Breast cancer matters: Why early detection cannot wait

Breast cancer is not a death sentence, but a delayed diagnosis can make the journey to treatment more difficult. Understanding personal risk, recognising changes in the breasts and seeking appropriate screening are among the important steps women and men can take to protect their health.

“Breast cancer is not a death sentence. Early detection, timely diagnosis and appropriate treatment can make a significant difference in a patient’s journey,” said Dr Derria Cornwall-Bernard, consultant radiologist and head of the Women’s Imaging Center at the University Hospital of the West Indies (UHWI).

Cornwall-Bernard believes the message behind ‘Breast Cancer Matters’ must extend beyond the annual observance in October. It requires understanding of who is at risk, how the disease is detected, and why screening should not be postponed.

The need is particularly pressing in the Caribbean, where breast cancer remains a major public health concern.

In Trinidad and Tobago, breast cancer was the leading cancer among women during the period 2015 to 2020. Figures supplied for this feature indicate an incidence rate of 75 cases per 100,000 women and approximately 654 new cases annually. In Jamaica, breast cancer accounts for approximately 33.1 per cent of all cancers diagnosed, according to the figures provided.

The reported mortality burden is also concerning, with a death rate of 35 per 100,000 in Trinidad and Tobago compared with 66 per 100,000 in Jamaica. These figures underscore the importance of public education, access to breast imaging, and timely follow-up when abnormalities are detected.

Although breast cancer risk generally increases with age, younger women can also develop the disease. Figures provided for this feature indicate that approximately 36 per cent of breast cancer patients in Trinidad and Tobago and 33 per cent in Jamaica are under 50 years old.

These figures challenge the assumption that breast cancer is a concern only for older women. “Breast cancer is not restricted to older women. We are seeing a significant proportion of women diagnosed before the age of 50, so women must understand their risk and have conversations with their healthcare providers about the appropriate time to begin screening,” Cornwall-Bernard said.

The mean age of diagnosis in Jamaica is reported to be approximately 56 years. However, the number of younger women affected highlights the need for greater awareness of symptoms and risk factors, as well as appropriate assessment when concerns arise.

Genetics is another important consideration. Changes in the BRCA1 and BRCA2 genes can significantly increase the risk of breast and ovarian cancers. A strong family history of either disease may therefore warrant formal risk assessment and, where appropriate, genetic counselling.

Breast cancer does not have one single cause. Risk develops through a combination of biological, genetic, hormonal and lifestyle-related factors.

Some risk factors cannot be changed. These include increasing age, inherited genetic mutations, a personal history of certain abnormal breast biopsies, and a family history of breast or ovarian cancer. Dense breast tissue is also associated with increased risk, and can make abnormalities more difficult to identify on mammograms.

Reproductive and hormonal factors may also influence risk. These include menstruation beginning at an early age, menopause occurring later in life, never having a full-term pregnancy or having a first pregnancy after age 30. Not breastfeeding and using certain forms of menopausal hormone therapy may also affect risk.

“Some risk factors are beyond our control. We cannot change our age, our family history or the genes we inherit. What we can do is understand those risks, communicate them to our healthcare providers, and make informed decisions about screening and follow-up,” Cornwall-Bernard says.

Other factors are potentially modifiable. Alcohol consumption, smoking, excess body weight, particularly after menopause, and physical inactivity have been associated with increased breast cancer risk.

Maintaining a healthy weight, exercising regularly, avoiding tobacco and limiting alcohol can contribute to overall health and may help reduce risk. However, healthy habits cannot guarantee that a person will not develop breast cancer. Women who exercise, eat well and have no family history can still be diagnosed.

Understanding risk should encourage appropriate screening, not create a false sense of security or unnecessary fear.

Screening is intended to identify possible disease in people who do not have symptoms. In breast cancer care, mammography is a key screening tool because it uses low-dose X-rays to produce images of breast tissue and can detect abnormalities before they become noticeable.

A mammogram is generally a quick procedure. The breast is positioned and gently compressed between plates while images are taken. The images are then interpreted by a trained professional, such as a radiologist, who looks for suspicious changes that may require additional assessment.

“Mammography is an important tool in breast cancer screening. The examination is relatively quick, and the images allow us to look for abnormalities that may not yet be felt by the patient,” Cornwall-Bernard said.

She emphasises that screening and diagnosis are not the same. An abnormal screening result does not automatically mean that a person has cancer. Further imaging, ultrasound or a biopsy may be needed to determine what the abnormality represents.

Screening recommendations vary according to age, personal risk and the guidelines adopted in a particular healthcare setting. Women should discuss their individual circumstances with a healthcare provider, particularly if they have a strong family history, a known genetic mutation or previous abnormal breast findings.

It is equally important not to wait for a scheduled mammogram if a change develops. A new lump, thickening, changes in breast shape or size, nipple inversion, unusual nipple discharge or skin changes should be assessed promptly. A normal screening mammogram does not mean that a new symptom can be ignored.

“Women should not wait until they feel a lump before becoming concerned about breast health. Screening is intended to identify abnormalities before symptoms develop, while any new or unusual change should be brought to the attention of a healthcare professional,” she said.

Breast cancer control involves more than one stage of care. Primary prevention focuses on reducing risk where possible and promoting health education. Secondary prevention involves screening and early detection. Tertiary care focuses on treating established disease, managing complications, rehabilitation and supporting quality of life.

Each stage matters. Screening is valuable only when people can access appropriate follow-up and treatment after an abnormal result. Timely referrals, diagnostic imaging, pathology services and coordinated cancer care are essential parts of the process.

Breast cancer also affects men, although it is much less common in men than in women. The information supplied for this feature estimates that one in every 1,000 men will develop breast cancer during his lifetime, compared with one in eight women. The lifetime-risk figures should be verified against a reliable source before publication.

Men should seek medical attention if they notice a breast lump, nipple changes or other unusual symptoms. Breast cancer should not be dismissed simply because the person affected is male.

A breast cancer diagnosis can be frightening, but it does not mean that treatment is futile. Outcomes depend on several factors, including the type of cancer, its stage, tumour biology, and the treatment available. Detecting cancer at an earlier stage can improve the likelihood of successful treatment.

Cornwall-Bernard stresses that breast cancer awareness must be translated into action.

“Knowing your risk, participating in appropriate screening, and seeking medical attention when something changes are important steps in taking responsibility for your breast health. Awareness must lead to action,” she said.

The message behind ‘Breast Cancer Matters’ is one of awareness, action and access. Knowing one’s risk, discussing screening with a qualified healthcare provider, and seeking prompt assessment of unusual changes are practical steps that can make a difference.

Across Jamaica, the conversation should continue throughout the year. Breast cancer awareness is not simply about recognising a pink ribbon; it is about understanding the disease, taking symptoms seriously, and ensuring that people have the information and healthcare services needed to act.

Breast cancer matters because early detection matters, access to care matters, and every opportunity to improve outcomes matters.

keisha.hill@gleanerjm.com