October is observed as International Breast Cancer Awareness month. According to the Cancer Association of South Africa (CANSA), breast cancer is one of the most common cancers among South African women. A diagnosis, however, does not have to be a death sentence, if it is detected early.
Q. When should I visit a breast clinic and why?
A. You should visit a breast clinic or health professional if you have any worrying symptoms such as a painless breast lump or a bloody nipple discharge. If you are a woman aged 40 years and above, you should visit the breast clinic for a general check-up and to schedule a mammogram. If no abnormalities are found in your check up or mammogram, then you should usually follow up once every year or two.
Q. Who should visit a breast clinic?
A. All women of any age who have any symptoms to cause concern, but more especially older women with painless breast lumps. If there is a history in your family of breast or ovarian cancer, then you should visit the clinic for a check-up, even if you don’t have any symptoms.
Q. Should I worry about a lump in my breast?
A. Many breast lumps, especially in very young women, may be benign or non-cancerous. Generally, the lumps that are more worrying are in older women (over the age of 35), painless breast lumps with lumps in the armpits as well and lumps that are growing in size very quickly. However, any new breast lump that is felt should at least be examined by a doctor or an experienced nurse.
Q. How does breast cancer develop?
A. Breast cancer most commonly begins when the cells within the milk ducts of the breast begin to multiply uncontrollably to eventually form a cancerous growth.
Q. How are the different stages of cancer, determined?
A. Breast cancer can essentially be divided into 3 main types:
• Early breast cancer: which means that it is a small cancer within the breast and armpit and has not spread to any other organs.
• Locally advanced breast cancer: this is a big cancer in the breast and often involves the skin or the muscle underneath the breast. There may also be very large lumps under the armpit. However, the cancer may not yet have spread to the other organs.
• Metastatic breast cancer: this is also called Stage 4 cancer, where there is now evidence that the cancer has spread to distant organs such as the lung, liver, bones or brain.
We usually determine the spread of the cancer by doing a few tests such as a chest x-ray, a sonar of the liver and blood tests. Sometimes we need to do a CT scan to see how far the cancer has spread.
Q. What are the treatments for breast cancer?
A. There are four main treatment options for breast cancer:
• Surgery, which may involve removing the entire breast (mastectomy) or conserving the breast and removing the cancer (lumpectomy).
• Chemotherapy (very strong treatment given by drip, that kills rapidly dividing cells such as cancer cells in the bloodstream). This is usually given every 3 to 4 weeks over a period of six months
• Radiation: this is a very intense form of x-ray given to the breast cancer to kill off any remaining cells, often after surgery is performed. This treatment is meant to reduce the chance of the cancer growing back in the breast.
• Hormone/Endocrine treatment: this is called target treatment and it acts on very specific cells of a tumour. Not all tumours will respond to this type of treatment. It is given as a tablet, usually taken every day for a period of 10 years and the commonly used tablets are Tamoxifen or Anastrozole.
Q. How do we decide what type of treatment you will receive for breast cancer?
A. It’s important to remember that just as every patient is different, every cancer is different and how we decide which patient gets which treatment depends on a number of different factors. For example, we will usually start with surgery as the first treatment in early breast cancer, however if the cancer is too big or has spread to other organs when initially diagnosed, the first treatment is often chemotherapy followed by surgery and radiation. Also, if a patient is too old or frail for chemotherapy we may consider endocrine or hormone as a safe first treatment. All decisions about how to treat breast cancer are made in a multidisciplinary forum with the different specialists involved.
Q. Can I still breast feed with the other breast after removing the one?
A. Yes, breastfeeding may still be possible with the remaining breast after a mastectomy on the other side.
Q. Is there anything that can help prevent breast cancer?
A. There are certain factors (like an increased genetic risk) that patients have no control of, however factors that can be controlled that may decrease your chances of developing breast cancer include: having an active lifestyle with plenty of exercise, a healthy diet, reducing alcohol and cigarette use. Also important is that women know to seek help if they notice any worrying symptoms and to have regular check-ups from the age of 40 onwards.
Q. Is South Africa winning the battle in fighting cancer? Please explain.
A. Although South Africa is still regarded as a third world country, we have made great strides in the treatment of cancer in our patients, breast cancer in particular.
Women even in the public sector have access to first world treatment modalities and specialist care. With increased awareness campaigns, NGO drives and many government initiatives, women are being diagnosed more and more with earlier stages of breast cancer, thus enabling earlier and more successful treatment and better survival.
There are still many issues to overcome, particularly in the more rural parts of South Africa where access to health care is still very difficult.
But overall, we are definitely moving in a forward direction in the battle against cancer.
Dr Nivashini Murugan
Specialist Surgeon, Breast Oncology
Senior Surgical Consultant
Chris Hani Baragwanath Academic Hospital