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In my earlier writings on breast cancer, I had discussed what every woman above 25years should do about her breast. I had said that no woman worth her life should leave off examining her breasts at least once a month or as she ages once a week. I had graphically explained how to examine each breast and position to take. I had said that during any of the examinations, if any lump is found, the person should consult a Gynaecologist straight away. I had warned that it was better to err on the side of the caution.
I am very emotionally concerned when it involves women. Apart from my mother (deceased), my wife and my daughter. I have eleven (11) sisters. While we are yet to prevent breast cancer as a threat to our health this is an exciting time for patients their families and health care professionals dealing with breast cancer. Before I go on let me state the following health facts.
Cancer of the breast is the most common cancer in women. After lung cancer it is the second most common cause of cancer death in women. In Nigeria it is estimated that 212,030 new cases of cancer of the breast and 40,870 deaths are witnessed yearly.
At the present rate of incidence a woman’s risk of developing invasive breast cancer in her lifetime from birth to death is 1 in 8. This figure is from the surveillance Epidemiology, and End results program (SEER).
Although a woman’s lifetime risk of developing breast cancer is 1 in 8, it must be emphasised that she still has a 7 in 8 chance of never developing breast cancer.
Women whose mothers or sisters had breast cancer are more likely to develop the disease than controls. The presence of an inherited genetic mutation in the BRACA 1 & BRACA 2 genes, which accounts for approximately 5% of all breast cancers also places women at increased risk of being diagnosed with breast cancer.
Risk is increased when breast cancer has occurred before menopause, was bilateral or was present in two or more, first degree relatives such as mother and sister.
However there is no history of breast cancer among female relatives in more than 90% of patients with newly diagnosed breast cancer.
Late menarche and artificial menopause are associated with a lower incidence of breast cancer whereas early menarche (before age 12 years) and late natural menopause (after age 50 years) are associated with a slight increase in risk of developing breast cancer.
Usually breast pain without a lump is not a sign of breast cancer, although about 10 percent of women who have this cancer have pain without a lump. At first a woman who has breast cancer usually has no symptoms. Most commonly, the first symptom is a lump which usually feels distinctly different from the surrounding breast tissue.
In more than 80 percent of breast cancer cases the woman discovers the lump herself. Scattered, lumpy changes in the breast especially the upper outer region usually aren’t cancerous. A firmer distinctive thickening that appears in one breast but not in the other may be a sign of cance.
In the early stages a lump may move freely beneath the skin when it is pushed with the fingers. In more advanced stages, the lump usually adhere to the chest wall or the skin over it. In these cases, the lump can’t be moved at all or it can’t be moved separately from the skin over it.
In advanced cancer, swollen bumps or festering sores may develop on the skin. Sometimes the skin over the lump is dimpled and leathery and looks like the skin of an orange except for the colour.
In inflammatory breast cancer, a particularly serious but uncommon type of cancer the breast looks as if it is infected. It is warm, red and swollen. Often no lump can be felt in the breast.
The following symptoms do not necessary mean that a woman has breast cancer however if a woman has them, she should consult her doctor these include.
A lump that feels distinctly different from other breast tissue or that doesn’t go away.
Swelling that doesn’t go away.
Scaly skin around the nipple
Changes in the shape of the breast
Changes in the nipple, such as turning inwards
Discharge from the nipple, especially if bloody.
Over the past decade standards of care for treatment of early stage breast cancer have changed and improved with the introduction of new, novel therapeutics that are more effective and less toxic than the traditional therapeutics they replaced – example Aromatase Inhibitors and Trastuzumba.
In order for these advances to be realised, new therapies in metastatic breast cancer patients provide a stepping stone for gains in the treatment of early – stage- breast cancer as the potential for cure improves.
I decided to treat this topic because most of my patients are killed by fright at the mere mention if cancer or that they could have breast cancer.
Listen attentively please or let me paraphrase read this with all amount of concentration – Breast Cancer is not a Death Sentence.
I feel pained and grieved why my patients die emotionally, when a mere lump is discovered in their breast. Sometimes they vehemently oppose or refuse to examine their breast saying that for them, because of the fear of the unknown, or what might likely be found, that ignorance for them is bliss. What arrant nonsense.
In its early stages breast cancer is highly curable with nearly 100% of patients with localised disease remain alive more than 5 years after and more; after standard new therapy.
One of my patients who religiously followed my advise in Dr Sun since 2003 on regular breast examination, was diagnosed with early breast cancer in 2010. Total mastectomy of the right breast was done. Today 14 years after she is still alive and kicking. She only visits my hospital occasionally where she insists I use my hand to examine the remaining left breast which is still healthy though shrunken in size. Can you beat that.
In later stages of breast cancer when distant metastases are present few patients are disease free, and cure is not a realisable concept but for a few patient.
Therefore the focuses of the new therapy in the metastatic settings are on prolongation of life and management of disease related adverse effects.
Response to therapy is measured DF not only by objective measures of tumour volume. But also by management of symptoms related to the metastases for research purposes note that an objective response is defined as
The shrinkage of tumour volume by 50%
An increase of less than 25% in tumour volume or
No change at all, is considered a stable disease.
Patients who experience prolonged stabilisation of breast cancer for more than 24 weeks have a similar overall survival compared with those patients who achieve an objectives response. Individual patients require an analysis if their entire clinical situation in order to determine whether a therapy is working for them. Always be medically guided.
M
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