Better Life raises awareness on breast cancer

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One in every eight women runs the risk of developing breast cancer at some point in her lifetime. The biggest risk factor in developing breast cancer is age, the older a woman gets, the higher the risk of developing the disease (with those most at risk being women over the age of 50).

Causes, signs and symptoms

Nobody knows for sure what causes breast cancer. It has been shown that women with a family history of breast cancer may be genetically disposed to developing the disease, and can definitely benefit from genetic counselling, and possible genetic testing, although 75% of women who develop breast cancer do not have a family history of it.

Early breast cancer usually has no symptoms, although as the cancer grows it can cause a lump that can be felt in the breast. Sometimes the skin overlying the tumour can become coarse and wrinkled, and there may also be discharge from the nipple.

Finding a Lump

A woman's breasts go through many perfectly normal changes throughout her lifetime. They are affected by hormonal changes during the menstrual cycle, pregnancy, breast-feeding, the menopause, and weight loss or weight gain. However, there are changes that you should always see your doctor about.

These include:

A lump in either breast or armpit.
A lumpy area or thickening anywhere in the breast that feels different from the rest of the breast tissue.
Enlarged glands under either armpit.
Bloodstained nipple discharge.
Any marked change of appearance in a nipple, such as the nipple pulling in or a rash around the nipple.
Differences in skin texture such as puckering or dimpling.
A change in the size or shape of one breast.
Swelling, thickening or persistent pain in either breast that feels different from pre menstrual tenderness.
Swelling of the upper arm.

It must also be remembered that 90% of breast lumps are benign (non cancerous).

Identifying a problem

Most breast cancer cases are discovered either by self-examination or a mammogram. The American Hospital Dubai recommends regular mammograms for all women over the age of 40 as these can detect lesions too small to be felt during an examination.

Women between 40 and 50 years old should be screened every two years, and women over the age of 50 should be screened annually. Women over the age of 20 should examine themselves at the same time every month, as the breasts can naturally become lumpier throughout the menstrual cycle. This should be 5-7 days into the cycle, when breasts are at their least swollen and tender.

Pregnant women and women with breast implants should continue to examine themselves, and nursing women can also continue this habit once all the milk has been expressed.

Most lumps found in the breast are not cancerous, however if a lump is found a doctor should always be consulted to ensure that it is not cancerous.

Diagnosis

On discovering a lump, it is essential to consult a physician for a triple assessment, rather than just a clinical examination, preferably at a specialist clinic.

A triple assessment (which is internationally recognised as the best way of assessing lumps in the breast) involves a clinical examination, where a doctor will review the medical history and examine the breasts to determine if they are healthy. This would be followed by an ultrasound or mammography (this depends on the age of the patient) to view images of the lump.

The third aspect to the assessment would be a biopsy, often a needle biopsy, where a needle is inserted into the lump to obtain fluid and tissue samples to allow accurate cell diagnosis. Although there are times where a doctor may recommend an incisional biopsy, which is where a small part of the lump is taken out through the incision.

The doctor will examine the tissue samples and, combined with results of the mammogram and clinical examination, will be able to determine whether the lump is cancerous (malignant) or non-cancerous (benign).

If the lump is benign (non-cancerous), no further surgery may be needed, however if the lump is cancerous, further treatment will be needed.

Treatment

When a lump is determined to be cancerous, the treatment may include surgical treatment, radiation therapy, chemotherapy, or hormonal therapy, or a combination of these, depending on the type of cancer and the age and medical condition of the patient.

Surgical treatment can include removal of the tumour, or removal of the breast, and sometimes removal of the lymph nodes in addition to this. Removal of the tumour can be conducted through an excisional biopsy, or lumpectomy, where the entire lump and some of the surrounding tissue are removed through the incision and removal of the breast would be performed during a mastectomy. Depending on which surgery is conducted, only one or two incisions are made; this procedure requires a general anaesthesia and one or possibly two nights stay in hospital.

Follow-up treatment

After surgery, doctors are likely to recommend one or more types of therapies to help prevent the cancer from re-occurring, these can include radiation therapy, hormonal therapy and chemotherapy, depending on the type of cancer, the type of treatment, and the individual patient's situation.

Services provided at the American Hospital Dubai

Breast Self Examination Clinics are where women are taught to examine their own breasts. Clinics are run once a month at the Breast Clinic.

Mammography services are provided by the Radiology Department, and can be arranged by a physician at the American Hospital Dubai, or by a referral letter from an outside physician.

The Breast Clinic provides a complete clinical and diagnostic service in one single clinic visit, for patient convenience and to avoid unnecessary long anxiety periods for patients with breast pathology. A patient diagnosed with a breast lump will have a full clinical evaluation, mammogram/ultrasound examination and a fine needle aspiration (FNA) biopsy if needed, and every effort will be made to give the patient the result of FNA biopsy on the same day.

Further information:
Jonathan Walsh
WPR Limited