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#EMMAseries : DISPELLING MYTHS & GETTING ENLIGHTENED ABOUT BREAST CANCER – By Dr Femi Olaleye

BREAST CANCER

Q: What are its risk factors? What is the incidence in black women (Nigeria?).

The incidence of breast cancer in Nigeria has been worked out to be 1-2 in 25 women. Some risk factors have been identified that can increase this incidence. For example, an important risk factor is genetics as the breast cancer genes (BRCA 1&2) can be hereditary. So a woman with a family history (mother, sister and maternal aunt) has a higher risk (2-fold) compared to a woman without such a history. Smoking, alcohol consumption, obesity, history of ovarian cancer, being more than 30 years old before having the 1st child and not having regular breast cancer screening have all been identified as factors that can increase the risk of breast cancer in a woman.

Q: Must there be a lump to signify the presence of breast cancer or are there other signs? If a lump is detected, what should one do?

Commonly a lump in a woman’s breast does not mean it is a cancer. However a woman with breast cancer almost always has a lump in her breast. Other signs that should alert a woman apart from a painless lump in her breast include skin changes over her breasts and nipples. Presence of nipple discharge from only one side especially if it is blood-stained is also a sign. So the 1st thing a woman should do whenever she detects a lump or any abnormal changes in her breast is to have it checked out by a qualified healthcare practitioner to confirm if indeed it is a cancerous lump or a non-cancerous lump (benign).

Q: How can one prevent it?

We cannot prevent a lump from growing in a woman’s breast but we can prevent the lump from growing so big enough to kill a woman and spread: a common feature of breast cancer, by detecting the cancerous lump very early. So every woman with a pair of breasts should learn how to conduct self breast examinations and do this EVERY MONTH. Early detection is the key to preventing breast cancer.

Q: Does breast cancer affect a certain age group?

Commonly we see breast cancer in women in the older age group (above 50) but we are now beginning to see more cases in young adults (women in their 20s), especially in women with positive family history.

Q: What is the incidence in people with first degree relatives (nuclear family) diagnosed of it?

The incidence is 2 in 25. The risk is doubled in a woman with positive family history.

Q: Can using a used and unwashed bra cause it? Can wearing bras for long hours including going to bed cause breast cancer?

NO. These are untrue myths

Q: What are the chances of survival if detected early? How early?

The 5-year survival rate is the standard measure for prognosis of a lethal disease like cancer. It is often expressed in percentages – the percentage of patients surviving after 5 years of a diagnosis. So for example, the 5 year survival rate of Stage 1 Breast Cancer is roughly 70% while that of Stage 4 is less than 10%. Translation: If 10 women were given a diagnosis of Stage 1 Breast Cancer and another 10 women were given a diagnosis of Stage 4 Breast Cancer in 2010, 7 women (Stage 1) would still be alive by 2015, while only 1 woman (Stage 4) would probably be alive 5 years later in 2015. So, EARLY DETECTION IS THE KEY TO SURVIVAL.

Q: Is there a relationship between diet and breast cancer? Does weight put one at risk for it?

Obesity increases the risk of developing some other cancers especially breast cancer and endometrial cancer (cancer of the lining of the womb). The risk of an obese woman developing breast cancer has been worked out to be close to 1.5 fold increase. Diet monitoring and regular exercise to reduce excess weight can therefore reduce this risk.

Q: What is the relationship between breast cancer and early menses and late menopause and nulliparity (not giving birth)?

Breast cancer seems to develop more in women who are exposed to more hormonal influences such as those who experience early onset of menses (menarche) and late stoppage (menopause). For the same reason, women that delay having their 1st child till after 30 years and those who don’t have any after age 40 (nulliparous) tend to have a higher risk as well.

Q: Does breast feeding or not breast feeding have any effect on getting breast cancer?

Breast cancer risks are not affected by breast feeding practices. If anything, breast feeding may even offer some protection as the woman would have been pregnant and also experience some menstrual stoppage which invariably reduces her exposure to some hormonal influences.

Q: We often hear that taking birth control pills, injectables etc could cause breast cancer. Is that true? If yes, what are the recommended ‘safe’ birth control methods?

Oral contraceptives and most other common birth control methods are safe and recommended for women depending on various factors such as age, parity and medical history. However, the use of combined oral contraceptives for a period LONGER THAN 10 years has been discovered to increase the risk of breast cancer by 1.5 fold. This risk reduces over time after discontinuation of use.

Q: Can males have breast cancer too? If yes, what is the incidence in Nigeria?

Men too can have breast cancer. Men have breasts too, although not developed as much as women because men don’t normally have estrogen levels high enough to develop their breasts unlike women. It has been stated that 1% of all breast cancers are attributable to males.

Q: How important is self breast examination and how often should a woman do it? What is the right way of doing a self breast exam (SBE)?

Since most forms of breast cancer present as a breast lump, women are encouraged to examine themselves regularly (self examination – monthly, screening annually).

The right way to do SBE: it is advisable for the woman to do the self examination just after her monthly period (or the 1st Sunday of every month, for menopausal women). Step 1: Use the right hand to examine the left breast and vice versa. Step 2: Use the front part of your fingers, close together, to feel the breast (without the thumb) starting from the top part, and then move clock-wisely round till all parts of the breast had been felt.Step 3: Repeat for the opposite breast using the left hand. Step 4: Don’t forget to feel for lumps in the arm pits too. Step 5: Squeeze each nipple to find out if any discharge comes out. Note the color and if both breasts are involved. Normally, non-lactating women should not have any discharge from their breasts.Step 6: report any abnormal findings such as hardness, skin dimpling and nipple discharge to your doctor at once.

NB: Self breast examination can start from teenage years once breast buds appear.

Q: At what age is it recommended to have a mammogram and how often?

Originally women over age 40 were advised to have annual mammograms (X-ray of the breasts) but we have had to lower this to 35 years as we are beginning to see more cases of breast cancer in younger women in Nigeria. We recommend annual mammograms from age 35, especially if there is a family history of breast cancer.

Q: Can drinking water from plastic bottles or drinking water from bottles left in the sun cause breast cancer? Can using microwaves or anti-perspirants cause it or put one at risk?

No to all 3 (plastics, Microwave ovens and anti-perspirants do not increase risk of breast cancer). There are no scientific evidence to support such claims.

Q: What are the different stages of breast cancer? At what stage is it terminal?

Stage 1 to 4 are the general simple staging that we use but there are other more complex bits of information about the cancer that can determine prognosis and how terminal the situation is. But generally, Stage 1 has a better prognosis than stage 2, but stage 3 may not be necessarily better than stage 4. Therefore women are advised to detect lumps as early as possible so that doctors can determine if is cancerous or not. And if it is cancerous, treatments should be commenced immediately.

Q: what forms of treatment are available? How effective are they?

Modern treatments for breast cancer include surgical removal of the cancerous lump (lumpectomy) or the breast (mastectomy) followed with chemotherapy, radiotherapy and adjuvant therapies depending on the case and staging.

The effectiveness of the treatment now depends on many factors, such as the stage at which the disease was discovered, the availability of financial resources to access the various forms of treatment, and availability of medical personnel to deliver the care needed over the short term and the long term. Sadly, majority of Nigerian women afflicted with breast cancer cannot afford the cost of care in Nigeria, let alone afford the cost of seeking care abroad. So all efforts should be geared towards preventing breast cancer by encouraging EARLY DETECTION THROUGH SCREENING OF WOMEN.

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