Breast cancer is the most common malignancy in females. In Pakistan, every 1 in 9 women is at risk of developing cancer at some stage of her life. Breast cancer diagnosis imposes significant emotional distress on a substantial proportion of patients. It causes many challenges for themselves, their spouses and families.
Due to social reasons and lack of awareness, women in our country seek medical help at later stages, when the disease has become advanced and treatment options become limited. Some women do not seek medical advice till the disease has become advanced due to fear of losing hair during chemotherapy, whereas, others do not seek medical advice due to fear of surgery. Cost of treatment is another concern.
The purpose of raising awareness is to become familiar with the signs and symptoms of breast cancer so as to facilitate early detection. Early diagnosis promises better survival rate and treatment may not be very aggressive. Women with smaller lumps may be candidates for breast saving surgery and may even avoid chemotherapy in some cases. Hence, there is need to create awareness amongst the general population for early detection.
There are very few options in the prevention of breast cancer, but every woman should be familiar with symptoms and signs of breast cancer for early diagnosis. Symptoms may include skin changes, thickening of skin, like orange peel, persistent reddish discoloration which is not settling with antibiotics, skin puckering, visible lump(s) which may or may not be painful, rupture of the lump if patient failed to seek medical advice. There may be a variety of nipple changes, like recent inversion of the nipple, ulceration of the nipple, or nipple eczema. There may be blood discharge from the nipple, which is alarming. Discharge which is yellowish, greenish or brownish may not be associated with cancer. Such colorations are usually associated with a benign condition but ultrasound of the breast should be done for every woman with even signs not related to cancer.
Breast cancer has four stages: Stages I and II are early. If patients come in at early stages, they may be offered breast saving surgery, while if they come at later stages, treatment is often very difficult and sometimes patients may not be offered surgery due to the spread of the disease. Women who do not have any symptoms of breast cancer should examine their breasts on monthly basis. This is known as breast self-examination. If they find any lump on their examination they can consult a doctor and undergo breast imaging. Patients above the age of 40 should undergo mammogram of both breasts and ultrasound for screening, routinely. Patients less than 40 years of age may undergo ultrasound only. Women, who have first or second degree relatives with breast or ovarian cancer, are considered as high risk group. They should do self-examination regularly and should undergo routine screening ten years earlier than the age of the affected relative. Cancer occurring in younger women is aggressive as compared to older women due to hormonal factors therefore these women should also do their self-examination .
There are many myths associated with the disease as well. One common myth is that breast cancer will not occur in pregnant and lactating women. However, cancer can arise during pregnancy or breast feeding.
Majority of the patients consult oncologists late, once the lump has become bigger, sometimes even when it is bleeding because the lump is painless. Patients do not consult the doctor as they think that painless lumps may not be cancerous. However, it is the opposite. Most of the cancer associated breast lumps are painless; only a few present with pain. Moreover, breast pain alone is usually not associated with breast cancer but preferably, this should be checked.
Breast cancer may be prevented by maintaining a healthy life style; eating fresh seasonal fruits and vegetables, nuts, low fat-diet and walk or exercise. High-fat diet, smoked food, fast food and red meat should be avoided. Unhealthy diet may lead to various cancers in addition to breast cancer. Every woman over the age of 18 years should perform her breast self-examination once a month and if she feels any changes she should consult a doctor.HH
The writer is an oncologist, working at Combined Military Hospital (CMH), Rawalpindi
E-mail: [email protected]
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