Dr Eugene Genga: 8 Seconds On Breast Cancer

Dr Eugene Genga: 8 Seconds On Breast Cancer

October is Breast Cancer Awareness Month, which is an annual campaign to increase awareness of the disease. While most people are aware of breast cancer, many forget to take the steps to have a plan to detect the disease in its early stages and encourage others to do the same. We have made a lot of progress but still have a long way to go and need your help!

1.What are the Kenya demographics on cancer?

  • Cancer is the 3rd highest cause of morbidity in Kenya [7% of deaths per year], after infectious diseases and cardiovascular diseases
  • Estimate 39,000 new cases of Cancer each year in Kenya with more than 27,000 deaths per year
  • 60% of Kenyans affected by Cancer are younger than 70 years old
  • Leading Cancers:
    • Women: Breast (34 per 100,000), Cervical (25 per 100,000)
    • Men: Prostate (17 per 100,000), Esophageal (9 per 100,000)
  • 70-80% of cancer cases are diagnosed in late stages
    • Due to: Lack of awareness; —Inadequate diagnostic facilities; —Lack of treatment facilities; High cost of treatment; High poverty Index

2.What is breast cancer?

Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too.

3.What are the risk factors for breast cancer?

A risk factor is anything that affects your chance of getting a disease, such as cancer. Different cancers have different risk factors. But risk factors don’t tell us everything. Having a risk factor, or even several, does not mean that you will get the disease. 

Gender

Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer, but this disease is about 100 times more common among women than men. This is probably because men have less of the female hormones estrogen and progesterone, which can promote breast cancer cell growth

Aging

Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older.

Genetic risk factors

About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene defects (called mutations) inherited from a parent. BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 andBRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. If you have inherited a mutated copy of either gene from a parent, you have a high risk of developing breast cancer during your lifetime. Although in some families with BRCA1 mutations the lifetime risk of breast cancer is as high as 80%, on average this risk seems to be in the range of 55 to 65%. For BRCA2 mutations the risk is lower, around 45%,

Family history of breast cancer

Breast cancer risk is higher among women whose close blood relatives have this disease.Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk. Having 2 first-degree relatives increases her risk about 3-fold.

The exact risk is not known, but women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, less than 15% of women with breast cancer have a family member with this disease. This means that most (over 85%) women who get breast cancer do not have a family history of this disease.

Personal history of breast cancer

A woman with cancer in one breast has an increased risk of developing a new cancer in the other breast or in another part of the same breast. (This is different from a recurrence (return) of the first cancer.) This risk is even higher if breast cancer was diagnosed at a younger age.

Race and ethnicity

Overall, white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer. However, in women under 45 years of age, breast cancer is more common in African- American women. Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer.

Dense breast tissue

Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Someone is said to have dense breast tissue (as seen on a mammogram) when they have more glandular and fibrous tissue and less fatty tissue. Women with dense breasts on mammogram have a risk of breast cancer that is 1.2 to 2 times that of women with average breast density. Dense breast tissue can also make mammograms less accurate.

A number of factors can affect breast density, such as age, menopausal status, certain medications (including menopausal hormone therapy), pregnancy, and genetics.

Menstrual periods

Women who have had more menstrual cycles because they started menstruating early (before age 12) and/or went through menopause later (after age 55) have a slightly higher risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen and progesterone.

Previous chest radiation

Women who, as children or young adults, had radiation therapy to the chest area as treatment for another cancer(such as lymphoma) have a significantly increased risk for breast cancer. This varies with the patient’s age when they had radiation. If chemotherapy was also given, it may have stopped ovarian hormone production for some time, lowering the risk. The risk of developing breast cancer from chest radiation is highest if the radiation was given during adolescence, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk.

Lifestyle-related factors and breast cancer risk

Birth control

Oral contraceptives: Studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them. This risk seems to go back to normal over time once the pills are stopped. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk. When thinking about using oral contraceptives, women should discuss their other risk factors for breast cancer with their health care team.

Depot-medroxyprogesterone acetate (DMPA; Depo-Provera®) is an injectable form of progesterone that is given once every 3 months as birth control. A few studies have looked at the effect of DMPA on breast cancer risk. Women currently using DMPA seem to have an increase in risk, but the risk doesn’t seem to be increased if this drug was used more than 5 years ago.

Breastfeeding

Some studies suggest that breastfeeding may slightly lower breast cancer risk, especially if it is continued for 1½ to 2 years. But this has been a difficult area to study, especially in countries such as the United States, where breastfeeding for this long is uncommon.

