October is world over recognised as International Breast cancer Awareness month. Pink Ribbon is a symbol used to create awareness about importance of early detection of breast cancer, salute survivors in their fight against breast cancer, and equally, spread the message of Hope, Courage and Survival.
In India, well over 100, 000 women are newly diagnosed with breast cancer every year; a staggering number that has overtaken cervical cancer to become the leading cause for death among women in metropolitan cities. The figure is expected to increase to 130, 000 every year by 2020. This is only the tip of the iceberg, as many breast cancers are not reported to the Cancer Registry & many States do not have a robust Cancer Registry. More than 60% of breast cancers in India present in the advanced stage and hence death rate from breast cancer is also very high. Lack of awareness & absence of an organized National Breast cancer screening programme are the main reasons accounting for late presentation.
The aim of this article is to empower the readership about the common Myths and evidence based Facts relating to various aspects of Breast health
MYTH
Most breast lumps are cancers
FACT
9 out of 10 breast lumps are not cancers. However it is vitally important to investigate the breast lump in order to obtain a definitive diagnosis instead of assuming that it is harmless
MYTH
Breast cancer affects only older women
FACT
Although majority of breast cancers occur in women over the age of 50 in the western world, it can in fact occur at any age. It is alarming to note that breast cancer is increasingly being diagnosed at a much earlier age in India
MYTH
Breast cancer does not occur in men
FACT
Many people are unaware that men can develop breast cancer because they do not think men have breasts. In fact, both men and women have breast tissue. It is important to be aware that a small proportion of men do get breast cancer each year. Although precise statistics in India are unknown, approximately 300 new cases of breast cancer are diagnosed in men each year in the United Kingdom (approximately 1% of breast cancers)
MYTH
We know what causes breast cancer
FACT
We do not know what causes breast cancer. There are however well recognized risk factors. Being a woman and increasing age are the two most important factors
Other known risk factors are:
• Previously diagnosed breast cancer in the same or other breast
• Strong Family history of breast cancer (close relatives with breast cancer)
• Early onset of menstrual period (before age 12)
• Mate menopause (after age 55)
• Not having children and having first child after age 30
• Long term use of Hormone replacement therapy
• Obesity (overweight particularly after menopause)
MYTH
If you have a risk factor for getting breast cancer, you are likely to get the disease
FACT
The risk of getting breast cancer is not a certainty, even if you have one of the strongest risk factors
MYTH
Family history of breast cancer is the most important risk factor for getting breast cancer
FACT
The vast majority of women with breast cancer do not have a family history of breast cancer. Strong family history (genetic predisposition) accounts for only 5-10% of breast cancers
MYTH
Breast feeding prevents breast cancer
FACT
Breast feeding does not prevent breast cancer, but reduces the risk
MYTH
Birth control pills causes Breast cancer
FACT
Modern day birth control pills contain a low dose of oestrogen and progesterone & hence are not associated with an increased risk of getting breast cancer
MYTH
Injury to the Breast can cause breast cancer
FACT
Injury to the breast does not cause breast cancer
MYTH
Breast self examination is no different from Breast Awareness
FACT
Breast self examination (BSE) is a regular & repetitive monthly self examination of the breast performed by a woman at the same time each month to a set method. The concept of BSE has not proven to be beneficial .
Breast Awareness is about becoming familiar with the breasts and the way they change throughout a woman’s life. It is a concept that encourages women to know how their breasts look and feel normally so that they gain confidence about noticing any change which might help detect breast cancer early.
BREAST AWARENESS, as a concept, is gaining increasing acceptance world over.
Changes that one should be aware of
• A change in size – it may be that one breast has become noticeably larger or noticeably lower
• A nipple has become inverted (pulled in) or changed its position or shape
• A rash on or around the nipple
• Blood stained discharge from one or both nipples
• Puckering or dimpling of the skin
• A swelling under the armpit or around the collarbone (where the lymph nodes are)
• A lump or thickening in the breast that feels different from the rest of the breast tissue
• Constant pain in one part of the breast or in the armpit.
Breast Awareness 5 – Point Code
1. Know what is normal for you
2. Know what changes to look & feel for
3. Look and feel
4. Report any changes to your Doctor without delay
5. Have a screening Mammogram (X- ray of the breast) every year if you are aged 40 and over
What is a Screening Mammogram?
A Mammogram (X ray of breast) done to detect breast cancer in the impalpable stage when neither the lady nor the doctor can feel a lump in the breast. It is advisable to have a Screening Mammogram once every year from the age of 40. Breast Screening by way of Mammography (X- ray of the breasts) is an effective proven way of detecting breast cancer early many years before it shows up. Early detection of breast cancer offers the best chance of successful treatment, which translates to significantly improved survival
MYTH
Breast cancer screening is effective in all age groups
FACT
Whilst it is important for women of all ages to be ‘Breast Aware’, Breast Screening is effective only in women over the age of 40 years. Routine breast screening for women under 40 and without symptoms is not effective.
MYTH
Mammography is painful
FACT
Whilst Mammography may cause momentary discomfort, it is not painful.
MYTH
Mammography is not safe. It causes radiation hazard.
FACT
Mammography involves a tiny dose of radiation – the risk to health from this is insignificant. The radiation dose delivered during Mammography is same as receiving a dental X ray.
MYTH
There is not much difference between Conventional Mammogram & Full field digital mammogram
FACT
Full Field Digital Mammography has revolutionized early detection of breast cancer. Its major advantages are less radiation, less discomfort and most importantly superior accuracy particularly in young women with dense breasts in detecting early subtle changes of Breast cancer
MYTH
Breast screening prevents breast cancer
FACT
No, breast screening only helps find breast cancer if it already there
MYTH
Population based Screening Mammography is effective in India
FACT
Although introduction of an organized population based Breast screening programme using Mammography is the best proven way of detecting cancers in the impalpable stage, it is not a viable option for population based breast screening in India due to the enormous costs involved, huge variation in Mammographic reporting & issues relating to quality assurance. Moreover, more than 87% of India’s population is under the age of 50 years, where screening by way of mammography is not effective at detecting early impalpable breast cancer (sensitivity of mammography is best over the age of 40 years)
There is considerable circumstantial evidence to suggest that Clinical Breast Examination (CBE), where trained Healthcare workers examine the breasts of women is relatively simple, inexpensive & a viable population based breast cancer screening option for a Country like India. Detecting breast cancers when they are small has a potential to help reduce mortality from this disease. More importantly, Healthcare workers will be able to create awareness about importance of early detection of breast cancer within the Community.
Dr. P. Raghu Ram
MS, FRCS (England), FRCS (Edinburgh), FRCS (Glasgow), FRCS (Ireland)
CEO & Director
Ushalakshmi Breast Cancer Foundation, Hyderabad
www.ubf.org.in
Email: p.raghuram@hotmail.com