Tue | Jan 15, 2019

Breast cancer may be dreadful BUT there is hope!

Published:Wednesday | October 18, 2017 | 12:00 AMDr Derria Cornwall
Dr Derria Cornwall
Breast cancer
Breast cancer


Breast cancer remains a major national (and international) concern. The breast is the leading site for cancer in females in Jamaica.

Currently, approximately 43 out of every 100,000 women in Kingston and St Andrew have breast cancer and it is predicted that one out of every 21 women in Jamaica will develop breast cancer in her lifetime.

Breast cancer causes serious burden on our local economy for provision of health care. In addition, the social implications of this disease are also enormous. Women are essential to our social framework (being mothers, wives, caregivers, workers and, in some cases, breadwinners).

The diagnosis of breast cancer not only affects the individual but her family and the community at large. The cost of treatment is huge and could deplete one's financial resources in a short period of time. This is especially so if the disease is not detected early (preferably before the patient has any signs or symptoms of the disease).




These signs can include: breast lump, bloody nipple discharge, a change in breast size or shape or dimpling of the skin of the breast. With dimpling of the skin, the skin has the texture of an orange peel. Less common signs include: breast swelling and redness or an enlarged underarm lymph node.

The best time to detect breast cancer is when there are no signs. This is because there is a high possibility that the disease is in its early stage, if there are no signs as yet. It is well known that detection of breast cancer in its EARLY stage results in the best possible chance for CURE of this disease.

This brings lots of hope; however, EARLY DETECTION is vital.




How then can we detect breast cancer early?

Answer: by doing a mammogram.

Mammography is considered the most powerful breast cancer detection tool for early-stage disease. A mammogram is an X-ray exam of the breast that is used to detect and evaluate breast changes. Mammograms are not only used in women who have signs and symptom of breast disease. It can also 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.

During a screening mammogram, two X-ray pictures, or images, of each breast are usually taken. These X-ray images make it possible to detect changes/tumours that cannot be felt.

These changes include micro-calcifications. Micro-calcifications are tiny deposits of calcium that look like 'grains of salt' that sometimes indicate the presence of breast cancer. These micro-calcifications are usually too small to be felt by either breast self-examination or breast examination by a health-care professional. These micro-calcifications may be difficult (if not impossible) to be seen on ultrasound.

Mammography is considered the most powerful tool for detection of these micro-calcifications.




All women who are 40 years and older should have a screening mammogram done every year (even if they do not have any signs or symptoms of breast disease and even if they do not have any family member with this disease). Almost 85 per cent of women who get breast cancer do not have any one in their family with this disease.


Some women may need to start doing screening mammogram before the age of 40 years old because they are at increased risk for getting breast cancer.

These include:

1. Women with mother, sister or daughter (first-degree/close blood relatives) who were diagnosed with breast cancer are at increased risk for getting this disease.

Having one first-degree relative with breast cancer almost doubles a woman's breast cancer risk. Having two first-degree relatives increases her risk about threefold. Having a first-degree male relative with breast cancer also raises a woman's risk.

2. Women, who as children or young adults were treated with radiation therapy to the chest area for another cancer (such as Hodgkin's lymphoma), have a significantly increased risk for breast cancer.

3. Women with a known defect (mutation) in genes such as the BRCA1or the BRCA2 gene inherited from a parent (or less commonly other genes such as PTEN or TP53) are at increased risk for breast cancer.

All women in any of the three categories above should talk with their health-care providers about starting mammograms before age 40 and how often to have them. In addition to routine mammograms, MRI or ultrasound examinations may be required in these high-risk populations as recommended by your health-care provider.


Given the demographic pattern of breast cancer in Jamaica (a predominantly black population), we are considering that women between the age of 35 and 39 years old should also be allowed to be screened for breast cancer by doing a mammogram, even if they ARE NOT in any of the three categories listed above, DO NOT HAVE family members with this disease or DO NOT HAVE any signs or symptoms of the disease.

Breast cancers that are found because they are causing symptoms tend to be larger and are more likely to have already spread beyond the breast at the time of diagnosis. We know that waiting until you feel a lump during a breast self-examination might mean you may already be in a later stage of the disease, so our goal is to detect cancer long before a woman can feel it.

Early detection tests for breast cancer (such as mammogram) save thousands of lives globally each year. Many more lives could be saved if even more women took advantage of these tests.

We are blessed to have such splendid technology as mammogram available as a weapon to detect breast cancer early and help in the fight against this disease.

HOWEVER, it is only effective if we utilise it. Do not delay; schedule your mammogram TODAY!


- Dr Derria Cornwall, MBBSDM, is the president of the Jamaica Association of Radiologists.