HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

“I should’ve nev­er ig­nored that lump!” the pa­tient ex­claimed with sunken eyes brim­ming with tears. Shriek­ing cries then bel­lowed through­out the cor­ri­dors as she slumped for­ward, face plant­ed in­to weary hands. As the room dead­ened with si­lence, the pa­tient then shak­ing­ly ut­tered a few un­for­get­table words, “I nev­er thought it could be me, no­body in my fam­i­ly has it…”. Un­for­tu­nate­ly, this pa­tient had just re­ceived news of her crip­pling di­ag­no­sis of Stage IV Breast Can­cer.

Can­cer is doc­u­ment­ed to be the sec­ond most com­mon cause of death in the Caribbean with Breast can­cer be­ing the most di­ag­nosed can­cer among Trin­bag­on­ian women. Can­cer of the breast proves to be fa­tal in most cas­es, main­ly be­cause ear­ly symp­toms of this dis­ease are not eas­i­ly no­ticed. The lat­er breast can­cer is de­tect­ed, the less­er are the chances of sur­vival of an in­di­vid­ual.

Ad­di­tion­al­ly, the Na­tion­al Can­cer In­sti­tute (NCI) projects that pan­dem­ic-re­lat­ed de­lays in di­ag­no­sis and treat­ment dis­rup­tion could re­sult in 10,000 ad­di­tion­al deaths from breast can­cer over the next 10 years. In ad­di­tion, re­searchers re­port that dur­ing the first three months of the COVID-19 pan­dem­ic, di­ag­nos­tic and screen­ing mam­mo­grams have de­creased over 80%. There has al­so been a 50% de­cline in vis­its to pri­ma­ry care physi­cians. All these plus dis­rup­tions in di­ag­nos­tic tests, lab work and de­layed ap­point­ments are all like­ly to have an im­pact on can­cer pa­tients.

So, what can we do about this?

Screen­ing Saves Lives

The most im­por­tant strat­e­gy in pre­vent­ing the se­que­lae of Breast Can­cer is ear­ly Screen­ing. The aim of screen­ing is to de­tect can­cer be­fore the on­set of symp­toms.

Breast can­cer that is di­ag­nosed be­fore spread (metas­ta­sis) is sig­nif­i­cant­ly eas­i­er to treat suc­cess­ful­ly and has high­er cure rates. Reg­u­lar screen­ing al­lows for us to di­ag­nose ear­li­er and it de­creas­es the need for ag­gres­sive treat­ment like chemother­a­py and sur­gi­cal re­moval of the breast (mas­tec­to­my). Ear­ly de­tec­tion of breast can­cer pre­vents deaths and im­proves longevi­ty and qual­i­ty of life.

Ear­ly warn­ing signs of breast can­cer

Symp­toms of breast tu­mors vary from per­son to per­son. Some com­mon, ear­ly warn­ing signs of breast can­cer in­clude:

Skin changes, such as swelling, red­ness, or oth­er vis­i­ble dif­fer­ences in one or both breasts

An in­crease in size or change in shape of the breast(s)

Changes in the ap­pear­ance of one or both nip­ples

Nip­ple dis­charge oth­er than breast milk

Gen­er­al pain in/on any part of the breast

Lumps or nodes felt on or in­side of the breast

Symp­toms more spe­cif­ic to in­va­sive breast can­cer are:

Ir­ri­tat­ed or itchy breasts

Change in breast colour

In­crease in breast size or shape (over a short pe­ri­od of time)

Changes in touch (may feel hard, ten­der or warm)

Peel­ing or flak­ing of the nip­ple skin

A breast lump or thick­en­ing

Red­ness or pit­ting of the breast skin (like the skin of an or­ange)

It is im­por­tant to re­mem­ber that oth­er, be­nign con­di­tions may have caused these changes. For ex­am­ple, changes to the skin tex­ture on the breast may be caused by a skin con­di­tion like eczema, and swollen lymph nodes may be caused by an in­fec­tion in the breast or an­oth­er, un­re­lat­ed ill­ness. See­ing a doc­tor for an eval­u­a­tion will help you de­ter­mine whether some­thing you no­tice is cause for con­cern.

