Female Breast Cancer – Causes, Symptoms, Early Detection, Prevention, Suggestions

One out of every eight women will develop breast cancer (BrCa) during their lifetime. Most cases occur in women over the age of 50, and approximately 6 per cent occur in women under 40.

BrCa is the number one cause of cancer deaths in women.

Sadly, the mortality rate in Black women is 40 per cent higher than in other races. One factor contributing to this is the increased prevalence of the triple-negative BrCa subtype among Black women. This subtype has a greater tendency to relapse and metastasize (spread).

BrCa has been linked to

● Being female
● Family history (genetics)
● Advancing age
● Dense breast
● Previous history of breast cancer
● Early onset of periods (menarche)
● Late cessation of periods (menopause)
● Never being pregnant or having the first child after the age of 30
● Hair dyes and chemical hair straighteners
● A sedentary lifestyle
● Alcohol usage
● Being overweight
● Hormone replacement therapy
● Red meat consumption
● Consuming processed foods
● Smoking
● Radiation exposure

Symptoms that may be indicative of BrCa

● A lump in the breast or armpit
● Any changes in the appearance of the skin of the breast including nipples
● Nipple discharge
● Retraction or pulling of the nipple
● Breast pain
● Thickening of any part of the breast

Detecting breast cancer early

● The current gold standard for the early detection of BrCa is full-field digital mammography enhanced with computer-aided detection (CAD) software. The commencement of mammographic screening and frequency (i.e. annually or biennially) is determined by the woman’s risk. The earliest age that a woman should start screening mammography is age 40, and screening mammograms are not recommended for women older than 75. It’s important to find out the vintage and capability of the mammogram machine being used.
● Self-examination – This modality is not emphasized by many current guidelines, however, studies have shown that monthly breast self-exams may uncover BrCas when they are relatively small.
● Clinical breast examination – If methodically and annually performed by a well-trained and experienced healthcare professional, it is quite useful in detecting BrCa lesions.
● Magnetic Resonance Imaging and Ultrasound – These are useful in evaluating breast abnormalities, however, neither is currently recommended as a screening modality for BrCa. MRI mammography is most helpful in assessing high-risk groups such as women who have tested positive for the BrCa gene – BrCa I or BrCa II.

How to reduce your chance of developing breast cancer:
● Normalise weight.
● Exercise regularly.
● Restrict alcohol intake to no more than one unit per day.
● Reevaluate the use of hair dyes and chemical hair straighteners
● Only use hormone replacement therapy if absolutely necessary
● Limit red meat consumption
● Stop consuming ultra-processed foods
● Cease smoking

Suggestions for ALL women diagnosed with BrCa

When confronted with a BrCa diagnosis, quite understandably, one is generally overcome with a deep sense of despair. Furthermore, if told “the cancer has spread”, there is often significant compromise in one’s ability to think logically, ask the right questions, seek out the best treatment options, and make informed and measured decisions in keeping with the BrCa’s specifics and the patient’s unique circumstances.

All BrCa patients should have someone – a partner, a close family member, a friend, or an advocate, who can attend all doctor’s appointments with them. The managing doctor should be asked at minimum the following questions:

● Is the BrCa oestrogen/ progesterone receptor positive or negative, HER2-positive or negative?
● Is further subtyping of the BrCa needed?
● What was the size of the BrCa?
● What stage is the BrCa?
● Is the treatment on offer the best treatment for the specific subtype of BrCa?
● What are the likely side effects of the proposed treatment?
● Is there a need for additional tests – e.g. PET scan?
● Are all the tests that are needed available locally? If not, what's not?
● Would radiotherapy be needed? If yes, where can such be accessed?
● Can copies of all the reports be provided?
● Are there additional treatments that can be beneficial, even if it means having to travel or pay to bring it into the country?
● Are other doctors going to be involved in my treatment?
● Is a second opinion recommended?
● Should I and my immediate family be tested for the BrCa genes?

Finally

In the Caribbean, women with BrCa are more likely to die from the disease when compared to women in North America and Europe. The reasons for this include inadequate public education, BrCa presenting at a more advanced stage, limited access to digital mammography, sparse availability of receptor typing, socioeconomic challenges, many Caribbean Ministries of Health not having a structured approach to the management of cancers (e.g. a national cancer registry), paucity of linkages with international nonprofit organizations funding BrCa prevention and management, and little Caribbean centric BrCa research.
Unfortunately, once these endemic deficiencies persist there will be little improvement regarding
the burden that BrCa places on our women and their respective families across our region.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.