Breast cancers: All answers


Dr Asif Channer

THE world celebrates October as breast cancer awareness month throughout the world every year. In 1990’s “Pink Ribbon” was introduced globally as symbol of breast cancer to express solidarity with patients and to draw attention towards its gravity. Mankind has very long history of breast cancer. The disease was footnoted more than 3,500 years ago by the ancient Egyptians…Breast is made up of three main parts which are lobules, ducts, and connective tissue. The lobules produce milk, ducts are tubes that carry milk to the nipple. The connective tissue consisting of fibrous and fatty tissue which holds everything together. There are different types of breast cancers. The most common breast cancers include Ductal carcinoma, Lobular carcinoma, Paget’s disease, Ductal carcinoma in situ (DCIS), Mucinous, medullary, inflammatory breast cancers. It can spread outside the breast through blood and lymph vessels. Breast cancer can develop both in women and men but it is more common in women. It is the second largest cause of deaths in women on the globe followed by the lung cancer.
The most common symptoms of breast cancer is painless hard mass with irregular margins but sometimes breast cancers are round, tender, soft, Puffiness of all or part of breast, dimpling of skin looking like an orange peel, pain in the nipple or breast, red, flaking or thickened breast skin, nipple retraction nipple discharge, swollen lymph nodes sometimes a breast cancer appear in armpits or around the collar bone even before this tumour in the breast is large enough to be observable. The exact cause of the breast cancer is not known however certain risk factors are associated to its development like being a female is the main risk, other include, increasing age, failure to get pregnant, family history of breast, fallopian tube, ovaries or peritoneal cancer, history of breast cancer in one breast, radiation exposure, female who have mutated BRCA1 and BRCA2 genes responsible for cancer, obesity, starting of monthly period at a younger age, menopause in relatively older age, first child in older age, Drinking alcohol and cigarette smoking. The commonly used diagnostic Imaging tests are Mammography, a type of X-ray most helpful in breast cancer screening, Magnetic Resonance Imaging(MRI) and Ultrasound scans. Biopsy is another diagnostic test which is used. Some breast tissue is removed and examined in biopsy. It describes cancerous and non-cancerous nature of the cells. Diagnosis of breast cancer also helps in determining the size, spread and aggressiveness like invasive or non-invasive of the cancer. Multiple dimensions are considered while devising a treatment plan for cancer treatment like age, overall health of patient, type, stage, grade of cancer, other medical conditions, socioeconomic status, preferences of the patient and availability of the various therapeutic facilities in the region,
Currently different treatment options are available which includes Radiation therapy, Chemotherapy, Hormone therapy, targeted drug therapy, and Surgery. Surgery includes Lumpectomy which involves removing the tumour and a small amount of healthy tissue around it. Mastectomy is the other surgical intervention which involves removing the lobules, ducts, fatty tissue, nipple, areola, and some portion of skin. Sometimes removal of lymph nodes and muscles in the chest is carried out. Breast Reconstruction and Cosmetic surgery can be performed following mastectomy procedure to reconstruct the breast to give it a natural look to overcome the psychological impacts. Breast cancer is prevalent both in developed and developing countries. Every year about 2 million new cases and 500000 deaths have been reporting globally and 39% are from Asia with peak incidence between 40 and 59?years of age.
Amazingly, developing countries such as Asia, Africa and Central America have low incidence rates but with high mortality rates due to less resources, poor access to cancer screening programs, lack of awareness about the disease, fear of surgery, chemotherapy, cultural, social taboos and using other traditional non-scientific treatments. Whereas developed Western Europe and North America, have high incidence but low mortality rates due early diagnosis and treatment, Unfortunately in Asia Pakistan is at the top regarding cases of breast cancer. 1 in 9 Pakistani women at some stage of lifespan may develop breast cancer. According to the World Health Organization (WHO) about 100000new cases and 17,000 to 40,000 female deaths are being recorded in the country every year. Remarkably, black women have lower prevalence of breast cancer compared to white women side by side black women develop it at a much younger age and it is an aggressive type/In the 21st century the top ten counties with high cases of breast cancer in the world in a chronological order are Belgium, Luxembourg, Netherlands, France, Lebanon, Australia, UK, Italy, New Zealand and Ireland. Always remember that all lumps and swellings in the breasts are not cancers however, if there is a single or even small size lump noticed it must be immediately evaluated by health professional without any social stigma, shame or fear, for early diagnosis, treatment and for better outcome.
Breast cancer risk can be reduced by regular exercise, healthy diet containing abundantly fresh vegetables, fruit, nuts, keeping a healthy body mass index (BMI), restraining postmenopausal hormone therapy, avoiding excessive alcohol intake( habit less common in Muslim world) and cigarette smoking. In this era of information technology various modern awareness tools are available like The Breast Cancer Health line Apps etc. connecting to online breast cancer communities thus gaining support and advice through group discussions. Federal and Provincial Governments should make necessary arrangement for free screening services like Mammography at all tertiary care hospitals. The simplest technique of Breast self-examination (BSE) to check one-self monthly be taught to Pakistani women especially living in rural areas. Establishment of modern state of the art advanced breast cancer care hospitals, at least one at each provincial level are inevitable with the dedicated female health care staff and professionals to overcome the religio-socio-cultural barriers being faced by women in Pakistan for effective diagnostic and therapeutic plans. Pakistan having 50% female population needs mass awareness campaigns to be launched in all girls’ schools, colleges. Women universities, medical colleges, professional institutions, Deena Madras through women parliamentarian and prominent celebrities to beat the breast cancer in the best interest of their gender and nation.
—The writer is freelancer.

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