Risk Fac­tors of Breast Can­cer

A breast can­cer risk fac­tor is any­thing that makes it more like­ly you'll get breast can­cer. But hav­ing one or even sev­er­al breast can­cer risk fac­tors doesn't nec­es­sar­i­ly mean you'll de­vel­op breast can­cer. Many women who de­vel­op breast can­cer have no known risk fac­tors oth­er than sim­ply be­ing women.

Fam­i­ly His­to­ry: Women who have ge­net­ic mu­ta­tions such as the pres­ence of the genes BR­CA1 & BR­CA2, had suf­fered from breast can­cer or cer­tain kinds of oth­er can­cers in the past and those who have a pre­vi­ous fam­i­ly his­to­ry of breast can­cer, amongst their close fe­male or male rel­a­tives, are at an in­creased risk of de­vel­op­ing breast can­cer ear­li­er.

Re­pro­duc­tive His­to­ry: Chances of breast can­cer tend to rise if a fe­male might have un­der­gone her men­stru­a­tion be­fore the age of 12 or her menopause af­ter 55. The pres­ence of more con­nec­tive tis­sue in women with dense breasts, make it dif­fi­cult to de­tect tu­mor­ous growth in the breasts, au­to­mat­i­cal­ly rais­ing the po­ten­tial of de­vel­op­ing breast can­cer ear­ly on.

Med­ical His­to­ry: Women who have un­der­gone ra­di­a­tion ther­a­py for can­cers such as Hodgkin’s lym­phoma, lob­u­lar car­ci­no­ma or atyp­i­cal duc­tal hy­per­pla­sia, to the chest or breasts ear­ly-on in life, can ex­pe­ri­ence an oc­cur­rence of breast can­cer ow­ing to this, as they progress in age. Hor­mon­al med­ica­tions such as oral con­tra­cep­tives and birth con­trol pills, tak­en with­out a doc­tor’s in­ter­ven­tion, al­so in­crease the risk of breast can­cer.

Poor Lifestyle Habits: Reg­u­lar con­sump­tion of al­co­hol, not be­ing phys­i­cal­ly ac­tive, smok­ing, con­sum­ing a di­et rich in fat­ty food and liv­ing in an en­vi­ron­ment of con­stant stress and anx­i­ety, can even­tu­al­ly con­tribute to a height­ened risk of breast can­cer.

Are Screen­ing Ini­tia­tives Help­ful?

Many clin­ics lo­cal­ly and glob­al­ly proac­tive­ly em­bark on Screen­ing ini­tia­tives. Dr Jevon Rush, Chief of Staff, The Care Clin­ic and Med­ical Cen­tre shared, “Our first ini­tia­tive in 2019, iden­ti­fied 20% of women screened as high-risk pa­tients for Breast Can­cer, who then re­ceived fur­ther eval­u­a­tions. From my per­spec­tive, screen­ing as a pub­lic health strat­e­gy is nec­es­sary as it al­lows us to prompt­ly iden­ti­fy un­recog­nised or ear­ly dis­ease in ap­par­ent­ly well, asymp­to­matic per­sons. This then al­lows for ear­ly in­ter­ven­tion in ear­li­er stages of dis­ease lead­ing to bet­ter out­comes and de­creased mor­tal­i­ty.”

Breast Can­cer and Men­tal Health

A breast can­cer di­ag­no­sis can make pa­tients and their loved ones of­ten feel pow­er­less. Some things tru­ly are out­side of our con­trol, and the as­so­ci­at­ed men­tal health is­sue can be dev­as­tat­ing. While breast can­cer and men­tal ill­ness may both feel like in­sur­mount­ably large prob­lems, you can take sim­ple steps every day to feel bet­ter. Stay­ing as ac­tive as you can, fo­cus­ing on healthy habits, and reach­ing out to friends, fam­i­ly, a sup­port group, or a faith group can all help. Know­ing your risks, what are the ear­ly symp­toms and the prop­er tech­niques for self-ex­am­i­na­tion are all ar­mouries to pre­vent the fa­tal­i­ty of Breast Can­cer.