Breast Cancer —early detection saves lives
Cancer is a group of diseases that cause cells in the body to change and grow out of control. Most types of cancer cells eventually form a lump or mass called a tumour and are named after the part of the body where the tumour originates.
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The five most common cancers worldwide are lung, breast, bowel, prostate and stomach cancer.
The top cancer in women worldwide is breast cancer, which is increasing particularly in developing countries where the majority of cases are diagnosed in late stages.
Breast cancer begins in the breast tissue that is made up of glands for milk production, called lobules, and the ducts that connect the lobules to the nipple. The remainder of the breast is made up of fatty, connective and lymphatic tissues.
Breast cancer typically produces no symptoms when the tumour is small and is most easily cured at this stage.
When breast cancer has grown to a size that can be felt, the most common physical sign is a painless lump.
Sometimes breast cancer can spread to the underarm lymph nodes and cause a lump or swelling, even before the original breast tumour is large enough to be felt.
Less common signs and symptoms include breast pain or heaviness; persistent changes to the breast, such as swelling, thickening, or redness of the breast’s skin; and nipple abnormalities such as spontaneous discharge (especially if bloody), erosion, inversion, or tenderness.
Pain or lack of pain, It is worthy of note, does not indicate the presence or the absence of breast cancer; hence, any persistent abnormality in the breast should be evaluated by a physician as soon as possible.
Breast cancer survival rates vary greatly worldwide, ranging from 80% or over in North America, Sweden and Japan to around 60% in middle-income countries and below 40% in low-income countries (Coleman et al., 2008).
The low survival rates in less developed countries can be explained mainly by the lack of early detection programmes, resulting in a high proportion of women presenting with late-stage disease, as well as by the lack of adequate diagnosis and treatment facilities.
Reproductive factors associated with prolonged exposure to endogenous estrogens, such as early menarche, late menopause and late age at first childbirth are also known to be the most important risk factors for breast cancer, while exogenous hormones are also said to exert a higher risk for breast cancer, with oral contraceptive and hormone replacement therapy users being at a higher risk than non-users.
The differences in breast cancer incidence between developed and developing countries can partly be explained by dietary effects combined with later first childbirth, lower parity, and shorter breastfeeding.
The increasing adoption of western life-style in low- and middle-income countries has also been identified as an important determinant in the increase of breast cancer incidence in these countries.
According to the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, one-third of these cancer deaths could be decreased if detected and treated early, meaning that about 400,000 lives could be saved globally, every year.
Thus increasing public awareness on the breast cancer problem and the mechanisms to control it as well as advocating for appropriate policies and programmes are key strategies of control.
In other words, there is the need for education to help people recognize early signs of cancer and seek prompt medical attention for symptoms as well as screening programs to identify early cancer or pre-cancer before the signs begin to show.
With awareness comes prevention, reduction of risk factors as well as effective integrated prevention of non-communicable diseases which promotes healthy diet, physical activity and control of alcohol intake.
According to the World Cancer Research Fund International (WCRFI), under its Continuous Update Project, (CUP) about a third of the most common cancers can be prevented through a nutritious diet, maintaining a healthy weight, and taking regular physical activity.
Adequate legislation is also said to be essential in reducing exposure and risk behaviours, taking the example of the first international treaty sponsored by the World Health Organization (WHO)— the Framework Convention on Tobacco Control— which, through taxes, advertising restrictions and other regulations and measures to control and discourage the use of tobacco, has contributed significantly to reducing tobacco consumption.
Early detection to improve breast cancer outcome and survival, however, remains key to breast cancer control, even though risk reduction could be achieved with prevention.
The two known methods of early detection methods are early diagnosis or awareness of early signs and symptoms in symptomatic populations, and screening, which is the systematic application of a screening test in a presumably asymptomatic population.
There are three methods of screening, namely Mammography screening, Breast Self-Examination (BSE) and Clinical Breast Examination (CBE).
Although mammography screening is the only screening method that has proven to be effective, with evidence that organized population-based mammography screening programmes can reduce breast cancer mortality by around 20% in the screened group versus the unscreened group across all age groups, there appears, in general, to be a narrow balance of the benefits, compared with the harms associated with it, particularly in younger and older women.
In other words, there is uncertainty about the magnitude of the harms – particularly overdiagnosis and overtreatment, while it is very complex and resource-intensive and no research of its effectiveness has been conducted in low resource settings.
The practice of BSE has, however, been seen to empower women, taking responsibility for their own health, and, is, therefore, recommend for raising awareness among women at risk rather than as a screening method.
On the other hand, research is underway to evaluate CBE as a low-cost approach to breast cancer screening that can work in less affluent countries, with promising preliminary results showing that the age-standardized incidence rate for advanced-stage breast cancer is lower in the screened group compared to the unscreened group.
The experts, therefore, recommend that yearly mammograms and clinical breast exams be undertaken by women aged 40 years, clinical breast exams every 3 years by women aged 20 to 30 years and annual self examinations for unexpected growth/lumps by women aged 20 years.
The experts also recommend that women follow recommended screening guidelines for detecting breast cancer at an early stage.
The writer is an officer of the Information Services Department.
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