Dubai: Sporting pink ribbons to observe breast cancer awareness month is a great way to show solidarity for the cause, but the two critical elements to battle this scourge are education and awareness. This fact cannot be overemphasised as early intervention dramatically increases the chances of survival and cure is nearly 99 per cent. Oncologists in the UAE point out that breast cancer is among the top five cancers in the UAE and the number one cause of fatalities among cancers.
Dr Mohannad Diab, senior oncologist at NMC Speciality Hospital, Abu Dhabi, presents alarming statistics: “Approximately, 12 new cases of cancer are diagnosed in the UAE every day, of which at least two or three are of breast cancer. This cancer leads the top five cancers in the UAE.”
Every year, the net for the high-risk group keeps widening. If the high-risk group for breast cancer are women in the menopausal age above 50, today even women in the their early thirties, who are under any hormonal pills for birth control or any treatment and who have a first or second degree relative with cancer, are at risk and require periodic screening.
For the Breast Cancer Month, Gulf News presents Frequently Asked Questions on the condition and speaks to survivors.
1. What is breast cancer?
Dr Allen Rezai, senior plastic and reconstructive surgery consultant at Dubai Health Care City, elaborates: “Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumour that can often be seen on an X-ray or felt as a lump. The tumour is malignant [cancerous] if the cells can grow into [invade] surrounding tissues or spread [metastasise] to distant areas of the body.”
Those who think breast cancer is strictly a women’s disease will be disappointed to know that men can suffer from it too.
“Cells in nearly any part of the body can become cancerous and can spread to other areas of the body. Breast cancers can start from different parts of the breast. Some start in the glands that make breast milk. A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and lymphomas.”
2. Who is at risk?
The following are considered high-risk factors by medical experts:
A) Family history: Women who inherit the BRCA1 and BRCA2 (or breast cancer 1 or 2) gene mutation from their mothers are at high risk of developing breast, uterine or ovarian cancers. The percentage of genetic predisposition to breast cancer is about 5-10 per cent. Dr Diab advises those who have inherited the BRCA genes to undergo regular screening and, although the measure of undergoing double mastectomy, hysterectomy and removal of ovaries as evidenced by the decision of Hollwyood celebrity Angelina Jolie even before the likely diagnosis seems a drastic measure, Dr Diab thinks this could be one of the best ways to prevent the cancer from occurring.
B) Obesity: This is a lifestyle issue but a high percentage of fat in the body would also mean a lot of dense fat in the breasts. Dr Rezai elaborates: “Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Someone is said to have dense breasts [on a mammogram] when they have more glandular and fibrous tissue and less fatty tissue. Women with dense breasts on a mammogram have a risk of breast cancer that is up to two times that of women with average breast density.“
C) Girls who menstruate before 12. This would mean the young girl has had a longer history of exposure to endogenous hormones — oestrogen and progesterone — which can raise the risk of incidence.
D) Women who smoke or drink: Alcohol and nicotine are natural triggers for cancers and breast cancer is not untouched by it.
E) Women who delay child bearing: Are at higher risk as their exposure to endogenous hormones is greater. According to the National Cancer Institute, USA, women who have children reduce the exposure to progesterone and oestrogen as they have fewer menstrual cycles. Women who delay child birth are usually on birth control pills and both oral contraceptives and intra uterine devices multiply risk of breast cancer.
F) Women who do not breastfeed their children: Breastfeeding also helps reduce exposure to ovarian hormones and reduces breast cancer risk.
G) Women who undergo radiation therapy as children: Radiation therapy to the chest for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) significantly increases the risk for breast cancer.
H) Women who lead sedentary lifestyles: Have a higher risk of developing breast cancer as opposed to those who indulge in regular physical activity.
Dr Rezai added that studies indicated that other factors such as induced abortion and breast implants do not trigger breast cancer.
Is it possible to prevent breast cancer?
Medical literature points out that good diet, a healthy lifestyle and exercise can help lower risk of breast cancer, even if you are predisposed to breast cancer. Early detection in case of breast cancer is literally the difference between life and death. Dr Diab sounded a note of caution: “Even if you are at high risk, due to genetic factors, if you are regular on screening it can be a great help as early detection in the first stage can help you avoid chemotherapy or radiation and help you beat cancer. There is a 80-90 per cent chance of curing breast cancer in the early stages.
Dr Rezai added: “Preventive screenings such as mammograms detect cancers before they start to cause symptoms. Cancers that are found early — when they’re small and haven’t spread — are easier to treat and have better outcomes. Breast cancers that are found [through physical examination] tend to be larger and are more likely to have already spread beyond the breast.”
What are the signs and symptoms of breast cancer?
1. Formation of a new lump or mass which is hard, painless and irregular in shape. But it is better to get any lump examined as sometimes tumours can be tender, soft and round too. Any new change in your breast merits a screening.
