Features | Online edition of Daily News

Delay in pregnancy and using Hormone Replacement Therapy can lead to breast cancer. Changing lifestyle in the Asian countries including Sri Lanka is pushing women to become victims of breast cancer, says Oncological Surgeon Dr. Naomal Perera.

Though breast cancer is the the most prevalent cancer among women in the world, its prevalence is relatively low here compared to the West.

How to identify?

Self examination of breasts


Step 1	Step 2

Step 4

Step 3

Step 1

Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
Here's what you should look for:
Breasts that are their usual size, shape, and colour.
Breasts that are evenly shaped without visible distortion or swelling

Step 2

Raise your arms and look for the same changes.
While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).

Step 3

Feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.

Cover the entire breast from top to bottom, side to side-from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Step 4

Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower.

Cover your entire breast, using the same hand movements described in the earlier step.

(Courtesy: breastcancer.org)

Western cultural patterns, food habits and birth controlling have significant impact in the high prevalence of the disease in these countries and now even Sri Lanka is treading the same way, the Oncological Surgeon warned.

'In Sri Lanka breast cancer prevalence is 10 times less. But the changing life patterns have a significant impact in raising the threat," he said. However there are other risk factors that make women prone to develop breast cancer.

Risk factors

Although it is very difficult to identify as to why certain women develop breast cancer while others do not, the root of the breast cancer is linked with hormonal influence on the breast cell, says the Surgeon.

Dr.Perera says there are certain risk factors that make women prone to develop breast cancer. A risk factor is something that may increase the chance of developing a disease. Women with one or more risk factors are at a greater risk in developing the disease, he says.

Age: Women who attain early menarche face an increased risk of breast cancer. Since hormonal influence may damage the gene of a cell in the breasts altering it, the women who had their first menstrual period at the early age and attain menopause late, experience more menstrual cycles in their lives. In other words, the breast cells of those women are subjected to prolong stimulation by hormones which could result in damage to the genes of a cell leading towards a breast cancer.

Family history: Family history is another important risk factor in developing breast cancer. If your immediate family member/s or relatives have had a history of breast cancer then you might be at a risk. Those women with a family history of breast cancer should screen and examine themselves regularly for breast cancer to identify a cancer at an early stage, the doctor advised. However, in Sri Lanka unlike in the West familial cancers are not very common though proper studies have not been done.

Delay in pregnancy: Pregnancy reduces the risk of breast cancer. During pregnancy, the menstrual cycles stops and the absence of hormonal influence in the breasts keep the risk of breast cancer at bay. The women who delay pregnancy through contraceptives and hormone pills for long (more than five years) are at danger.

HRT- Women on Hormone Replacement Therapy (HRT) for a long period to delay menopause are at a high risk of getting breast cancer, the Surgeon says. Delaying the menopause means your body experience more menstrual cycles the number of times the hormones attack the breasts will also be more.

If you have one or more risk factors it is advisable to meet a consultant to prevent future mishaps, the doctor said.

However, a direct link of food habits, smoking and consuming alcohol with breast cancer is not confirmed.

Formation of breast cancer

Brest cancer forms with one genetically altered cell in the breast. The bad cell multiplies during a course of time and the doubling of bad cells takes around 90 days.

The cancer cells which have certain immortal behaviour spread in the breast destroying the normal cells. Once it forms a substantial number, enough nutrients will not travel into the centre of the cell mass which ultimately makes blood vessels growing into the tumour to supply the nutrients for the cells to grow.

Dissemination through these newer blood vessels and lymphatics results in spreading of the cancer cells into other organs such as lymph nodes, bone, liver, lungs and brain.

The cancer cells proliferate harming the entire system and it disseminates initially to armpits. Later, those spread to the liver, brain, bones and lungs.

Diagnosis

Oncological Surgeon Dr. Perera says if diagnosed at the very early stage, the possibility in curing the patient could be almost 90 percent.

"If diagnosed early, breast cancer can be treated successfully," he said. It takes at least six to seven years to form a tumour of 0.5 to one centimeter size. If the tumour is less than five centimetres it is considered as the early stage. If it was diagnosed when it is two to three centimeters the chances of saving life is very high, he said.

However, if it is grown over five centimeters or disseminated to other organs it has reached the advanced stage. The chances of survival is very low (5 year survival is less than 30 per cent.)

According to Dr. Perera the self examination of breasts should be conducted once a month just after menstruation.

Screening mammogram

This method is very popular in the West but Sri Lanka lacks facilities and funding to apply this. In developed countries all women above 55 years undergo mammographic screening.

The symptoms

Feeling a lump in the breast or a blood stained nipple discharge would be symptoms of breast cancer. In addition, if the breast getting bigger than the normal with redness of the skin over the breast like the skin of an orange and persistent pain in the breast could be possible signs, he said.

Itchiness in the nipple could be another sign which is not very common. This type of breast cancer is known as Paget's disease and indicates an underlying cancer of the breast.

Treatment

Once diagnosed breast cancer can be treated according to the stage of the disease. If it is diagnosed at the very early stage, a portion of the breast (Breast conservation surgery) can be removed through a surgery. If the cancer has reached the advanced stage then the total breast with the nodes in the arm pit will be removed entirely. Other than that chemotherapy, radio therapy and hormonal therapy are used to treat breast cancer.

After surgery, depending on the pathology report, radio therapy treatment will be carried out for one month and chemotherapy for six months.

After seven months the patient should undergo regular checkups. Check ups are done to identify a recurrence on the side of the disease, occurrence of a new cancer on the opposite breast, and possible occurrence of deposits in other organs. Ultra sound scanning of the abdomen, chest X ray, Bone scans are done to identify any possible spread to other organs. These tests should be performed once in six months or annually and mammography every year, he said.

Breast reconstruction

The breasts can be reconstructed even after being removed entirely, avoiding social embarrassment. The breast can be reconstructed with silicon implants and by replacing the skin with the skin of the abdomen or upper back. The Maharagama Cancer Hospital and Badulla Provincial Hospital has carried out breast reconstruction successfully, he said.

Dr. Naomal M.A. Perera is Breast Surgeon/ Oncological Surgeon, Apollo Hospital, Colombo