What Every Woman Should Know About Breast Cancer

What is breast cancer?

Breast cancer is a disease in which the cells in the breast grow uncontrollably. It is a major cause of death among women globally. It is estimated that by 2025, over a 19.43million women (with the majority from Sub-Saharan Africa) will be suffering from breast cancer.

Currently, it is the most common cancer in the world with an incidence of 38.3 per 100,000, and is associated with the highest mortality rate compared to other cancers.

Source: https://gco.iarc.fr/today (December, 2020)

Overall, breast cancer is the most common cancer in both sexes and in females only, and the leading cause of cancer deaths in Ghana. 

Source: https://gco.iarc.fr/today/data/factsheets/populations/288-ghana-fact-sheets.pdf ( December, 2020)

In 2020, an estimated 247,611 new breast cancer cases occurred in West Africa, with 164,930 deaths recorded. The main challenges facing the management of breast cancer cases in West Africa are late-stage disease presentation, lack of screening and therapeutic infrastructure, lack of awareness and limited resources.

The five-year survival rate of breast cancer in Sub Saharan Africa is less than 40% compared with countries like the US, with survival rates of 86%.

What are the early warning signs and symptoms of breast cancer?

It is important to remember that having in mind the early warning signs and symptoms of breast cancer does not replace the need to see your doctor to have certain examinations or investigations carried out.

It is also very important to see your doctor when you detect any of the following early signs and symptoms because early detection and diagnosis of breast cancer has been shown to be effective in fighting the disease:

1. Painless lump: You may begin to feel a lump which was not previously in your breast or armpit. You must also know that it is not every lump you feel in your breast/armpit that signifies a developing breast cancer. Always seek the help of a qualified health professional.
2. Soreness of nipple: Your nipple may become sore and painful.
3. Dimpling of the skin of the breast: Sometimes the skin of your breast may look like an
   orange peel (also termed “peau d’orange”). This may be due to other breast conditions but it is prudent to contact your doctor when you see these signs.
4. Change in size, shape, and feel of the breast. 
5. Redness of the breast. The breast tissue may become inflamed and this makes the skin surrounding the breast look reddish and sore-like (painful). 
6. Thickening in the breast.
7. Nipple retraction: You may observe that the nipple of an affected breast will be turned inwards.
8. Nipple discharge: There may be a discharge other than breast milk from the nipple(s).

What are the risk factors of breast cancer?

Risk factors are things that increase your chance of developing a disease. It is therefore important to understand that having any of the risk factors stated below does not necessarily mean you have developed breast cancer, or will develop one. It only means your chances are higher:

1. Female gender: Men can develop breast cancer, but the occurrence is about 100 times more
   common in women.
2. Genetic disposition (Family history or mutations in certain genes): A woman’s risk of developing breast cancer doubles if she has a first-degree relative (parent, child, or sibling) who has breast cancer. Women with mutations in the BRCA1 or BRCA 2 gene are at a higher risk.
3. Personal history: Having breast cancer in one breast increases the chance of cancer in the other breast or additional cancer in the original breast.
4. Early menarche/late menopause: Having your first menstrual period early, and late menopause is known to increase chances of breast cancer. This is because one is exposed to the hormone estrogen for a much longer period.
5. Age: Chances of breast cancer increases as one gets older.
6. Use of oral contraceptives: using oral contraceptives does not increase your chances of breast cancer overnight. However, exposure to these contraceptives for a period of about
   10years will increase your risk of breast cancer.
7. Having fewer or no children
8. Obesity
9. Alcohol

What are some common myths or wrong beliefs about breast cancer in women?

In the care or treatment of any disease condition, the health beliefs/myths of the society are important factors to consider, and where appropriate, myths demystified. The following are some popular myths about the causes of breast cancer in women that have not been scientifically proven:

1. Putting money under the bra
2. Breastfeeding for a long time
3. Scratching the breast
4. Prolonged fondling of the breast by a man
5. When a child bites the mother during breastfeeding
6. Large breasts
7. Small breasts
8. Guinea worm infection

What should you note about the diagnosis of breast cancer?

