LILIAN NUWABAINE: What everyone should know about Breast cancer

In a global effort to raise awareness on breast cancer, October has been designated annually as the Pink Month.  The Pink Month is a month where there are efforts to educate everyone about breast cancer including early identification and signs and symptoms associated with breast cancer.

In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally. As of the end of 2020, there were 7.8 million women alive, who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life.  
Nearly one-half of Ugandan women who are diagnosed with breast cancer will die of their disease. These high mortality or death rates can be attributed to a late stage at diagnosis for women with breast cancer, with up to 89% of women in Uganda presenting at the hospital with stage III or stage IV disease, a time at which breast cancer is more difficult to treat and the outcomes are poor.

Hence, increasing the capacity for the early detection of breast cancer via early diagnosis or screening programs, in combination with improving access to appropriate and timely diagnosis and treatment, are critical to improving outcome.

Who is at risk of getting breast cancer? 

Unlike some cancers that have infection-related causes, such as human papillomavirus (HPV) infection and cervical cancer, there are no known viral or bacterial infections linked to the development of breast cancer. Breast cancer is not a transmissible or infectious disease. 

Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years).  

Certain factors that increase the risk of breast cancer include; increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use and postmenopausal hormone therapy. 

Behavioural choices and related interventions that reduce the risk of breast cancer

These include: prolonged breastfeeding; regular physical activity; weight control; avoidance of harmful use of alcohol; avoidance of exposure to tobacco smoke; avoidance of prolonged use of hormones; and avoidance of excessive radiation exposure. Unfortunately, even if all of the potentially modifiable risk factors could be controlled, this would only reduce the risk of developing breast cancer by at most 30%. 

Signs and symptoms of breast cancer

Generally, symptoms of breast cancer include: a breast lump or thickening of the breast, alteration in size, shape or appearance of a breast, dimpling, redness, pitting or other alteration in the skin; change in nipple appearance or alteration in the skin surrounding the nipple (areola); and/or abnormal nipple discharge.

Medical treatment of breast cancer

Breast cancer treatment can be highly effective, achieving survival probabilities of 90% or higher, particularly when the disease is identified early. Treatment generally consists of surgery and radiation therapy for control of the disease in the breast, lymph nodes and surrounding areas and systemic therapy (anti-cancer medicines given by mouth or intravenously) to treat and/or reduce the risk of the cancer spreading (metastasis). Anti-cancer medicines include endocrine (hormone) therapy, chemotherapy and in some cases targeted biologic therapy (antibodies). 

The author is Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s’ Health Specialist working with Aga Khan University & the Heroes in Health Award Winner-Midwife of the year 2021