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= Awareness of Breast Cancer =

Introduction:
You probably know how Diet affects health and you may be aware as to how a balanced and nutritious diet is important in order to build up resistance and increase immunity levels. Let us learn here what could happen to our bodies if the resistance levels are lowered and immunity drops. Our bodies become more prone to various kinds of diseases. You probably know that Cancer is nowadays considered to be a lifestyle disease like hypertension and several other diseases. Cancer is the second largest killer in the world following cardiac diseases. Despite the research that is being carried out on all over the world, and although 80% who get cancer live for five years or more, yet many lives are lost to this dreadful killer disease. The two types of Cancers which affect women the most are Breast Cancers and Cervical Cancers. We shall restrict our discussion to learn about Breast Cancer. We shall explain the risk factors which are linked to Breast Cancer and what happens when a woman is affected with Breast Cancer. Many Cancers are treatable and can be said to be cured if it is diagnosed in the early stages. The signs and symptoms of Breast Cancer and the various screening techniques which are used to detect Breast Cancer will be listed and will be explained.

Risk Factors which cannot be changed:
We do not know for sure what causes Breast Cancer, but what we do know is that certain risk factors are linked to the disease. A risk factor means anything that can increase the chance of a person getting a disease like Breast Cancer in her entire lifetime. Some risk factors can be controlled or changed, like smoking, but there are some others which cannot be changed or controlled. What you should remember is that simply having a risk factor does not mean that a woman will get the disease. Some women who have one or more risk factors never get the disease, whereas most women who do get Breast Cancer may not display any risk factor. Just being a woman means that you are at risk. The factors listed herein may increase a woman’s chance of getting the disease at some time in their lifetime.

Gender:

Simply being a woman is the main risk. Do men not get Breast Cancer? Men can also get Breast Cancer, but it is a much rarer occurrence for a man. Usually Breast Cancer detected in men is genetic or hereditary in nature. Breast Cancer is quite common in women and the incidence of Breast Cancer is more in the developed countries of America and Europe. The incidence of Breast Cancer in India is on the increase especially in the urban areas. The chance of a woman getting Breast Cancer in her lifetime is 1:8 in U.S.A; 1:10 in Europe; 1:20 in Urban India and 1:60 in rural India. It is termed as a lifestyle disease as it is seen to be increasing in the developed countries with changing styles of diet and lifestyle.

Age:

Breast Cancer increases with age. A woman above 50 years is more prone to get the disease and it is rare in women under 30 years of age. Of late, however it is seen that many younger women are presenting with Breast Cancer. Hence the need for awareness of breast cancer is felt among all age groups.

Genetic Risk factors:

Women with BRCA1 and BRCA2 gene changes have an 80% chance of getting breast cancer during their lifetime. Only about 5 to 10% of breast cancers are linked to (mutations) changes in certain genes. Other genes may also raise the breast cancer risk. It is now possible to test for genetic mutations and preventive methods are available. Those women who are likely to be affected must be advised to take the help of an expert genetic counselor.

Family and personal history:

The Breast Cancer risk is higher for those women whose close blood relatives have had breast cancer. Say an aunt or mother or sister. The relative could be from the father’s side too. Also a woman who has had breast cancer in one breast cancer is at risk of developing it in the other breast or in another part of the same breast if she has had a lumpectomy (removal of only the cancerous lump from the breast). This is different from a recurrence or a metastasis. Therefore women with such a history must be aware of their bodies and undergo regular screening.

Early menarche and/or late menopause:

Those women who started menstruation at an early age, say before the age of 12 years, or those with a late menopause (stopping of the menstrual cycle), say, after the age of 55 years have a slightly higher risk of breast cancer. This is because many types of Breast Cancer are related to and dependant upon hormones. Hormonal changes in the body increase the risk of getting Breast Cancer.

These are some of the risk factors which cannot be changed or controlled. There is no need to be unduly perturbed or worried and anxious if you have any of the above mentioned risk factors. But it is important to be aware of these factors and to go in for regular screening to facilitate early detection in the unfortunate event of being affected with the disease.

Risk Factors that can be changed or controlled:
Cancer, it has been mentioned earlier, is a life style disease. This means that by having a close re-look at our own lifestyle, it can be changed appropriately so as to try to control the risk factors. It is not necessary to be affected with the disease before you wake and look at your own lifestyle. You can very well learn from other’s experience however difficult it may appear. But often it is noted that until a serious jolt is received, we refuse to wake up and keep justifying our lifestyle.

Late age of marriage and late age of child bearing:

Over the last few decades it is seen that the average age at which girls get married is being delayed. This could be due to various factors like completion of education, start of a career etc. Many girls do not even consider getting married and/or bearing children. When a woman does not give birth to children, she also does not get a chance to breast feed her children.It must be borne in mind that as a woman we have certain biological role which must not be ignored. A woman balances many things in her life and is known to be an excellent multi-tasker. Delay in age of marriage and refusal to give birth can lead to many complications which may show up later. Women who have not had children or who have had their first child after the age of 30 years, have a slightly higher risk of breast cancer. Pregnancy more than once at an early age reduces breast cancer risk. Young women must consider all these aspects, as these are related to changes in hormonal behaviour which is directly linked to higher risk of getting Breast Cancer.

