Spread the message of ‘We can. I can’ to fight the most common cancer
Breast cancer is the most common cancer in the women worldwide including the UAE, where it accounts for 40 per cent of all cancers among women. In the UAE, cancer is the second common cause of female death. Approximately 20 per cent of all female deaths in the year 2014 were due to breast cancer.
The Centre for Arabic Genomic studies (2010) reported that Arab women are more likely to have breast cancer at a much earlier age —10 years earlier — than their western counterparts and is the same for Asian women too. Cancers at younger age are generally more aggressive, less likely to have a sustained response to treatment protocols. Any woman can be affected, regardless of their age, race, reproductive history, family history and hence screening of all women as per screening guidelines is very important to detect cancer at early stages for better cure and survival.
More than 65 per cent of women in the UAE with breast cancer are diagnosed at a later stage. Possible reasons for the delay are lower education, low socioeconomic status, lack of knowledge and awareness, cultural belief and lack of insurance covering screening programmes.
The major risk factors for breast cancer includes hormonal influences like early menarche (first period), late menopause, being childless, late first child birth, exogenous hormone intake, history of cancer in first and second degree relatives, history of benign breast diseases and previous breast biopsy. The modifiable risk factors include alcoholism, obesity and less physical activity. Women with breast cancer may present with the following warning signs like a new lump in the breast or armpit; any changes in the skin over the breast like redness, dimpling, ulcer, nodule; pulling in of nipple and blood like nipple discharge or swelling and redness of entire breast.
Prevention is always better than cure and we can achieve that by controlling modifiable risk factors like avoiding obesity by regular or daily 60 minutes of physical activity, reducing alcohol intake, avoiding hormone replacements and healthy dietary habits rich antioxidants and fibres. Early diagnosis and treatment is the key for better cure, prognosis and survival. To achieve this, women and men should be educated about breast cancer awareness after the age of 25 and routine screening programmes after age 40, which includes monthly self breast examination, half yearly clinical breast examination and mammograms in one to two yearly intervals.
Screening mammograms have reported a reduction in breast cancer related death rate by 15 to 25 per cent in screened populations compared to unscreened populations. Screening mammogram is an outpatient procedure of taking two X-rays of breasts; it hardly takes 10 to 15 minutes and one can get the reports immediately in institutes where it is done routinely. The radiation exposure has been equated scientifically to a normal person living in USA exposed to just seven weeks of his or her yearly cosmic back ground radiation.
The treatment of breast cancer depends on patient age, performance status, grade, stage, hormone receptor status and molecular subtypes of cancer. The available modalities of treatment include surgery, chemotherapy, radiotherapy, hormone therapy and molecular targets. Surgical treatment includes mastectomy (removal of entire breast), breast conservation surgery (only tumour with margins) with immediate or late reconstruction, complete axillary dissection and sentinel lymph node biopsy depending on the local extent of cancer. Chemotherapy consists of injecting drugs in to veins to kill the cancer cells at primary site as well as those spread all over the body. Radiotherapy helps in killing cancer cells by radiating over the local tumour site using machines. Hormone therapy mostly includes tablets or injections to block excess hormonal effects on cancer. Molecular targets and immunotherapy are latest modalities showing promising tumour control and survival in advanced cases.
More than screening, investigations and treatment options, cancer patients need financial, psychosocial and rehabilitation support. We have to unite to spread the awareness of breast cancer and reduce the global cancer burden by raising the slogan “We can. I can” — the World Cancer Day theme for 2016-18.