Sat | Nov 25, 2017

Garth Rattray | Stay abreast of breast cancer

Published:Monday | October 23, 2017 | 12:00 AM

Breast cancer is scary and it's the most common cancer in women. It is estimated that one in eight women will probably develop breast cancer. In spite of the advances in medical science, it remains a serious threat to all women.

The risk of developing breast cancer is increased in women with a strong family history of the disease, women who have no children, women who can't or don't breastfeed (for whatever reason), and women who have drifted far above their healthy weight. In spite of all that, most women who are diagnosed with breast cancer are from the 'low-risk' group, but there is no place for overconfidence or complacency.

Early detection is the mainstay in the fight against breast cancer. There are only two cancers that can be prevented - colon and cervical cancer. They can be prevented because we can detect precancerous changes and intervene in a timely manner before those changes lead to cancer. We depend on early detection of all other cancers in order to decrease suffering and improve long-term survival.

Over 80 per cent of breast cancers are found by the patient herself. Many women complain to me that they don't know what they are feeling or what to feel for. I always tell them to just examine their breasts monthly. They know their breasts better than anyone else, so if something new pops up, go to a doc or to the Jamaica Cancer Society.

Because breast cancer is usually painless, women need to do regular breast self-examination. The first thing to do is to look at the breasts in a mirror. Look at them with the arms by the side, then with both arms raised above the head, and then lean forward to see if they swing away from the body evenly. Look for unusual bulging, nipple retraction or dimpling elsewhere on the breasts. Look if there is any nipple discharge or rash/eroding of the skin around the nipple.

 

CHECKING THE BREAST

 

Then, check the breasts by feeling (palpating) them. This can be done while standing, usually when in the shower where the water provides the lubrication to glide over the skin. Or, it can be done while lying flat on the back.

In both instances, the arm on the side of the breast being examined is held overhead to flatten out the breast tissues. The other hand is placed on that breast with fingers outstretched and kept together. The examination begins by squeezing the nipple and looking for a discharge. Then, the flattened fingers are pressed against the breast and the hand is moved around the nipple in a circular motion and pattern, making certain to cover all areas as the circle spirals outwards towards the edge of the breast. Press down and glide, do not knead the breasts. Women should also examine their armpits, since it is important to report any lumps felt in those areas.

Screening involves breast examination by a medical professional and is followed by an investigation. The investigation includes a mammogram and possibly an ultrasound. The mammogram is an X-ray. It is not high dose and has not been implicated as a cause of breast cancer. It involves flattening the breasts and then X-raying them. Some women find the procedure to be very uncomfortable, but this is not true for everyone, and it is worth the brief uneasiness.

The mammogram might be followed by an ultrasound. This is done in instances where the breast tissue is thick or if something found requires investigation outside the scope of an X-ray.

Some centres use digital mammograms for better resolution. There is also the adjunctive breast specific gamma imaging, which utilises a contrast medium. It is about 95 per cent sensitive and useful for dense breasts. Finally, there is magnetic resonance imaging of the breasts. It also utilises a contrast. It's used for detailed, high-risk screening or for high-resolution imaging of suspicious masses or for cancer staging. All suspicious masses are subjected to some form of biopsy.

Currently, the most important weapon in the fight against breast cancer is early detection through self-examination and annual screening. Early detection can save your life and it may even save your breast. Women, your life is literally in your hands.

- Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.