Avoidance of Breast feeding:

Some studies have shown that breast feeding slightly lowers breast cancer risk. It is beneficial to breast feed for even a year and a half or two years. This is probably because breast feeding like pregnancy reduces the number of menstrual periods and lowers the risk of Breast Cancer.

High Fat diets and Obesity:

High Fat diets have been linked to several diseases like Heart disease and also several other types of Cancer. Being overweight is linked to a higher risk of breast cancer particularly if the weight is gained in adulthood, after menopause and is around the waist.

Lack of exercise:

Studies have shown that exercise lowers the risk of breast cancer. Little exercise of about one to two hours brisk walking exercise per week has been seen to reduce risk by 18%. It is suggested that you should exercise moderately for 45 to 60 minutes at least 5 days a week.

Consumption of Alcohol:

Consumption of alcoholic drinks has become quite common and this is also known to be a risk factor for breast cancer. Women are advised to limit or restrict the consumption of alcoholic drinks.

Uncertain Risk Factors:
A lot of research is being done to learn how environment is affecting breast cancer. No clear link has been proven between breast cancer risk and environmental pollutants, like pesticides. No direct link has been found between smoking and breast cancer directly but smoking is related to other cancers. There is also no evidence to support that underarm deodorant and under wire bras cause breast cancer. There is no evidence to prove that induced abortions and miscarriages are linked to breast cancer. It is suggested that women who work at night are more prone to get breast cancer but this has not been proven. We do not know exactly what causes Breast Cancer but do know that the incidence of Breast Cancer is rapidly on the rise.

Signs and Symptoms of Breast Cancer:
The first noticeable sign of Breast Cancer is a hard painless lump which can be felt any where within the breast tissue which extends up to the collarbone on top and the armpits on the side. There are usually no other symptoms. As the disease progresses, other symptoms may be discernable.

These can be: a) change in size and shape of the breast b) b) discharge from the nipple, may be blood stained c) nipple drawn inward as if it is being pulled inside, or rash around the nipple or surrounding area d) change in appearance of the skin in a part of the breast which looks wrinkled and puckered like an orange skin e) swelling in the armpit or around the collarbone f) sometimes it can also be a painful lump All lumps are not cancerous however and they may be cysts or benign lumps too.

Why is early detection important?
You may have noticed that most women have a tendency to give less importance to their own health. Also it is quite natural that when there are no bothersome symptoms you will not visit a doctor. Even if you have a simple cold but with bothersome symptoms like a heavy feeling in the head and a running nose or a painful and sore throat, you would visit a doctor to obtain relief, but you would not imagine that something as seemingly negligible as a painless tiny lump could be life threatening. Although the incidence of Breast Cancer in Europe and America is far more, the number of deaths is proportionately less, whereas in a less developed country like India there are far more deaths occurring due to presentation at an advanced stage of the disease in the less developed countries where awareness is poor.

Breast Cancer is also known to be the Best Cancer as it arises in an external organ and can be far more easily treated with surgery, chemotherapy, radiotherapy etc. if detected at an early stage. After the treatment is complete the woman can return to a normal life and is required to go in for regular follow up checks. If the Cancer has already set in, it cannot be wished away. By neglecting or ignoring the lump, there is a greater likelihood that it may spread rapidly, making the treatment more difficult, painful and also reducing the chances of a complete recovery.

Hence early detection is of utmost importance for the simple reason of saving a life and giving a chance of a less painful and less expensive treatment.

How can Breast Cancer be detected?
There are various methods for detection of Breast Cancer. These are enumerated and explained below

Breast Self Examination:

This is the easiest method which involves no cost in detecting the cancer. It can be done systematically by examining one’s own breast with the hand and fingers. Gentle pressure is added by keeping the fingers flat against the breast tissue and a woman tries to feel any lump which was not there before. A visual examination before the mirror to look for any abnormality is also useful. We shall learn soon how to perform a Breast Self Examination

Mammogram:

This is a special kind of x-ray machine. The breast is placed between two plates by standing in front of the machine. There is a slight pressure and mild x-rays can detect a suspicious lump even before it is felt by the hand. This is because the tissue in the lump is denser. Mammograms are used preferably after the age of 50 years. Only if a woman is at risk or there is a suspicious lump she will be asked to undergo a mammogram. In some countries, women are regularly screened once in a year or once in two years after the age of 40 years. There is an ongoing debate whether mammogram screening should be done after 40 years or 50 years. Since Breast Cancer is being detected in many women under the age of 50 years, it is felt that it may be beneficial to begin screening after the age of 40 years. Mammograms are not useful in cases of younger women as the breast tissue is quite dense and the lump may not show up. In older women the breasts are less dense and hence mammograms are very useful in early detection. Mammograms are quite expensive and a digital mammogram may cost about 600 to 800 Rupees. India does not have a national screening policy; however, several hospitals and Cancer Support Organizations organize free screening in the month of October, which is known as Pink October all over the world to create awareness of Breast Cancer. You may advise all women whom you know to get a mammogram screening done once in every 2 years and avail of the benefit of free screening.