2. Swelling of all or part of a breast.
3. Skin irritation or dimpling.
4. Breast or areola pain.
5. Nipple retraction (turning inward).
6. Redness, scaliness, or thickening of the nipple or breast skin.
7. Nipple discharge (other than breast milk).
8. Swollen lymph nodes.
What to do when diagnosed with breast cancer?
1. Do not panic. Once diagnosed, treatment for breast cancer can be invasive or non-invasive.
2. Usually, it is invasive so prepare for surgery — removal of breast (mastectomy) or tissue removal such as a lumpectomy or quadrantectomy or partial mastectomy, depending on the stage of your cancer
3. This will be followed by targeted therapy such as chemotherapy, immune therapy, radiotherapy, depending on the stage and type of cancer an individual has. Some may be physical therapies and some therapies may include oral medication.
Dr Rezai added: “Targeted therapy for breast cancer is a more recent innovation. As researchers have learnt more about changes in cancer cells that cause them to grow out of control, new types of drugs have been developed to target some of these cell changes. These special drugs are designed to block the growth and spread of cancer cells. However, they work differently from chemotherapy drugs, which attack all cells that are growing quickly, and not just the cancer cells. Targeted drugs sometimes work even when chemotherapy does not, and they can also help other types of treatment work better. They also tend to have less severe side effects than chemotherapy.”
Can women bear children after breast cancer?
Yes, it is possible for women to start a family after treatment of breast cancer, say oncologists, but a lot would depend on the stage when the cancer is detected and the kind of treatment a woman undergoes, If it is the early stage and the woman is able to store and freeze her eggs before undergoing chemo, her chances of being a mother are higher. A patient needs to discuss these issues with her physician before the treatment starts,
Dr Rezai adds: “Many breast cancers are sensitive to oestrogen, so there has been concern that for women who have had breast cancer, the high hormone levels that result from a pregnancy might increase the chance of the cancer recurring. However, studies have shown that pregnancy does not increase the risk of the cancer returning after successful treatment. There is also no proof that breastfeeding after cancer treatment increases the risk of recurrence. In fact, some research suggests having a history of breastfeeding might actually lower the risk of the cancer recurring. Many doctors advise breast cancer survivors to wait at least two years after treatment before trying to get pregnant. This is thought to be enough time to find any early return of the cancer, which could affect a person’s decision to become pregnant. However, this advice is not based on data from clinical trials, and some breast cancers can return after the two-year mark. There is no proof that a woman’s past breast cancer history has any direct effect on her baby. On the other hand, for those still getting any type of treatment for breast cancer, it is essential to talk to their doctor before trying to become pregnant.”
Those who have had breast surgery and/or radiation may have problems breastfeeding from the affected breast. Studies have shown reduced milk production in a treated breast as well as structural changes that can make it difficult and painful for the baby to latch on to the breast. Yet, many women are able to breastfeed.
Do you need psychological counselling after surviving breast cancer?
The invasive treatment of breast cancer and the aggressive therapies are likely to leave a woman feeling devastated and shattered. Breast cancer often destroys a woman’s sense of femininity and self-image as there are many changes in physical appearance she has to come to terms with. Such a close brush with mortality leaves her feeling vulnerable and stressed, say doctors. It is important that apart from the dealing with the physical changes, a woman seeks psychological counselling to stay positive and come to terms with her illness. In addition, the woman has to deal with the threat of the disease revisiting her. So, life for a survivor can be challenging.
How can the risk of breast cancer progressing or returning be lowered?
Dr Rezai says: “People who have had breast cancer can still get other cancers, although most don’t get cancer again. Breast cancer survivors are at higher risk of getting another breast cancer, as well as some other types of cancer. Indeed they can be affected by a number of health problems, but often the major concern is facing cancer again.
“The most common second cancer in survivors of breast cancer is another breast cancer. The new cancer can occur in the opposite breast, as well as in the same breast for women who were treated with breast-conserving surgery. The risk of a second breast cancer is increased no matter which treatments have been employed. This is probably because factors like genetics or hormonal risk factors might play a role in these cancers,” Dr Rezai said.
To help maintain good health, breast cancer survivors should also:
• Get to and stay at a healthy weight.
• Keep physically active.
• Eat a healthy diet, with an emphasis on plant foods.
• Limit alcohol intake to no more than 1 drink per day.
These steps represent solid general wellness advice and may also lower the risk of some other health problems.
What are the new therapies in breast cancer?
1. Targeted therapies that focus on the cancer cells only. These include HER 2 (a human growth factor receptor present in 20 per cent of breast cancers) and PARP inhibitors.
2. Anti-angiogenesis drugs, inhibiting blood supply to cancerous cells; and bone-directed treatments such as bisphosphonates and denosumab that help strengthen and reduce the risk of fractures in bones that have been weakened by metastatic breast cancer.