My phone rang. It was a call from the hospital. ‘Dr, you have a new patient in the surgical ward’, she says. I sighed and thanked her.
I picked up my white coat, backpack and headed to the hospital. I exchanged pleasantries with the nurse on duty and asked her what we were dealing with. She brought me up to speed and then I peruse the case file.
I headed to the patient’s bedside. She was in a very pitiable condition. A lady in her mid-30s, surrounded by her sister and husband. I introduced myself, asked some questions, explained her condition and prognosis. She was being managed as a case of breast cancer.
Prior to her coming to the hospital, she had been to several spiritual homes and herbal centers. When all failed, she resorted to coming to the tertiary hospital. I need not say that at the time I was seeing her the prognosis was very bad. She was terminally ill.
Breast cancer is a malignant growth or tumor resulting from the uncontrolled division of abnormal breast cells. According to WHO, it’s the most frequent cancer among women impacting about 2.1 million women every year. It also causes the greatest number of cancer-related deaths among women. The above findings obtain in Nigeria where breast cancer in women is responsible for about 34.2% of all deaths due to cancer WHO.
There are a number of risk factors associated with breast cancer. Many of which are linked to the amount of estrogen the breast is exposed to. According to the CDC, being a woman and getting older are the main risk for breast cancer. Breast cancer may occur in males (about 15% of cases) and when it does the outcome is usually worse. Most breast cancer cases are seen in women above the ages of 50, however, in recent times, it’s been noticed that younger people are coming down with breast cancer.
Other risks include:
A family history of breast cancer also is an important risk factor. This includes breast cancer in the first-degree relative (mother, daughter, sister), second-degree relative (grandmother, aunt, niece), a male relative, a relative with bilateral cancer, two or more relatives that have had breast cancer/ ovarian cancer. According to the Canadian cancer society, having a first degree relative with breast cancer doubles a woman’s risk and the more first degree relatives with breast cancer, the higher the risk.
Personal history of breast cancer increases the risk of breast cancer in the same breast/the other breast.
Genetic mutations (changes to a gene)is another. BRCA 1 and BRCA 2 are genes that help to control the growth of cancer cells. When mutated, they lose this function and allows for the proliferation of breast and ovarian cancer cells. These mutations may be inherited from either father/mother.
The reproductive history which includes early menarche(age at onset of menstruation earlier than 12yrs), late menopause(55 years and above), nulliparity( not having children), having few children and not breastfeeding increases the risk of developing breast cancer. Experts believe that estrogen helps the growth of breast cells and thereby contributes to breast cancer cells, hence, the longer the exposure of breast cells to estrogen the more the likelihood of developing breast cancer. This explains the relationship between breast cancer and reproductive history.
Long term use of hormone replacement therapy and oral contraceptive predisposes to breast cancer. Hormone replacement therapy with estrogen alone or combined estrogen and progestin increases the risk by 1% and 8% respectively based on a study conducted by Women Health Initiative(WHI). Long term use(10 years and above )of oral contraceptive that contains estrogen and progesterone increases slightly the risk when compared to people who don’t use combined oral contraceptive.
Lifestyle which includes physical inactivity, alcohol and being obese shouldn’t be left out. The risk increases with the amount of alcohol consumed. This might be due to alcohol increasing level of estrogen in the body as well as depleting body storage of nutrients eg folate, vitamin A and C which are known to protect cells from damage.Lack of exercise also increases the risk. Body mass index (>31.1)Increases by 2 fold the risk when compared to a BMI of 26.6 in postmenopausal women. Fat tissue has been discovered to produce a small amount of estrogen, hence having lots of fat can increase estrogen levels. Smoking(active and second-hand) has been linked to breast cancer, however, research is still ongoing.
Exposure to ionizing radiation to the chest, armpit, and neck increase breast cancer risk.
Prophylactic oophorectomy (surgical removal of ovaries) And mastectomy ( surgical removal of breasts)in high-risk individuals is protective. There are no established links between bras, breast implants, antiperspirant/deodorant, abortion and breast cancer.
I should also mention that some women have no risks/ are low risk, yet they come down with this condition. Having 1/more risk factor doesn’t translate to having the disease.
Breast cancer may not have any symptom nor sign. However, the most common symptom is a hard/firm lump that doesn’t shrink in size or disappear with your menses. It’s usually painless. This usually occurs when the tumor is grown enough to be felt. You might also notice your breast tissue become hard and thickened. There could be changes in shape and size of breasts, Lump in the armpit, breast ulcer and inverting nipples.
There may be fluid/blood discharging from the nipple. Late signs of breast cancer occur when cancer has spread to other organs/part of the body. This includes hip fracture, weight loss, jaundice, anemia and a host of other symptoms.
After all, is said and done, deaths and poor outcome from breast cancer can be prevented. The risks of cancer can also be reduced. Self-examination, healthy lifestyle and early detection is key. Know what your normal breast feels like, if you notice any changes e.g swellings/lump, Visit a health professional immediately. If above the age of 40years with high-risk factors, I suggest you do a mammogram every 1-2 years or discuss with your physician. Above the age of 50, it’s recommended you have a mammogram done yearly especially if you are high risk or at most biannually. Lifestyle modification including reducing alcohol intake, avoid smoking, exercising, eating healthy can help reduce the risks.
On a final note, the 5-year survival rate in developed countries is far higher than developing countries including Nigeria. For instance, 5 year survival rate in Canada is 87% (87% of women diagnosed with breast cancer will survive another 5years) http://www.cancer.ca/en/cancer-information/cancer-type/breast/prognosis-and-survival/survival-statistics/?region=bc While in Lagos, Nigeria, a study was done in Lagos State University Hospital revealed it as 25.6% https://www.researchgate.net/publication/268383754_Five_Year_Survival_of_Patients_with_Breast_Cancer_at_the_Lagos_State_University_Teaching_Hospital_Nigeria
You will agree with me that that’s a very wide difference implying that only one out of every four women with breast cancer can survive another five years.
This is due to so many factors which are beyond the scope of this write-up.
My take, do all you can to reduce the risks, screen regularly and if you feel a lump/changes in your breast, see a physician URGENTLY. God be with us all.
Our next series will be on lifestyle modification with focus on exercise. A professional in sports medcine and exercise will be anchoring this series. Please stay tuned!
© Dr Bussy.