Act Fast, Act Now
By Priyangwada Perera
“If you are above 35 years, at least one basic mammogram for life is an essential requirement advised by the WHO. Mammography has minimum radiological exposure. It is not painful. The beauty of doing a mammograph is such that even the very early stages of breast cancer where very tiny or micro calcifications are present can be detected. Two radiologists look at one mammogram. That is the standard. Two years before you can feel the lump, microcalcifications can be detected if you get yourself checked which makes a world of a difference.
“If microcalcifications are detected, a minor surgery can be done. With a Needle Local Aspiration, we remove the microcalcification which is the start of breast cancer. You will not then get it again. Your breast is preserved. That is why a mammogram is very important,” said founder of Cancer Care Association, Dr. Samadhi Rajapaksa.
Every year, the month of October is named the Pink Month, in commemoration of World Breast Cancer Awareness Month. Why is it so important? Globally and even in Sri Lanka, it is the most common form of cancer. Apart from the 1 per cent males who get it, breast cancer is the commonest cancer in females. If a male gets breast cancer, it is more aggressive. After all, males have very little breast tissue, so it spreads. But we are talking of female breast cancer. Dr. Samadhi Rajapaksa, simplified the bigger picture.
“In Sri Lanka, there are eight-10 new cases diagnosed every day. That makes it 3,000-3,600 new breast cancer patients in Sri Lanka every year. These statistics are calculated going only by the patients recorded in our centres. We have nine cancer treatment centres in the nine provinces plus the sub district centres. Those who come to these treatment centres are those we count. Therefore, the figure should be higher than this as people go to other places or just keep quiet. Every day, two breast cancer patients die of breast cancer. That makes it 60 patients a month - 750 patients a year. But the positive part of it is that, if detected early, this is a cancer that can be cured 100 per cent. It is also sad to think that such a curable disease has a sad ending due to ignorance. Globally why we speak of breast cancer the entire October is because we need to raise awareness.
How to detect early
“Awareness is crucial. Every female should understand the importance of screening themselves. To diagnose, you have to have a triple assessment. One should be clinically diagnosed, radiologically and histologically diagnosed. Now they say, every female from the age of 20 should start self breast examination. Earlier we gave the age group as older. Even now, in Sri Lanka, the most prevalent age group is 50-60-year-old females. But now breast cancer is becoming younger. Twenty year olds, too should start self breast examination.”
Dr. Rajapaksa said the self breast examination should be done monthly. “That is only 12 times a year,” he said. But there are things to be mindful about. When should the examining be done? “If you have regular periods, then every 28 days you are on menstruation. Avoid that period. Some females have slight pain in the breast when menstruating. It is better to check a week after your periods are over because you are sure. This can be done while bathing, taking a body wash, changing your clothes, standing or lying down.
Dr. Rajapaksa explained in simple terms. “With your right hand, check your left breast and the right breast with your left hand. Check from top to bottom. Do not squeeze. Take the four fingers, from the tip of the finger to the second phalange there is a good surface. Check the underarm as well. One need not have to be an expert for this. Who knows the best about your breast? It is you. You know the size, the changes and so on.
According to Dr.Rajapaksa, one should feel for three things. Any pain or tenderness which is not normal. Under normal circumstances, breasts are not painful. Any lump or a swell which is new is important. Gently squeeze your nipple. If you are a breastfeeding mother milk may come. That can be ignored. But if you are not a breastfeeding mother and if something comes out, that is a sign.
“If in February you do not feel anything but in March you feel tenderness or feel it is swollen, then you must act immediately. If you find one or a few of these, you could tell it to your mother, daughter or your husband. Do not hide. Tell it. You can tell it to the midwife, nurse, your doctor, your doctor-friend. Tell them you felt something like this. Then the clinician will refer you to the right person. You need not run to a specialist at the first go. But do not postpone. Do not give excuses that you cannot get hold of the best doctor, there are no channel numbers available and so on. Just go to your family doctor or midwife. Do not miss it. Do not postpone. Time is crucial and precious,” Dr.Rajapaksa emphasised.