Ultra Sonography:

Sometimes when anything suspicious is noted on a mammogram, the doctor may like to use an ultra sonography on the breast to correlate any earlier finding. This may also be used as a guide while performing a Fine Needle Aspiration Cytology (FNAC) test.

FNAC/Biopsy:

When there is a suspicious lump seen on the mammogram, the doctor would like to draw a sample of cells from the tumour and send it for further pathological/laboratory testing. Some of the cells are drawn by inserting a fine needle syringe, sometimes using an ultra-sonography to ensure greater accuracy. A slide is prepared, which is then sent for laboratory examination. This is called an FNAC. When a larger portion of the tumour is removed surgically it is a biopsy. If the laboratory tests reports are positive and indicate a malignant tumour, it is very important for you to consult an oncologist and an onco-surgeon with no further delay. The line of treatment will be determined specifically in relation to the individual patient and you must talk openly with your doctor and seek any information that you may desire to your complete satisfaction. You may also like to seek the support from volunteers of a support group. Such support can prove to be very beneficial as the volunteers have already gone through similar circumstances and may be in a better position to understand your feelings, fears, apprehensions and emotions.

How to perform a Breast Self Examination (BSE):
Every woman must be aware and conscious of her body and examine herself closely every month. The best time to perform a BSE is on the fifth day of your monthly menstrual period. Before the periods, the breasts tend to become heavy and sensitive due to hormonal changes which occur in the body. At times they are also tender and painful and hence the ideal time to perform a BSE is immediately after the periods are over. The BSE must be performed at a regular interval and if the periods are irregular or if you have already reached the stage of menopause you may prefer to examine your breasts on a fixed date every month. In many developing countries, like India, there may not be a National Health Policy for regular screening of all women. In such case, it is cheapest to perform a BSE as no cost is involved and the results are excellent as most women discover the lump themselves. Who else would know your body better than you yourself? Instances have been noted where the test report were negative but the concerned woman was not at rest and had a premonition that something was wrong with herself. Ultimately it was shocking to note that the tests were false negative and that she did indeed have Breast Cancer. It is always in your interest to be conscious and aware but not unduly anxious and worried. We can instill a habit in our daughters and ourselves to do a self examination of our breasts every month, just like we brush our teeth after every meal.

But how does one do it?

After your bath on the appointed day, stand before a mirror and look at your breasts carefully to see if there is any change in shape, size or skin texture. Then bend down from the waist and swing from side to side and continue visually observing any change in shape. Secondly, lie down on a bed with a folded blanket or towel right up to your neck and shoulder. With your right palm absolutely straight and fingers flat, begin to examine your left breast. Move your palm upwards and downwards with firm pressure as shown in the diagram. Examine each part of the breast looking for any tiny hard lump. It may be very small, even less than a centimeter, maybe the size of a small pea. Move your palm systematically so that no part of the breast is left unexamined. Take care to examine using the entire palm and flat fingers held firmly together and not just the tips of your fingers. Again divide the breast imaginarily into four quadrants and feel the entire breast moving in small circular motions in each of the four parts. First examine the upper left and upper right quadrants moving right up to the collar bone as well as the armpit region. Instances of lumps being detected at beauty parlours when the woman had visited for having a facial massage are there. Move to the lower quadrants and examine carefully. Likewise examine your right breast using your left palm exactly as mentioned above. If you find anything unusual or strange and suspicious, please consult your doctor immediately. Remember that all lumps are not cancerous and therefore remain calm and do not panic until any test reports, if any, are positive. Also do remember that in the unfortunate event of a test report being positive for malignancy, you are not alone. Breast Cancer is the ‘Best Cancer’ and continuous research in the field is yielding better treatment options.

Let us sum up
We have attempted to give you information about the various risk factors for Breast Cancer. You may have noted that some risk factors can be controlled whereas others cannot be controlled. You have also learnt what are the signs and symptoms of Breast Cancer and how it can be detected. The various screening techniques have been listed and you have been explained how to perform a Breast Self Examination. You also now know why you must consult a doctor immediately on suspecting any symptom and how early detection can help to save a life. Do spread this information to every person you know as Life is very precious and must be lived to the fullest with a hope which never dies.

Some Useful Websites
http://en.wikipedia.org/wiki/Breast_cancer http://www.breastcancer.org/ http://www.cpaaindia.org/ http://www.breastcancerindia.net/ http://abcsgp.org/