Ladies (and gentlemen), feel up your breasts!

Michael Abrahams

October is Breast Cancer Awareness Month, with its purpose being to increase awareness of the disease and raise funds for research into its cause, prevention, diagnosis, treatment and cure. So, in keeping with the observance of the month, I have decided to add my two cents worth.

Breast cancer is the most common invasive cancer in women worldwide, the term invasive being used to describe cancer that spreads. In 2012, 1.7 million women were diagnosed with breast cancer and there were 6.3 million women alive who has been diagnosed with the disease in the previous five years. It is also the most common cause of cancer deaths in women, causing 522,000 deaths in 2012. It is estimated that one in eight women will be diagnosed with the disease by the age of 85.

One of the most important principles to grasp in the fight against breast cancer is that early detection saves lives. Over 90 per cent of women diagnosed with early breast cancer will be alive five years after the diagnosis was made. The best approach is to combine monthly self-examination with annual physician breast examinations and mammograms for women over 40 years of age. In some instances, additional radiological investigations such ultrasonography and MRI (magnetic resonance imaging) may be employed.

Self-examination is best performed during the first half of the menstrual cycle, preferably after the period, when the breasts are less tender, in women who are pre-menopausal. This involves inspection as well as examination of the breasts with the hands. If this is done on a regular basis, and a woman is well acquainted with the look and feel of her breasts, the moment there is even a subtle change, she is likely to notice it and present herself to a doctor for further evaluation. Approximately 70 per cent of breast cancers are found by self-examination.

Mammography has been a useful tool in the fight against breast cancer. This procedure has been found to reduce the risk of death from the disease by about 35 per cent in women over the age of 50. However, myths about mammography and the causes and clinical course of the disease persist, and may present barriers to treatment.
For example, many times when I recommended that patients get mammograms done, they tell me that no one in their family has breast cancer, so their risk is low and they have nothing to worry about. This is an erroneous concept that may lead many women at risk to having a false sense of security.
It is true that having a family history does increase one's risk. As a matter of fact, having a first degree relative (mother, sister or daughter) with the disease makes a woman twice as likely to get it, compared with a woman with no family history. But the truth is that only about 10 per cent of breast cancer patients have or have had a family member with the disease. So, for a majority of women, this cancer 'comes out of nowhere'.

Another myth is that the mammogram causes or spreads cancer. Firstly, mammography does utilize radiation, but the levels involved are very low and have not been found to increase cancer risk. Secondly, although some compression of the breasts takes place during the procedure, there is no evidence that having a mammogram done can cause a pre-existing tumour to spread.
The mammogram does have its limitations though. For example, in younger women, the breast tissue tends to be dense and may not be penetrated sufficiently by x-rays and the resulting images may be unhelpful, so the procedure is not recommended for women under 40.

And, by the way, men get breast cancer too, so they should check themselves as well, at least with their hands, as mammography would not be appropriate for them, for obvious reasons.

Significant advances have been made in the fight against breast cancer, such as the discovery of breast cancer genes, which have helped us to better understand the disease and how to manage it. Unfortunately, apart from prophylactic bilateral mastectomies (surgically removing both breasts in patients who are high risk), there is no foolproof method for preventing the disease. So, in the meantime, adopting lifestyle changes that have been shown to reduce risk should be considered, such as engaging in regular physical exercise, losing weight, if overweight, and avoiding the regular consumption of alcohol, as the ingestion of even one alcoholic drink a day increases a woman's risk of developing breast cancer.

Fear of diagnosis is what impedes many women from presenting themselves for screening and examination, but, as frightening as the diagnosis is, cancer is not a death sentence. There are many survivors living normal lives decades after diagnosis and treatment. So, ladies (and gentlemen) feel up your breasts. Remember, early detection is your best protection.
Michael Abrahams is a gynaecologist and obstetrician, comedian and poet.

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