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

One out of every eight women will develop breast cancer (BrCa) during their lifetime. Most occur in women over 50, and approximately 6% 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% higher than in other races. Contributing to this is the prevalence of the triple-negative BrCa subtype among Black women. This subtype is more likely to:

• Be discovered at a more advanced stage
•  Relapse
• Metastasize (spread)
• Be resistant to treatment.

BrCa has been linked to:

• Being female
• Advancing age
• Dense breast
• Previous and family history of cancer – breast, ovarian, uterine
• Early onset of periods
• Late cessation of periods
• Never being pregnant or having the first child after 30
• Hair dyes and chemical hair straighteners
• A sedentary lifestyle
• Alcohol usage
• Overweight
• Hormone replacement therapy
• Red meat consumption
• Consuming processed foods
• Smoking
• Having the BrCa 1/ BrCa 2 genes
• Chest, neck, or face radiation
• No breastfeeding, or short breastfeeding period
• Chemicals leached from food packaging and plastic tableware.

Symptoms that may be indicative of BrCa

• Lump in the breast or armpit
• Change 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

Available modalities for detecting breast cancer

• The current gold standard for the early detection of BrCa is full-field digital mammography enhanced with computer-aided detection (CAD) software. Women should start screening mammography at age 40, and depending on the woman’s risk, annually or biennially thereafter. It’s important to find out the vintage and capability of the mammogram machine being used.
• Self-examination – Many guidelines do not emphasize this, however, studies have shown that monthly breast self-exams may uncover BrCas when they are relatively small.
• Clinical breast examination – If performed methodically and annually by a well-trained and experienced healthcare professional, it is 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 1 or BrCa 2.

How to reduce your chance of developing breast cancer:

• Normalise weight.
• Exercise regularly.
• Stick to a nutritious diet
• Restrict alcohol intake.
• Minimize the use of hair dyes and chemical hair straighteners
• Only use hormone replacement therapy if necessary
• Limit red meat consumption
• Stop consuming ultra-processed foods
• Cease smoking
• Breastfeed your children
• Undergo regular screening.

Suggestions for women diagnosed with BrCa

When confronted with a BrCa diagnosis, quite understandably, one is overcome with a deep sense of despair. Furthermore, if told “the cancer has spread”, there is a further 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 a partner, close family member, friend, or 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 sub-typing 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 travelling or paying 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 non-profit 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, their families, our societies, and healthcare services across our region.

Author: Dr. C. Malcolm Grant – Family Physician, Family Care Clinic, Arnos Vale.
Former tutor in the Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados. Host of programme: Physician On Call. For appointments 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.