If one feels/suspects he or she has breast cancer, the person should see a doctor. The fact that you experience some, or all, of the symptoms stated above does not necessarily mean you have breast cancer.

Your doctor will carefully examine your breasts and lymph nodes and ask if you have a family history of breast cancer. If there is a suspicion of breast cancer, your doctor may order for further laboratory investigation.

A final test your doctor will arrange for in order to confirm your diagnosis may be a tumour biopsy.

If breast cancer is confirmed, hope is not lost. You will be taken care of by a team of specialists at a centre/facility/unit dedicated to managing breast cancer cases.

What treatment options are available for breast cancer?

There are a number of treatment modalities that can be employed to slow down the progression of the cancer, if not to totally remove the growth by surgery. Your medical doctor and/or pharmacist will discuss with you the various options available.

Your treatment option will, however, depend on how far advanced your cancer is, the type
of cancer you have, and a risk assessment.

DO NOT resort to taking unproven medicines with the hope of ‘curing’ your cancer without the knowledge of your physician and/or pharmacist. Treatment options currently available include:

1. Surgery: Part or all of your breast tissue may be removed, depending on the extent of spread of the cancer.
2. Radiotherapy: this option takes advantage of the ability of ionising radiations to damage DNA of cancerous cells. Sometimes, the team managing your case may recommend radiotherapy after the surgery.
3. Chemotherapy: this involves the use of chemical drug therapy to destroy rapidly growing cells and hence to stop the progression of the cancer. Some of the medicines used as part of chemotherapy include cyclophosphamide, doxorubicin and fluorouracil.
4. Endocrine therapies: these are aimed at reducing the effect of the hormone oestrogen in certain types of breast cancer. Some of the medicines used to achieve this include tamoxifen, anastrozole, and exemestane.
5. Biological therapies: this approach involves the use of the body’s immune system to kill cancer cells. Examples of drugs in this class include trastuzumab, bevacizumab and atezolizumab.

Potential side effects of any of the above treatment modality will be discussed with you before commencement. You may be given some ‘everyday’ medicines like metoclopramide to counteract the side effect of nausea and vomiting as a result of certain medicines for your cancer.

Take-home message

• In the fight against Breast cancer, and any other form of cancer or ailment, early detection/diagnosis has proven to be a major key.
• You may get emotionally overwhelmed with news of your diagnosis. Speak to a Doctor, Nurse, Pharmacist or Psychologist about your feelings. Breast cancer is not a death sentence.

References:

1. Ikhuoria E.B and Bach C. Introduction to Breast Carcinogenesis Symptoms, Risks Factors, Treatment and Management. European Journal of Engineering Research and Science Vol. 3, No. 7, July 2018. Pg 1-10.
2. ESMO Patient Guide Series based on the ESMO Clinical Practice Guidelines (esmo.org). 2018. Page 1-24, 59.
3. Sayed S et al. Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya. BMC Public Health (2019) 19:180. https://doi.org/10.1186/s12889-019-6464- 3
4. Cumber SN et al. Breast cancer among women in sub-Saharan Africa: prevalence and a situational analysis. Southern African Journal of Gynaecological Oncology 2017; 9(2):35–37 https://doi.org/10.1080/20742835.2017.1391467
5. https://www.cancer.org/cancer/breast-cancer/about/breast -cancer-signs-and- symptoms.html
6. https://www.academic.oupcom/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdaa099/5869901?redirectedFrom=fulltext 
7. International Agency for Research on Cancer (2020), https://gco.iarc.fr/today/data/factsheets/populations/914-western-africa-fact-sheets.pdf. [Accessed on: 7/03/2021] 
8. International Agency for Research on Cancer (2020), https://gco.iarc.fr/today/data/factsheets/populations/288-ghana-fact-sheets.pdf. [Accessed on: 7/03/2021]