Dr Anirban Banerjee (MS,MRCS) – Consultant Surgeon
Screening of breast cancer
Screening is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike most medical practice when screening for a disease, tests are performed on those individuals without any clinical signs of disease.
Self breast examination.
Mammography
Self breast examination
Do you know how to do a
self breast exam?
The self-exam should be done each month. Pick a day and try to be consistent.
The steps to follow for a breast self-exam:
Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Look for any changes in the size, shape, and colour. Look for any dimpling, puckering, or bulging of the skin. Has the nipple changed position or become inverted? Is there redness, soreness, a rash, or swelling?
Now, raise your arms and look for the same changes.
Next, feel your breasts while lying down, using your right hand to feel your left breast so that no areas are missed. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage. 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 Step 4.
Gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).
If you find any changes,
lumps, or nipple discharge,
see your physician
Mammography
What is a mammogram?
A mammogram is an x-ray of the breast. Mammograms can be used to check for breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a screening mammogram.
Screening mammograms usually involve two x-rays of each breast. They make it possible to detect tumours that cannot be felt. Screening mammograms can also find micro calcifications (tiny deposits of calcium) that sometimes indicate the presence of breast cancer.
Mammograms can also be used to check for breast cancer after a lump or other signs or symptoms of breast cancer have been found. This type of mammogram is called a diagnostic mammogram. Signs of breast cancer may include pain, skin thickening, discharge from nipple, or a change in breast size or shape.
What is the recommendation for women to have screening mammograms?
Women aged 40 and older should have
mammograms every 1 to 2 years.
Women who are at higher than average
risk of breast cancer should speak with
their health care providers about whether
to have mammograms before age 40 and
how often to have them.
What are the factors against routine mammograms in women?
Studies have identified a number of barriers to mammography screening. Some may be overcome with health education; others require programmes to make mammography more accessible for women.
The commonest reasons according to women are:
“I don’t need a mammogram because my doctor has never recommended it.”
“I’ve never thought about it.”
“I have no breast problems, so mammography isn’t necessary.”
“I have had a mastectomy (double mastectomy, radical mastectomy) and don’t have breasts.”
“I don’t have a family history of breast cancer.”
“Fear about pain from the procedure.”
“Fear of a diagnosis of breast cancer.”
“Concerns about costs.”
“Concerns about the financial burden of further diagnostic procedures and treatment, if needed, after doing a mammogram.”
“No routine source of health care.”
“Physical distance from screening facilities.”
STAGES OF BREAST CANCER
What is early breast cancer?
Stages I, IIA, IIB, and IIIA are considered “early-stage” breast cancer and refer to invasive tumours that may have spread to nearby areas but not to distant parts of the body.
What is advanced
breast cancer?
Breast cancer is considered advanced when it has spread from its original site to distant areas of the body. There are two different ways advanced breast cancer can be classified: locally advanced or metastatic. The term locally advanced breast cancer indicates that the cancer is large and may have spread to underarm glands. Locally advanced breast cancer is considered Stage III. The term metastatic breast cancer (stage IV) indicates that the cancer has spread from the breast to other parts of the body such as bone, lung, liver, or brain.
TREATMENT OF BREAST CANCER
How can we detect the breast cancer early?
One of the earliest signs of breast cancer can be an abnormality that shows up on a mammogram before it can be felt. The most common signs of breast cancer are a lump in the breast. Finding a lump or change in your breast shape does not necessarily mean you have breast cancer. Additional changes that may also be signs of breast cancer include:
Any new, hard lump or thickening in any part of the breast.
Change in breast size or shape.
Dimpling or puckering of the skin.
Swelling, redness or warmth that does not go away.
Pain in one spot that does not vary with your monthly cycle.
Pulling in of the nipple.
Nipple discharge that starts suddenly and appears only in one breast.
An itchy, sore or scaling area on one nipple.
What is the treatment for breast cancer?
The basic treatment choices for breast cancer are surgery, radiation, chemotherapy, and hormonal therapy, depending on hormonal dependence of the growth of the tumor.
Surgery may be performed to remove the cancerous tumour, and may also be performed to allow diagnostic testing of tumour tissue (Biopsy).
Radiation therapy uses penetrating beams of high-energy waves or streams of particles to kill and hinder the growth of cancer cells.
Chemotherapy may be used if it is believed the breast cancer will not respond to hormonal treatment. Chemotherapy is the use of drugs that target and destroy rapidly dividing cells, including cancer cells. It is frequently used in metastatic breast cancer and used in locally advanced breast cancer to shrink the tumour and make it amenable to surgery.
Hormonal therapy can be used to retard the growth, spread, and recurrence of breast cancer. If the cancer is found to be of the type that may be sensitive to estrogen, hormonal treatment (anti-estrogen) may be able to keep estrogen from helping the cancer cells to grow and divide.
