Breast cancer is the most common cause of death in women worldwide. According to the World Health Organisation (WHO), breast cancer is the most frequent cancer among women, impacting 2.1 million each year and also causes the greatest number of cancer-related deaths among women. In 2018, it is estimated that 627 000 women died from breast cancer, that is approximately 15 percent of all cancer death among women. It is against this background that the month of October has been dedicated to be a month of breast cancer awareness globally and our Health reporter Sharon Kavhu (SK) had a Question and Answer (QnA) with an Oncologist Dr Nomsa Tsikayi (D.N.T) and below is the QnA.
S.K: What does it mean when one is said to be having breast cancer?
D.N.T: Cancer is a group of diseases characterized by abnormal growth of cells in an uncontrolled manner leading to the development of a lump or non-healing ulcer in any part of the body. When the abnormal growth occurs in breast tissues this is called breast cancer. Importantly small parts of these abnormal cell growths can break off, enter into blood and lymph vessels and thus spread to other parts of the body.
S.K: How can breast cancer be examined in both men and women?
D.N.T: There are a number of scenarios in which a person can be examined for breast cancer. It may be that the person has developed a lump (which is usually painless) or skin changes in the breast, which causes them to seek medical attention. Some breast lumps are benign or non-cancerous. Non-cancerous lumps occur especially in younger women. However the older a patient is when they develop a breast growth, the more likely it is that the growth is cancerous. However there is no sure way of distinguishing between cancerous and non-cancerous breast growths. Any person, male or female, who has a lump or any other unusual change in the breast, should seek a medical opinion.
In this case their medical practitioner will examine the lump to see if it has any features that suggest breast cancer. The most common sign of breast cancer is a painless lump. At this point the cancer is usually of a lower stage and more easily curable. The following features are associated with cancer which is already advanced (ie it has been neglected and allowed to grow extensively). These may include the following; hard and fixed lump which may become painful, local skin changes such as ulceration or peau d’orange (dimpling of the skin), reddening of the skin and nipple changes such as retracted nipple which is starts to point inwards, spontaneous nipple discharge which can be bloody. One can also develop signs of spread which can be to lymph glands in the armpit or base of the neck, or spread to other organs far away from the breast such as the lungs, liver or bone.
The other scenario in which breast cancer is examined is called ‘screening’. This entails actively searching for breast cancer in asymptomatic women (ie who have no detectable breast changes yet). It is done using three methods which are as follows:
- Self-breast examination: This is the simplest and cheapest test and it involves examination of one’s own breasts once a month to look for any changes that could point towards cancer.
- Clinical Breast Examination: This involves the examination of breasts by a health provider which could either be a trained nurse or doctor. It is recommended that this test be performed twice a year.
- Mammography (special type of X-ray of the breast) once a year. This test is recommended for women over the age of 50yrs, it may be started at an earlier age for women who have a strong family history of breast cancer.
S.K: Can you explain how breast cancer is scientifically tested?
D.N.T: This is done by what is called a triple assessment which consists of:
1) Clinical examination by a doctor;
2) Radiological tests which maybe an ultrasound scan or mammogram of the breast and
3) A biopsy (obtaining a sample of the tissue to examine under the microscope).
The last step is the most important as it allows a definite diagnosis of cancerous or non-cancerous breast mass.
S.K: What are the types and stages of breast cancers?
D.NT: Breast cancer is divided into stages 1 to 4 depending on how extensive it is. Stages 1 to 3 refer to cancer which is confined to the breast with or without spread to the nearby lymph glands (most commonly in the armpit and at the base of the neck). Stage 1 is the earliest disease which carries a better chance of being completely cured and stage 3 at the most advanced end of the spectrum, with stage 2 being intermediate between stages 1 and 3. Stage 4 breast cancer is one where there is spread to other organs (distant metastases).
S.K: How can these stages be treated?
D.N.T: Almost all stages 1-3 cancers are all treated with some kind of operation. Even though during surgery the operating doctor removes the breast lump and nearby lymph glands there is still need for further treatment! This is because by the time a cancerous breast lump is half a centimetre in size it has already planted small roots in other parts of the body, which will grow and manifest even years later if they are not eradicated with further treatments. A long time ago when surgery was the only available treatment for breast cancer it was observed that almost all the women who had only the operation developed cancerous growths at the operation site and on other parts of the body.
Fortunately due to advances in medicine there are now treatments that eradicate the small roots that the cancer has planted and thus drastically reduce the risk of the cancer relapsing either at the operating site or further afield. After surgery, cancer specialist will consider all the factors related to a particular patient’s cancer and recommend one or a combination of the following treatments: chemotherapy, radiotherapy or hormonal therapy.
Stage 4 cancer is a different case. Unlike the others, it is not curable. However it can be controlled even for many years mainly with chemotherapy and/or hormonal therapy. However radiotherapy or surgery may still have a role to play in a few special circumstances.
S.K: Can you explain the radio therapy is used to treat breast cancer?
D.N.T: Radiotherapy is treatment with high energy X-rays which are directed at the areas where the cancer cells are concentrated. It is called a local therapy because it is directed to only a small limited area of the body. It is used to treat the operation site and the nearby lymph glands. It is painless and the patient will not feel anything while they are being treated. Its main effect is to reduce the risk of the cancer recurring in the local area.
S.K: Some cancer patient prefers chemotherapy, how is the processed used to treat breast cancer?
D.N.T: Chemotherapy refers to drugs which are mainly given as injections, but may also be in tablet form. It is a systemic treatment because it is not limited to one body site (unlike local therapy). Instead it travels in the blood stream to all parts of the body. Therefore it works to eradicate small roots that the cancer has spread to other parts of the body in Stage 1 to 3 cancers. In stage 4 cancer it is used to reduce the size of and control the distant sites where the cancer has spread (ie where the small roots have had a chance to grow into large trees!)
S.K: What are the chances of survival after one has been diagnosed breast cancer?
D.N.T: The diagnosis of breast cancer does not mean death. It is possible to receive treatment that has been mentioned in the previous section and survive for a long time after treatment. The most important factor in survival after a diagnosis of breast cancer is the stage at presentation. The earlier the stage for example Stage 1 versus the other stages 2 to 4, the better the outcome of treatment leading to longer the survival. It is therefore recommended that regular screening be done so that breast cancer is caught early when it is curable.