A month of Breast Cancer Awareness
Pinktober: A month of Breast Cancer Awareness
On a beautiful Saturday morning, 35-year-old Nina was busy looking after her one year old son. She had been so busy for the past few months that she hadn’t had any time for herself. While in the shower on this particular morning, Nina felt that there was slight thickening of the skin on the upper, outer part of her right breast. On Monday morning she went to her doctor, who organised an ultrasound scan and breast mammogram. There was some concern regarding the possibility of cancer and she was referred to the hospital where a biopsy was done. The biopsy proved that she did have breast cancer and required further scans and tests. She was diagnosed with Stage 1 breast cancer. Nina had surgery – a mastectomy (removal of the breast). Because radiation therapy is not available in Fiji, the option of lumpectomy (removing only the lump in the breast) together with radiotherapy was not an option. Nina did well after the surgery and continued with her usual activities. When 45-year-old Manju woke up at dawn on a rainy Monday morning she noticed a bloodstained discharge on her bra. She also had a pain in her left breast and could feel a lump. She was shocked; this was the first time something like this had happened to her. Manju had a real fear of doctors and the hospital because her mother had died of breast cancer. So Manju didn’t go to see a doctor, she was in denial that anything was really wrong. It wasn’t until she developed a rapidly growing mass over her breast that she went to the doctor and was sent to hospital. By this stage Manju’s cancer had spread from the breast tissue to the surrounding lymph nodes. The surgeon performed a mastectomy and removed the lymph nodes. Manju survived for a year but her cancer spread to her liver and lungs and she passed away. In a nearby village lived Mereoni, aged 60. For the past six months she had been feeling more tired, losing weight and had a lump on her right breast. Mereoni had been using some traditional medicine to relieve her pain. She did not believe in modern medicine and refused to see a doctor. Within four weeks she became more short of breath, had abdominal swelling and passed away. It appeared that she died of metastatic breast cancer, cancer that had spread to other organs. These sort of cases are not uncommon when it comes to awareness and management of breast cancer in the developing world. The American Cancer Society and the pharmaceutical company Astrazeneca founded Breast Cancer Awareness Month in 1985. Its campaign pink ribbon is synonymous with October and many people refer to the month as “Pinktober.” The activities of the month help to increase attention and support for the awareness, early detection and treatment as well as palliative care of this disease. There are about 1.38 million new cases and 458 000 deaths from breast cancer each year (IARC Globocan, 2008). Breast cancer is by far the most common cancer in women worldwide, both in developed and developing countries. In low- and middle-income countries the incidence has been rising up steadily in the past few years due to increased life expectancy, increased urbanisation and adoption of western lifestyles. (World Health Organization) Currently there is not sufficient knowledge on the causes of breast cancer. Early detection of the disease remains the cornerstone of breast cancer control. When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance that breast cancer can be cured. If detected late, however, curative treatment is often no longer an option. In such cases, palliative care to relief the suffering of patients and their families is needed. The majority of deaths (269 000) occur in low- and middleincome countries, where most women with breast cancer are diagnosed in late stages due mainly to lack of awareness on early detection and barriers to health services. According to the latest World Health Organization data published in May 2014, Breast Cancer Deaths in Fiji reached 114 or 2.13%of total deaths. The age adjusted Death Rate is 31.38 per 100,000 of population. Fiji ranks number two in the world with regard to death rate from breast cancer. The World Health Organization (WHO) promoted early detection strategies for low- and middle-income countries are awareness of early signs and symptoms and screening by clinical breast examination. Mammography screening is costly and is feasible only in countries with good health infrastructure that can afford a long-term program. So what advice can we give women in developing countries? Well, if we can minimise the factors that increase our risk of developing breast cancer then we may have some hope. These risks include obesity, lack of physical activity, drinking more than one standard drink of alcohol daily, hormone replacement therapy during menopause, early age of first menstruation, not having any children or having children late in life. Breastfeeding may reduce the risk of breast cancer slightly. Although some risks might be reduced by prevention strategies, such as more exercise and losing weight, they can’t stop the majority of breast cancers in low- and middleincome countries. So finding out as early as possible is the most important way to improve the chances of controlling and surviving breast cancer. (Anderson et al., 2008). There are two ways to detect cancer in the early stages: diagnosis or awareness of early signs in symptomatic
populations, people most at risk, so they can get early treatment, and screening, which is the systematic application of a test in groups of people considered to be most at risk. The test aims to identify individuals with an abnormality that suggests it could be cancer. It is important that women are aware of the symptoms and signs of breast cancer. The most common symptom is a new lump. A painless, hard mass that has irregular edges is more likely to be cancer, but breast cancers can also be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new breast mass, lump, or breast change checked by a health care professional experienced in diagnosing breast diseases. Other possible symptoms of breast cancer include: Swelling of all or part of a breast (even if no distinct lump is felt) Skin irritation or dimpling (sometimes looking like an orange peel) Breast or nipple pain Nipple retraction (turning inward) Redness, scaliness, or thickening of the nipple or breast skin Nipple discharge (other than breast milk) Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast is large enough to be felt. Swollen lymph nodes should also be checked by a health care provider. Although any of these symptoms can be caused by things other than breast cancer, if you have them, they should be reported to a health care professional so that the cause can be found. With regard to screening tests, many developed countries such as Australia offer routine screening mammograms for women aged 50 and over every two years to pick up any early changes in the breasts. This is not feasible in developing countries due to the cost. However women who can afford to pay for a mammogram can have mammograms every two years after the age of 50. Self breast examination monthly by the women herself can make the woman more aware of her breasts and if there are any concerns, then a health care provider should be consulted. Clinical breast examination by a health care provider every year after the age of 20 can also act as a screening test. It is important to note however, that this may pick up more advanced stage cancers as opposed to early breast cancer. Women who have a strong family history of breast cancer may need to be screened more often. This October truly understand what the pink ribbon signifies. Pink is only a colour and cure is an illusion. We desperately need more research to turn breast cancer into a manageable disease for all women, not just some. To this day about 30% of all breast cancer patients will go on to develop incurable disease. So to all you breast cancer survivors- tell your story and celebrate strength and survival. To those women who have succumbed to breast cancer, it is a time to honour them. Beautiful words by Jim Valvano: “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.”
“Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.”
DR. KRUPALI RATHOD TAPPOO is an Australian qualified General Practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical Coordinator for Fiji-based NGO Sai Prema Foundation. Dr. Krupali is based at Mitchells Clinic in Tappoocity Suva and has a special interest in women and children’s health.