FEATURE: Breast Cancer - A preventable menace

Breast cancer is one disease that is troubling people all across the globe. Research has shown that breast cancer is now the most common cancer in women with an estimate of 1.67 million women affected as at 2012. It constitutes 25% of all the cancers that affect women. This cancer affects all breasts- be it male breasts or female breasts. It has a male incidence of 1% globally. Of all cancers that can affect humans, breast cancer forms 11% of them. The incidence rates across the world vary, with approximately 27 people affected out of every 100,000 people in Africa and Asia; and as many as 92 persons affected out of every 100,000 in the United States of America (USA). However, the US has the least mortality rates with 2 people dying out of the 92 affected and as many as 20 people dying in Africa and 6 in Asia (Clegg-Lamptey, 2018). The varying mortality rates have been attributed to stages at which detections are made across the different countries. Judging from the above, the time of detection is influential in the mortality of cancer patients.

In Ghana, the Korle Bu Teaching Hospital (KBTH) exclusively records 400 new cases every year. Of this annual diagnosis, about 2.4% (approximately 10) are males. Out of about 2,260 cumulative cases, 1,021 people have died so far. The age group mostly affected is between 40 and 49. About 60-70% of patients go to seek medical attention only at very late stages of the cancer when little or nothing can be done about their situation. Most people present as late as after 6 months after noticing signs- medics can only do little to help the situation at this stage (Clegg-Lamptey, 2018).

Causes of Breast Cancer

Researchers have still not concluded on the exact cause(s) of breast cancer. However, certain predisposing factors are associated with it. These factors have been discussed below.


Age
The risk of getting breast cancer increases with increasing age. It is rare before age 20 and its incidence rises steadily from 30-80 years before it flattens (Archampong, Naaeder & Ugwu, 2015). The highest incidence is observed to be in the fifth decade of one’s life.

Genetic predisposition
There seems to be an inherited predisposition to breast cancer. In cases where one’s mother, aunt or sister (first degree relative) has had the disease, there is a greater risk of one acquiring it. Hereditary breast cancer is associated with an early age of onset, bilateral breast disease, multiple cases in one side of the family and is related with other cancers like ovarian, colonic or prostate (in men) cancers. However, it is worthy of note that eight out of nine people who develop breast cancer do not have an affected first degree relative; hence, hereditary breast cancer accounts for only 5% of all breast cancers (Archampong et al., 2015).

Prolonged oestrogen exposure
A longer duration of exposure to oestrogen is associated with a greater risk of one developing breast cancer. The body is exposed the more to oestrogen due to the following factors: early onset of menstruation and late menopause, having a first child after age 30, not having any children at all (nulliparity), and oestrogen in hormone replacement therapy and combined contraceptives (Archampong et al., 2015).

Previously treated breast cancer
About 6% of patients who present with breast cancer have had correction of cancer of the other breast previously. The risk of recurrence is about 16 times higher than in the normal population (Archampong et al., 2015).

High dietary fat
Westernization of diet is associated with a higher risk of breast cancer. Foods with high fat content are probably associated with an increased production of oestrogens and other steroids, leading to a higher cancer risk.

Radiation exposure
Radiations like X-rays are likely to cause mutations in all body cells of which breast cells are no exception.

Postmenopausal obesity
High dietary fat with the related excess fat storage in the body, especially after menopause, is likely associated with high oestrogen production with its related high breast cancer risk.

Alcohol intake and smoking
Continuous alcohol consumption is associated with a greater risk of breast cancer due most likely to increased production of oestrogens. Smoking in itself is not a risk factor, but when combined with a genetic defect, which makes the body unable to detoxify the carcinogens in cigarette, the risk is increased about four times than in the normal population (Archampong et al., 2015).

Symptoms

Early detection of this menace can save many lives. Women and men are encouraged to conduct monthly breast self-examinations to allow for early detection of any of the features of breast cancer. This can aid in taking early steps by rushing to the hospital for correction. The features of breast cancer include:
• a breast lump,
• gross asymmetry in the sizes of the breasts where one breast looks either extremely bigger or extremely smaller than the other breast,
• changes in the nipple area which include nipple retraction, where the nipple is pulled into the breast,
• bloody nipple discharge,
• skin changes on and around the breast which consist of peau d’orange, where the skin resembles the skin of an orange,
• ulceration or sores on the skin and nodules,
• tethering or dimpling where there is a dimple on a part of the breast,
• changes in the armpit area which could include ulceration and nodules,
• Swelling of one arm due to blockage of the free flow of lymph from the arm.
Some of the symptoms which point to spread of the cancer include breathlessness, indicating spread to the lungs; jaundice, ascites (swelling of the abdomen due to accumulation of fluid), pointing to spread to the liver; spread to the brain leading to unconsciousness and confusion; and bone metastasis giving rise to high blood calcium levels and pathological fractures.

Preventing Breast Cancer

Prevention of breast cancer heavily hinges on early detection and also cutting down on some of the predisposing factors. To prevent breast cancer, one could engage the principles outlined below:
• a regular (monthly) breast self-examination,
• reduction of oestrogen exposure by reducing/stopping the intake of oral contraceptive pills and trying other birth control methods,
• maintaining/reducing one’s weight, especially after menopause,
• reducing dietary fat intake,
• Reducing alcohol intake and avoiding smoking.

Men and women are encouraged to perform breast self-checks every month. Women in their reproductive ages can do it a week after their period. Men can choose a day every month to examine their breasts, and so can women in their menopausal years. The examination involves standing in front of a mirror with both breasts exposed and observing the breasts closely by leaning forward and moving backward. After, one should lift both hands and observe the area under the breasts. From here, one should then proceed to feel all the areas of the breasts with the flats of the finger (not the finger tips) whiles watching out for any of the signs of early breast cancer. This link here can be helpful (https://www.youtube.com/watch?v=_0_O-Df8ET8).

Conclusion

Breast cancer is a silent killer; it is painless in its early stages. One should therefore rush to the nearest health center upon detection of any of the aforementioned symptoms. Do not wait for such symptoms to get painful. Breast cancer, though prevalent in the ages of 40-49, can occur in someone as young as 20 years and in a person as old as 80 years. Most people present in the late stages when little or nothing can be done, hence the call for early detection. Breast cancer is real. Don’t be a victim!