A clinician equipped with clinical knowledge can feel the breast and refer one to a radiologist for an ultrasound scan or a mammogram. If the hardness or the lump is prominent, the doctor sends you to a histopathologist or surgeon to take a fine needle aspiration. It is a simple procedure done under local anesthesia where a tiny needle is inserted to take a biopsy. “Remember, most of these felt lumps are not malignant. They are ‘innocent lumps’. So, if you feel something, do not panic. Just tell it. Go to the doctor and get yourself checked. Histological examination is if you have a lump you get a FNAC or fine needle aspiration and a pathologist can decide.”
Who is at risk?
There is an unmistakable familial pattern to breast cancer. In Government hospitals, you can request for a family screening, if the one above you -your mother, one below you - your daughter and one lateral in the family tree – your elder or younger sister has breast cancer. The family tree is one determination whether you are at risk. If you do, you must check yourself and get professional help where required.
Next are the etiological factors. There are preventable risk factors and unpreventable ones. Of the latter, one is being a female. Next is the age. With aging, one is more prone to cancers. Next is the genetic predisposition. But all these contribute only 10 per cent. The other 90 per cent is preventable. Early menarche means you are active in your hormone function. Breast cancer is hormone related. Late menopause is the other. Normally, by 50-53 years one has menopause. But if you go further without menopause, it might be risky.
Dr. Rajapaksa added that in Sri Lanka, younger and younger girls attain puberty. The average age used to be 10-12 years, yet now they attain age at five or six years. Sometimes before even starting school. Your eating patterns, use of alcohol, smoking, obesity and physical inactivity contribute to breast cancer. “Self-examine your breast. If you are alert, you can protect yourself. Don’t get caught up in the social stigma - the big C of Cancer. It is not contagious. It is not a death certificate. It is not your karma and it is not that you have done bad things in a past life. Cancer treatment is expensive. But you have to get it done. The process is long, painful, stigmatised and takes money. Yet, remember breast cancer does not occur overnight. If you are alert you escape it all.
“Every day 10 people are diagnosed with breast cancer. If you detect it in Stage I or II, it is 100 per cent curable. We now have minimal invasive methods. You don’t have to remove the breast. Even if it is removed it can be reconstructed with the nipple itself. We have all types of brilliant doctors here. You do not have to undergo all kinds of immunotherapy, chemotherapy, target therapy or radiotherapy. Mere removable of that bit is enough if you detect it early,” said Dr. Rajapaksa.
In other countries, every year one has to get oneself checked. That is what we also should do. From a diagnosis to the last hormone therapy (which is very expensive), for one breast cancer patient the Government roughly spends nine million rupees. If every female gets herself checked before it is too late, you save yourselves and the country money. The Sri Lankan Government medical system still gives you royal treatment all for free. Even topography is available. “Husbands should pay attention to their wives,” he said.
“The month of October is known for many International Days. We ignore that October is also World Breast Cancer Awareness month. The WHO declared it so, because breast cancer is the most common cancer among females in 140 countries in the world”, said Consultant Community Physician Dr. Nayana De Alexis, from the National Cancer Control Programme (NCCP).
“Plus the number of new cases is going up even in developed countries. The increase can partly be due to awareness. Women are more vigilant and there is diagnosis and more cases are reported now than ever before. Apart from that, it can be due to the ambiguous nature of breast cancer where a definite cause is not recognised. We only know the risk factors,” Dr. De Alexis elaborated. Dr. De Alexis said that means we know somebody’s chances of getting the disease. However, that does not mean everybody who has a chance is bound to get breast cancer. She elaborated that there are several risk factors identified by scientific research. So, women are informed to be cautious. Apart from the dietary and lifestyle changes, there are no other precautionary methods. “Even if you cannot prevent it, there is always the possibility of early detection. If you detect it early, it is curable. There are simple surgeries. Cost for the Government is less; the patient’s quality of life is improved. Due to this, we as the NCCP do a lot of awareness campaigns and the media is involved,” she said.
Breast Cancer can be beaten. Act fast. Act now.