Early detection: The key to surviving breast cancer
Years ago I treated an older lady. She came to me for a physical. I examined her and felt a small lump in her left breast. I asked her to get a mammogram and ultrasound and return to see me. She did not come back. I called her several times. No answer. A year later she returned for another physical. She had not done the mammogram or seen another doctor. The lump was larger with visible skin changes. She had obvious breast cancer and needed urgent evaluation to decide on the best approach. I referred her to a surgeon who specialized in breast pathology. She eventually went for one visit, but she never followed up and eventually died as the cancer spread untreated.
Years later I sat on the phone with a very close friend. She had been diagnosed with very early cancer, detected on MRI. She had several aunts who had been diagnosed with breast cancer, and her mother was a breast cancer survivor, having been diagnosed and treated more than 15 years prior. Over a two year period my friend had the cancer removed, had local radiation treatments and chemotherapy. She continues to follow up with her doctor regularly to check for recurrence, but all indications are that she is cured.
October is Breast Cancer awareness month and so I thought it a good time to discuss this common disease affecting women. Early detection is the key to effective management of breast cancer. Modern breast cancer management employs early detection, surgical excision and tumour marker –directed adjuvant therapy as the main pillars of management.
Early detection
The mainstay of early detection for most women is regularly monthly breast self-examination (BSE). This is very important. Women who examine their own breasts regularly find small abnormalities more readily than their doctors. Some things to look for include:
- Change in breast size or shape
- Dimpling or changes in the skin of the breast
- Recent nipple inversion or change in shape or orientation
- Any nipple discharge, particularly if blood-stained
- A lump in the armpit
If anything feels different your doctor will examine and request the appropriate tests. After age 40 screening imaging should be done every year, in addition to the BSE.
The options for imaging include breast ultrasound, mammography and Magnetic Resonance Imaging (MRI). Breast ultrasound is preferred in young women and mammography in older women. Commonly both studies are done especially in women with dense breasts. In women who are high risk for breast cancer, often based on a strong family history of breast cancer, MRI surveillance is recommended. These women should have genetic screening performed. This screening is available in Jamaica.
What do I do if I have breast cancer?
The most important factor determining survival when diagnosed with breast cancer is the stage of the disease. Staging is based on the local extent of disease and the presence and extent of spread. Thus early detection is essential to a good outcome. If a cancerous lump is found in the breast a biopsy will be done to decide exactly what kind of tumour it is. This is essential as the drug treatment offered will depend on the cellular markers present in each case. Modern breast cancer treatment is tailored to the specific make up of each tumour. In most instances the lump will be removed. Surgical options include wide excision of the lump or removal of the entire breast (mastectomy) with or without reconstruction.. The survival rates for wide excision (which allows preservation of the breast), and mastectomy (which removes the breast) are the same. Each woman must decide for herself. Some may even decide to have bilateral mastectomy to prevent a cancer developing in the other breast. This will be decided with the surgeon taking the patient’s wishes and risk factors into account. Ultimately it is the patient’s choice. If there is wide spread there may still be a role for adjuvant chemo or radiation therapy to make the patient comfortable.
It is always important to cultivate a positive attitude, eat healthy nutritious food, minimize stress and get enough rest. This creates a strong immune system and helps to prevent the development of a cancer, or create a healthy internal environment to help combat and existing tumour.
Coping with a diagnosis of breast cancer
The emotional issues that arise for women who are diagnosed with breast cancer are numerous. The diagnosis of cancer itself is very stressful. A lot of information is given in as sort space of time and decisions have to be made quickly. Beyond that self esteem and body image issues are common. Struggle with their sense of womanhood, and worry about whether their partner will find them attractive should they choose to remove the breast. Many are concerned about being around for their children, especially when the prognosis is poor. Some may become depressed. They will need support of friends and family, and the guidance of a knowledgeable surgeon. The family doctor will help the patient navigate a very scary situation.
Breast cancer is the leading cancer among Jamaican women occurring in 43.1 per 100,000 women with a mortality rate of 18.3 per 100,000. Approximately 300 women in Jamaica die annually from breast cancer. Many women avoid screening out of fear of finding something wrong. In doing so those who have tiny lesions deny themselves the opportunity to intervene early and enjoy a long life. I have shared two very different stories with very different outcomes. Which would you choose?
Dr. Simone French is a consultant emergency physician, and the medical director at the Emergency Medicine Division of the UHWI. She is the physician owner of Imara Medical Centre where she practices general and urgent care medicine.