One explanation for this possible effect may be that breastfeeding reduces a woman’s total number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or going through early menopause).

Drinking alcohol

The use of alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who consume 1 alcoholic drink a day have a very small increase in risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol. Excessive alcohol consumption is also known to increase the risk of developing several other types of cancer.

Being overweight or obese

Being overweight or obese after menopause increases breast cancer risk. Before menopause your ovaries produce most of your estrogen, and fat tissue produces a small amount of estrogen. After menopause (when the ovaries stop making estrogen), most of a woman’s estrogen comes from fat tissue. Having more fat tissue after menopause can increase your chance of getting breast cancer by raising estrogen levels. Also, women who are overweight tend to have higher blood insulin levels. Higher insulin levels have also been linked to some cancers, including breast cancer.

But the connection between weight and breast cancer risk is complex. For example, the risk appears to be increased for women who gained weight as an adult but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this.

 Physical activity

Evidence is growing that physical activity in the form of exercise reduces breast cancer risk. The main question is how much exercise is needed. In one study from the Women’s Health Initiative, as little as 1.25 to 2.5 hours per week of brisk walking reduced a woman’s risk by 18%. Walking 10 hours a week reduced the risk a little more.

Tobacco smoke

For a long time, studies found no link between cigarette smoking and breast cancer. In recent years though, more studies have found that long-term heavy smoking is linked to a higher risk of breast cancer. Some studies have found that the risk is highest in certain groups, such as women who started smoking before they had their first child. The 2014 US Surgeon General’s report on smoking concluded that there is “suggestive but not sufficient” evidence that smoking increases the risk of breast cancer.

An active focus of research is whether secondhand smoke increases the risk of breast cancer. Both mainstream and secondhand smoke contain chemicals that, in high concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast tissue and are found in breast milk.

4.Can breast cancer be found early?

Screening refers to tests and exams used to find a disease, like cancer, in people who do not have any symptoms. The goal of screening exams, such as mammograms, is to find cancers before they start to cause symptoms. Breast cancers that are found because they can be felt tend to be larger and are more likely to have already spread beyond the breast. But screening exams can often find breast cancers when they are small and still confined to the breast.

The mammogram is the main test recommended by the American Cancer Society to find breast cancer early. The American Cancer Society also recommends breast MRI for women who are at high risk of breast cancer because of certain factors

5.Signs and symptoms of breast cancer

The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new breast mass or 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
  • 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 tissue is large enough to be felt. Swollen lymph nodes should also be reported to your doctor.

Although any of these symptoms can be caused by things other than breast cancer, if you have them, they should be reported to your doctor so that he or she can find the cause.

6.General types of treatment for breast cancer

The main types of treatment for breast cancer are:

 7.Can breast cancer be prevented?

There is no sure way to prevent breast cancer. But there are things you can do that might lower your risk such as changing risk factors that are under your control. (See the section “What are the risk factors for breast cancer?“)

 

For example, body weightphysical activity, and diet have all been linked to breast cancer, so these might be areas where you can take action.

 

If you have a strong family history of breast cancer, you can talk to your doctor about genetic testing for mutations in genes that increase the risk of breast cancer, such as the BRCA genesIf you have such as mutation or come from a family with a mutation but haven’t been tested, you could consider surgery to lower your risk of cancer.

 

Breast Cancer Prevention and Early Detection has more detailed information about ways to lower your risk of breast cancer.

A monthly self-breast exam will also be useful for active screening and early diagnosis of the disease

8.How Should A Breast Self-Exam Be Performed?

1) In the Shower 

Using the pads of your fingers, move around your entire breast in a circular pattern moving from the outside to the center, checking the entire breast and armpit area. Check both breasts each month feeling for any lump, thickening, or hardened knot. Notice any changes and get lumps evaluated by your healthcare provider.

2) In Front of a Mirror 

Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead.

Look for any changes in the contour, any swelling, or dimpling of the skin, or changes in the nipples. Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match—few women’s breasts do, so look for any dimpling, puckering, or changes, particularly on one side.

3) Lying Down

When lying down, the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit.

Use light, medium, and firm pressure. Squeeze the nipple; check for discharge and lumps. Repeat these steps for your left breast.

References

  1. American Cancer society
  2. Kenya cancer statistics & national strategies

Dr Eugene Kalman Genga

Consultant physician/ lecturer

University of Nairobi/ Kenyatta National Hospital/ Nairobi Arthritis Clinic

For more information and queries concerning health please contact me via email at eugenekalman@gmail.com

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