Cancer – the emperor of all maladies – is on the rise, and the causes for the same are multi-factorial.
Breast cancer is the most common cancer in women, affecting more than 10 million women worldwide. According to the World Health Organization (WHO), in 2018, it is estimated that 627,000 women died from breast cancer – that is approximately 15 percent of all cancer deaths among women.
Cancer also affects women about 100 times more than men. In Sri Lanka too, the incidence has been rising steadily throughout the years.
Early detection remains the cornerstone of breast cancer control. In October, which is observed as breast cancer awareness month, campaigns are conducted all over the world to increase awareness of the disease. Though the public is enlightened about prevention strategies, early detection too is highlighted in recent years because it is possible to cure the disease through adequate diagnosis and treatment.
Breast cancer originates from the lobes or the ducts of the breast. Normally, changes in the breast can occur during pubertal development, reproductive age, during pregnancy and menopause. When there is an uncontrollable, purposeless abnormal cell growth in the breast, it is recognized as breast cancer.
“Every individual is at some risk of getting breast cancer, and there is no assured way to prevent the disease. However, there are a lot of preventive measures which can be undertaken at an individual level for reducing the risk,” National Cancer Control Programme (NCCP) Director Dr. Janaki Vidanapathirana said.
Although breast cancer is thought to be a disease of the developed world, almost 50 percent of breast cancer cases and 58 percent of deaths occur in less-developed countries. The age distribution of breast cancer is also changing as younger women too are also developing breast cancer.
Breast cancer is among the top ten cancers found in Sri Lanka. “The commonest cancers among men are oral and lung cancers, while in women they are breast and cervical cancers. One fourth of all cancers in women are breast cancers,” NCCP Consultant Community Physician Dr. Suraj Perera said.
“The breast contains structures such as lobes, ducts and glands (lobules) that open to the nipple and the rest consists of fatty tissues. In Sri Lanka, breast cancer usually occurs due to abnormal growth in glands and ducts. The two most common types of breast cancers in Sri Lanka were the ‘Inter lobular carcinoma’ and ‘Inter ductal carcinoma’.
Inter lobular carcinoma occurs when abnormal cell proliferation occurs in the lobules. Inter ductal carcinoma occurs when abnormal cell proliferation occurs in the ducts.
‘Triple negative breast cancer’ is where the three receptors that contribute to breast cancer growth are not present in the tumour. This type is not prevalent in Sri Lanka,” Dr Perera added.
Breast cancer occurs in four stages: Stage 1: The tumour is around two centimetres in breadth and can be easily detected through routine self-examination.
Stage 2: Palpable lumps can be found in the breast. The lumps are at least two centimetres in breadth and the tumour is more than two centimeters in breadth.
Stage 3: The cancer has spread to the lower surrounding body like the spine and the chest.
Stage 4: The cancer has spread to distant parts of the body. Cancer deposits might be found in the brains, lungs and liver.
Speaking on the subject, Indira Cancer Trust Chairperson/Trustee Dr Lanka Jayasuriya-Dissanayake points out that breast cancer is amenable to early detection since it involves a superficial organ which is not hidden deep in the body. In fact, the very symptoms of the same can be detected by oneself.
“This is the most important basic level of inspection for detecting breast cancer. TLC (Touch, Look and Check) is a convenient, no-cost tool that anyone can use regularly and at any age. A self-breast examination is ideally done by self seven days after your period starts,” she explained.
Ideally, one should examine themselves every month and especially after the period is over, because one is less likely to be bloated or swollen. However, for women who have already gone through menopause, they should set a particular date on the calendar for TLC.
“Start at 20 years and make your self-breast exam a habit. There is no age limit for TLC. Whenever you detect anything abnormal, immediately visit a well women clinic, healthy lifestyle centre, family physician or a physician in the family clinic closest to you,” Dr. Dissanayake advised, adding that breast cancer does not always start with a lump.
Being up-to-date about the five most common signs and detecting them early can save a woman’s life.
Though research has not revealed the exact risk factors which lead to the disease, two types of risk factors have been recognized by experts: modifiable risk factors and non-modifiable risk factors. Obesity, inactive lifestyle, unhealthy dietary habits, consumption of alcohol, smoking, stress and anxiety, overexposure to radiation, women who have not given birth, women who have not lactated before the age of 35, women who take oestrogen containing medication for Hormone Replacement Therapy (HRT) and long-term exposure to oestrogen therapy fall under modifiable risk factors.
