Breast cancer: Early detection is essential

The incidence of breast cancer in South Africa is increasing and is one of the most common cancers among women. It is the most prevalent cancer amongst white and Asian women and the second-most common cancer among black and coloured women.

Early detection can lead to effective treatment and a positive prognosis. Breast cancer forms in the cells of the breasts.

There are two main types:

1. Ductal carcinoma starts in the tubes (ducts) that carry milk from the breast to the nipple. Most breast cancers are of this type.
2. Lobular carcinoma starts in the parts of the breast, called lobules, which produce milk.

In rare cases, breast cancer can start in other areas of the breast. About 90% of patients survive for many years after diagnosis when breast cancer is detected at the early stages. Regular self breast examination and regular mammograms are important for early detection.

Early diagnosis may result in more effective treatment leading to a reduction in pain and suffering, and a significant decrease in the loss of life. Breast cancer can occur in both men and women, but it’s far more common in women.

Substantial support for breast cancer awareness and research funding has helped improve the screening, diagnosis and advances in the treatment.

Breast cancer survival rates have increased, largely due to a number of factors, such as earlier detection, a new personalised approach to treatment and a better understanding of the disease. If you find a lump or other change in your breast – even if a recent mammogram was normal – make an appointment with your doctor for prompt evaluation.

Causes

It’s not clear what causes it. According to scientists breast cancer occurs when some breast cells begin growing abnormally.

These cells divide more rapidly than healthy cells and continue to accumulate, forming a lump or mass. The cells may spread (metastasise) through your breast to your lymph nodes or to other parts of your body.

Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma).

It may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast. Researchers have identified hormonal, lifestyle and environmental factors that may increase the risk of breast cancer.

But it’s not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do.

It’s likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

It is commonly inherited. It is estimated that about five to 10% of breast cancers are linked to gene mutations passed through generations of a family.

If you have a family history of cancer, your doctor may recommend a blood test to help identify specific gene mutations that are being passed through your family.

Risk factors

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 it. Many who develop breast cancer have no known risk factors other than simply being women.

The following factors have been associated with an increased risk of breast cancer and they include:

• Being female: Women are more likely than men to develop breast cancer.
• Increasing age: Your risk of breast cancer increases as you age.
•  A personal history of breast cancer: If you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other.
•  A family history of breast cancer: If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk is increased. Still, the majority of people diagnosed have no family history of the disease.
•  Inherited genes that increase cancer risk: Certain gene mutations that increase the risk can be passed from parents to children. These genes can greatly increase your risk of breast cancer and other cancers, but they don’t make cancer inevitable.
•  Radiation exposure: If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
•  Obesity: Being obese increases your risk of breast cancer.
• Beginning your period young: Beginning your period before age of 12 increases your risk.
• Beginning menopause at an older age: If you began menopause at an older age, you’re more likely to develop breast cancer.
• Having your first child at an older age: Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
•  Having never been pregnant: Women who have never been pregnant have a greater risk of breast cancer than women who have had one or more pregnancies.
• Postmenopausal hormone therapy: Women who take hormone therapy medications that combine oestrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
• Drinking alcohol: Drinking alcohol increases the risk of breast cancer.
•  Not being physically active: Women who are not physically active have a higher risk of getting breast cancer
• Having dense breasts: Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumours on a mammogram. Women with dense breasts are more likely to get breast cancer.
• Taking oral contraceptives (birth control pills): Certain forms of oral contraceptive pills have been found to raise breast cancer risk.
• Having not breastfed: Breastfeeding can lower breast cancer risk, especially if a woman breastfeeds for longer than a year.
•  Smoking: Smoking causes a number of diseases and is linked to a higher risk of breast cancer in younger, premenopausal women.

Diagnosing breast cancer

Tests and procedures used to diagnose breast cancer include:

•  Breast exam. Your doctor will check both of your breasts and lymph nodes in the armpit, feeling for any lumps or other abnormalities. You can also Google self-examination videos on YouTube which are very helpful. Know your breasts so you can pick up if there are any changes.
• Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor
  may recommend a diagnostic mammogram to further evaluate that abnormality.
• Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst.
• Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous. A biopsy sample is also analysed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options.
• Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. This is the most expensive of all the above tests and is only done rarely. Other tests and procedures may be used depending on your situation.

Staging breast cancer

Breast cancer stages range from 0 (zero) to IV (four) with zero indicating cancer that is non-invasive or contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body.

Once your doctor has diagnosed breast cancer, he or she works to establish the extent (stage) of your cancer. The stage helps determine the prognosis and the best treatment options. Complete information about your cancer’s stage may not be available until after breast cancer surgery.

Tests and procedures used to stage breast cancer will include tests that will confirm if the cancer has spread beyond the breast tissue.

The tests include: blood tests, such as a complete blood count; mammogram of the other breast to look for signs of cancer; breast MRI; bone scan; computerised tomography (CT) scan and positron emission tomography (PET) scan.

Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances and taking into account new symptoms you may be experiencing.

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