October Is Breast Cancer Awareness Month

October is designated as Breast Cancer (BC) awareness month and it is important for all women to know what can be done to detect breast cancer early. In Ghana, and other limited resource countries, Breast Cancer is the leading cancer related death among women.

Research shows that death rates are higher in these countries because detection and treatment are late. Both breast and cervical cancers are the leading causes of cancer in women and the deaths have huge socio-economic impacts on both families and the nation. Ghana records approximately 4,500 cases of breast cancer annually according to the Ghana Atomic Agency. Unfortunately, only about 25% of women diagnosed are cured with the rest dying from it within 5 years; because the vast majority arrive late for treatment. Most may be diagnosed up to a year after a women detects a mass in her breast.

Early Detection Saves Lives
Early detection through education, awareness and screening leads toearly treatment which can give women a chance to live life to the fullest. Detection of Breast Cancer In effect, this is screening for breast cancer in someone without symptoms. Early detection is the key to successful treatment or cure. The death rates from breast cancer in developed countries have been decreasing over the last few years due to increased awareness, screening, and improved treatment methods.

Screening for Breast Cancer
The recognized ways to screen for breast cancer include a three part action plan, according to the American Cancer Society.

Three Part Action Plan
1. Self-Breast Examinations (Breast Awareness)

Although it has been debated whether this saves lives, it has been found to lead to early treatment. Some experts do not recommend it; however, it is good for a woman to know what her breasts feel like so that if there is a new lump, mass, or thickness she quickly recognizes it. Those in countries without regular Mammogram availability need to do this. The best time to do this examination, if you still menstruate is about 7-10 days from the start of the period. If you are post-menopausal just fix a particular day of the month and do it at that time; for example, you may choose the first day of each month or the last day of each month. Learn How To Do Breast Self Examinations It is important that prior to starting breast self-examinations, one goes to a health professional for an examination and is taught how to do the examination properly. The health professional after examining and declaring that there is nothing of concern in the breasts, will then make you confident to do your own self breast examinations. This helps you get to know your own breasts. You can also watch internet videos of the different techniques after their exam. As soon as you feel a mass or anything unusual please see a health professional immediately.

Breast Examination Using A Breast Light
Several devices have been developed to enhance a woman’s self-breast examination and a prototype consists of a hand held infrared light which one shines in a systematic way on different parts of the breast in a darkened room. Veins and blood vessels appear as dark lines and any tumors/masses may show up as shadows. These may help, and use of such a device should not give women a false sense of assurance as mammogram is the Gold standard for screening. In low resource countries where mammograms may not be readily available, this may be useful in the hands of a health professional or even for some devices a woman can get one for herself and use as an adjunct Self Breast exam device.

Examples are the Luminous Breast Device, I-Breast, and the BREAST-I devices. The Breast-i device was used in a study at the Cape Coast Medical School/Hospital and in 2018, they reported it detected more breast cancers then health professional examinations. They do not replace a clinical breast exam or Mammogram. The luminous Breast Device has been used in studies as well and is approved by the European Union and UK as devices augmenting self-Breast exams.

2. Health Professional Examination (Clinical Breast Exam – CBE)

If you do not have access to regular mammograms, you will have to consult a trained health professional to do your breast examination. This is known as a Clinical Breast Examination (CBE). Some doctors, especially in developing countries, are not proactive in conducting preventive examinations like breast exams. So, you need to go and ask your doctor to do your breast examination and to refer you to go and have the BILATERAL SCREENING MAMMOGRAM with or without a Breast Ultrasound (scan) done. Explain to them that you want to do breast examinations by yourself, so, you would like them to check your breasts first and secondly teach you how to do SBE properly. A CBE can be done once a year after the age of 40 years and at interval of every 3 years between the age of 20-40 years.

3. Screening Mammography
This is the main or gold standard screening test for Breast Cancer. A Mammogram is a special x-ray imaging to detect abnormal growths in breast tissues. These include infection, benign tumors, cancers, or fluid filled sacs (cysts). Before your examination, you may have to fill a questionnaire asking you about your breast history, for example, previous breast issues like biopsies, surgery, etc. and family history of breast cancer. What does the examination entail? During such an examination, the technician compresses each breast between 2 plates and takes two pictures of each breast. It may be a little uncomfortable but lasts less than 15 to 20 minutes and most women do not have any problems with it. It is important that the breasts are flattened so that any lump present can be detected. Drink lots of water before the exam and wipe any deodorant or powder from under your arm pit. Screening about a week after the start of your period is ideal since your breasts will likely not be painful at that time.

Other Modes of Breast Cancer Screening
Other modes that have been developed include AI Breast Thermography, Breast Ultrasound, and Breast MRI.

Each has its advantages and disadvantages and Ultrasound for example is used as an additional imaging when a mass is seen on a mammogram, or to distinguish between a mass and a cyst (fluid filled). However, it is used in low resource setting for screening where mammograms are expensive or not available. Thermography uses the temperature of the breast skin to detect Breast masses and use of AI makes it more accurate than without it.

MRI is used for screening ladies who have a high risk for Breast Cancer or have extremely Dense Breasts. It is more sensitive than mammograms in these situations in detecting early Breast Cancer.

Please, get a mammogram done if available in your community because it may save your life. Your children, husband, and loved ones will want you around for many years.

Most medical groups advocate starting at age 40 years, while others recommend at 50 years, and screening every 2 years if you are not high risk .

However, in Ghana a lot of Breast cancer patients are in their late 30s and early 40s, so I recommend yearly mammogram screening starting at 40 years.

Most medical organizations recommend to stop screening mammograms at age 75 years, however; many issues like life expectancy, frailty, and medical or ill health, previous Breast cancer have to be taken into consideration.

BREAST AWARENESS IS BREAST HEALTH
Dr. Barbara Entsuah MD, MBChB, MHSc, Fellow Ghana College of Physicians and Surgeons,

Board Certified Family Medicine.
Author, Health Educator and Youth Motivator