These modifiable risk factors can be controlled by adopting certain lifestyle changes. These changes will not only help in reducing the risk of breast cancer but also the chances of developing other diseases such as diabetes, hypertension, heart disease and stroke.
Being a female, ageing, family history, menarche before the age of 11, menopause after 50 years of age and mutation in BRCA1 or BRCA2 genes fall under non-modifiable risk factors. If a blood relation has had breast cancer or ovarian cancer, the other women in the family can be at high risk for breast cancer.
Dr. Perera said that due to early menarche, the breast is exposed to the hormone oestrogen from a young age. Due to late menopause, the breast is exposed to more oestrogen hormones. Studies have found that high level of oestrogen in the blood increases the chance of breast cancer in women.
“The diagnosis of breast cancer due to gene mutation detection is rare in Sri Lanka due to the high cost of the gene testing,” he said.
Dr Perera stressed the importance of early detection, noting that a total or near-total cure is possible.
“When a patient is detected in either Stage 1 or Stage 2, there is almost a 90 percent chance of survival,” he said.
Being diagnosed with breast cancer today is entirely different to what it was about three decades ago. Prior to the 1970s, the only option for a woman diagnosed with breast cancer was to undergo a radical mastectomy where the whole breast along with nipple, lymph nodes in armpit and chest wall muscles was removed.
However, over the last 20 years, the surgery for breast cancer has become more and more conservative. Moreover, breast reshaping and reconstruction are increasingly done to rebuild the breast.
The wearing of a pink ribbon is fairly common in October as it serves as an international symbol for breast cancer awareness. People wear it in solidarity with those who have been diagnosed.
The Indira Cancer Trust which had been set up in memory of Indira Jayasuriya who passed away in November 2016 from breast cancer at the age of 40, has many programmes lined up for the month to spread the word about breast cancer awareness.
However, due to the recent spike in COVID-19 cases in the country, they had to cancel most of the events. Nevertheless, a Breast Cancer Virtual Awareness Talk will be held on Zoom on October 16 from 7.00 pm to 8.00 pm. The statistics, risk factors, signs and symptoms of breast cancer will be discussed at the event. TLC and a survivor’s story too will be shared with those who register on shorturl.at/gjnF2. A Zoom ID will be sent to registered participants. The Lions Club of Veyangoda and the Lions Club of Mangalore, Balmatta, India, have joined hands with the Indira Cancer Trust in organizing this event.
‘Virtual Pink: Walk. Run. Cycle’, an event in which a participant can walk or run three kilometres or cycle 10 km and submit their photo will be on from October 22 to 25. Those who wish to take part can sign up for the event on http://bit.ly/pinkTLC. ‘Tea in the Hills’, a pink afternoon tea event organized by Theva Residency Hotel, Kandy, will also be held.
The Indira Cancer Trust has launched many projects to support cancer patients. ‘A Cut for a Cause’ is one of their most successful programmes which they launched together with Ramani Fernando Salons. It is the world’s only continuous hair donation programme and it enables them to donate wigs made with natural hair to cancer patients. In addition, they also offer counselling support, a breast prosthesis project, a livelihood development programme, sponsor a child programme for his or her educational needs and funding for the needs of cancer patients.
Today, the women diagnosed with breast cancer have a much brighter future. Though breast cancer still affects a lot of women, it kills only a few. While much has been achieved, much more needs to be learned. Many women still develop recurrence and succumb to the disease.
The story of breast cancer remains incomplete. Let us look forward to the day that breast cancer is announced as a preventable disease.
****
What you can do for Breast Cancer Awareness Month
* Wear a pink ribbon daily in October.
* Light up some key buildings in pink to raise awareness.
* Wear it on Pink Day – October 23 – wear pink to work or to your educational institute.
* Don pink nails for October to show solidarity.
* Use print, electronic, and social media to boost breast cancer awareness and the TLC campaign.
* Have a pink creative workspace at workplaces or schools to spread awareness.
* Light up for breast cancer with a candle light vigil.
* Conduct a walk or run or cycling event which can be a virtual one.
* Hand out pink ribbons or pink facemasks to display support.
* Conduct DIY fundraisers individually or as a team for patient support, especially to fund hair wigs and breast prosthesis.
****
Self-breast examination
Find a comfortable place. Sit down, stand up or lay down. You can also do this while bathing.
- Touch your breasts.
- Look for changes.
- Check anything that is unusual with your doctor.
* Skin texture
* Rash or crusting
* Nipple discharge
* Appearance or direction of the nipple
* Lump (may not be seen, but might be felt)
