, but for people who do not have any other choice I suggest they do so. It helps a woman know what her breasts feel like and so any new lump which appears can be detected.

Screening mammogram

Since early detection is key to preventing advanced or late breast cancer, getting a mammogram is important especially for women over 40 years. A mammogram is a special type of X-ray used to take pictures of the breasts.

A screening mammogram is done on a woman who does not have any symptoms in the breasts. When a lump is detected after having a screening mammogram, a woman may be sent to have a Diagnostic Mammogram which involves more pictures and also an ultrasound of the involved breast may be needed.

During the process, the breasts are individually placed on a flat surface with the woman in an upright position and a second plate is used to flatten the breasts while the picture is taken. The procedure takes about 20 minutes.

The flattening of each breast may be a little uncomfortable but drinking enough water before the procedure and trying to avoid caffeine the day before may be helpful. Breasts may be tender around the period or menses and so scheduling the appointment after one's menses may be a better time.

Best option

Mammograms do not discover all breast cancers and may miss about 10 per cent of them (range from 5-17 per cent); however, they are presently the best option for screening and discovering early breast cancers. How often one has a mammogram has been controversial.

Some suggestions include every 1-2 years for women between the ages of 40-49 years; and every year for women older than 50 years. Some countries also recommend starting at age of 50 and getting one every 2-3 years for women who are at average risk for developing breast cancer.

Some researchers try to discourage the use of screening mammograms because they feel that women undergo a lot of unnecessary breast biopsies (small amount of breast tissue is taken surgically and examined under a microscope to look for cancer cells), coupled with anxiety prior to results because of lumps which may not be cancerous but are detected by mammograms. However, early detection may lead to early treatment and will reduce the number of deaths from breast cancer especially for women above the age of 50 years.