By Awa Sowe
Breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among women. Since last two decades, researches related to the breast cancer have led to extraordinary progress in our understanding of the disease, resulting in more efficient and less toxic treatments. Increased public awareness and improved screening have led to earlier diagnosis at stages amenable to complete surgical resection and curative therapies. Consequently, survival rates for breast cancer have improved significantly, particularly in younger women.
According to the World Health Organisation (WHO) female gender is the strongest breast cancer risk factor. Approximately 0.5–1% of breast cancers occur in men. The treatment of breast cancer in men follows the same principles of management as for women.
Certain factors increase the risk of breast cancer including increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use and postmenopausal hormone therapy. Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years).
The WHO Global Breast Cancer Initiative (GBCI) is meant to reduce global breast cancer mortality by 2.5% per year, thereby averting 2.5 million breast cancer deaths globally between 2020 and 2040. Reducing global breast cancer mortality by 2.5% per year would avert 25% of breast cancer deaths by 2030 and 40% by 2040 among women under 70 years of age. The three pillars toward achieving these objectives are: health promotion for early detection; timely diagnosis; and comprehensive breast cancer management.
Dr Lamin Jaiteh, Consultant General and surgical oncologist at the Edward Francis Small Teaching Hospital, underscored that breast cancer is the number one cancer in women after cervical cancer. He defined breast cancer as cancers originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.
He mentioned that breast cancer cells begin inside the milk ducts or in the milk-producing lobules of the breast. The earliest form (in situ) is not life-threatening. Cancer cells can spread into nearby breast tissue (invasion) and this creates tumours that cause lumps or thickening.
The breast is composed of two main types of tissues - glandular tissues and stromal (supporting) tissues. Dr Jaiteh explained that the glandular tissues house the milk-producing glands (lobules) and the ducts (the milk passages) while stromal tissues include fatty and fibrous connective tissues of the breast. The breast, he said, is also made up of lymphatic tissue-immune system tissue that removes cellular fluids and waste.
“There are several types of tumors that may develop within different areas of the breast. Most tumors are the result of benign (non-cancerous) changes within the breast. For example, fibrocystic change is a non-cancerous condition in which women develop cysts (accumulated packets of fluid), fibrosis (formation of scar-like connective tissue), lumpiness, and areas of thickening, tenderness, or breast pain.”
For the types of breast cancers, the oncologist said there are two main types, ductal cancer that affects the ducts; and the lobular cancer. “This distinction is important because their outcome and survival rates are not the same.”
On the stages of breast cancer, Dr Jaiteh mentioned that the stage scan be categorised as early and late diagnosis of breast. “When we talk about early stage cancer that is still within the breast and it may or may not spread to the armpit or the next stage where the cancer cells will grow; so early cancer detention will be a small lump that will not involve the whole breast”.
He went on: “Late diagnosis of breast cancer is having a lump that affects the whole breast or change the color of the breast, and cancer that has moved away from the breast to other parts of the body can affect the lungs, brain etc”.
The consultant highlighted that cancer diagnosis takes the participation of the individual and a health care worker. He emphasised that there is a need for awareness creation as there is what is described as breast self-examination. ”Women can examine their breast by themselves to be able to get used to the normal anatomy so that if anything abnormal appears they can get attention from a health care professional”.
On the other hand, the Dr explained that as health care workers they can also examine the breast to look for signs such as breast lump or thickening (often without pain), change in size, shape or appearance of the breast dimpling, redness, pitting or other changes in the skin, as well as change in nipple appearance or the skin surrounding the nipple (areola) and abnormal or bloody fluid from the nipple.
He went on to recommend a mammogram or mammography - an x-ray of the breast or using a needle and taking a small piece out of that lump and examine it under a microscope. This, he said is the most reliable way to confirm if someone has breast cancer.
On the treatment methods the general surgeon said that, thereare various and most of the time depends on what stage the cancer is,He explained that the early stage of treatmentis limited in some ways.breast cancersurgery is always at the main stage,
He further explained that the surgery can be in two folds, breast conserving surgery meaning when the lump is small it can be operated whiles if the lump is bigger Metastatic can be done removing the entire breast and this is why it is very important to sensitize women to come for early diagnosis.
Chemotherapy is the use of anti-cancer drugs to treat cancerous cells. Specific treatment for the breast cancer will be based on; overall health, medical history, age, type and stage of the cancer, tolerance for specific medications and procedures etc. He underscores that Chemotherapy treatments are often given in cycles; a treatment for a period of time, followed by a recovery period, then another treatment.
“Chemotherapy can be given before surgery to shrink the tumor and sometimes make breast conserving surgery possible rather than a mastectomy. Many times, it is given after surgery and may be given every three weeks or every two weeks in a dose dense”. He noted
Radiotherapy is the same principle with x-rays but is more powerful that is used in order to kill cancer cells and radiotherapy sometimes may not be necessary for example if the breast is remove, one may not need radiotherapy if only the lump is removed.
Hormone therapy is also another option as breast cancer is known to be a hormonedependent and the hormone involve in that is estrogen so hormonetherapy is given to actually reduce the level of hormone.
On the long term treatmentDrJaiteh said chemotherapy is given for six months, radio therapy 3-4 months, some women might be put on hormone therapy for two- five years just to make sure the cancer does not come back
“Once treatment is done we tend to Follow up onwomen on regular basis for further investigations and to also avoid reoccurrence”. He noted
According to DrJaiteh, genetics plays an important part in breast cancer as there are certain genes that exposes the individual and make you likely to get breast cancer and also the notion of the family history, in some families if the mum has breast cancer the daughter should be a bit worry and should examine herself constantly to be able to detect cancer if there is any at an early stage. Certain inherited high penetrance gene mutations greatly increase breast cancer risk, the most dominant being mutations in the genes BRCA1, BRCA2 and PALB-2. Women found to have mutations in these major genes may consider risk reduction strategies such as surgical removal of both breasts.
“On child birth and Breastcancer he said breast cancer does not affect child birth but the issue comes during treatment because some of the modalities used (chemotherapy radiotherapy) are very toxic in the sense that they tend to affects the body and the womb.”
He said the chances of survival depends on how early it is detected and in early stage breast cancer for every 100 women 95%of them can survive it for 5 years. He revealed that breast Cancer is more common in younger women and according to the medical literature women 65-60 years of age are very vulnerable
He concluded by urging women to go by healthy lifestyle, regular physical exercises to boast the immunesystem, healthy eating habits (fruits and vegetables) avoid heavy weightor obesity as it can make women vulnerable to breastcancer. Today there are so many approaches, which can be made for the treatment of the cancer of breast such as surgery, radiation therapy chemotherapy, hormonal therapy and recently nanotechnology and gene therapy. With advances in screening, diagnosis, and treatment, the death rate for breast cancer can declined and we all have a role to play and together we can make a change
