Breast cancer awareness; a simple needle test goes a long way in saving lives

Breast cancer is the most common cancer in women across the globe. National cancer incidence data (Sri Lanka) has shown, a significant increase in the number of breast cancer patients. The peak incidence of breast cancer is between 50 – 58 years of age (can vary from country to country).

Risk factors:

1. Age – Peak incidence of breast cancer is between 50 – 58 years of age. The incidence of breast cancer decreases after 60 years. Breast cancer is uncommon in women less than 30 years of age.

2. Family history – Women who have a first-degree relative with breast carcinoma have a two to three times higher risk of getting t

he disease than that of the general population.

3. Genetic mutations – Germline mutations of BRCA1 and BRCA2 genes are associated with an increased risk of having breast cancer.

4. Menstrual and reproductive history – Increased risk is correlated with early menarche (beginning of menstrual cycles), nulliparity, late age at first birth and late menopause.

5. Exogenous oestrogen – Exogenous oestrogen is considered as a risk factor of breast cancer.

6. Ionizing radiation – An increased risk of breast cancer has been documented with exposure to ionizing radiation.

7. Alcohol consumption

8. Cigarette smoking

9. Obesity

10. Lack of physical exercise

However, in most cases a definitive cause for breast cancer cannot be identified. It is important to know that you can get breast cancer without having any of the above mentioned risk factors. Why it happened and how it happened may not be clear at all times. Do not blame yourself, it is not due to your fault. It can happen to anyone… rich or poor, big or small, black or white. Do not let breast cancer destroy your life. If you come early the disease can be controlled. Be knowledgeable about the symptoms of breast cancer. If you feel something is not right, without taking it lightly resort to medical advice.

Symptoms:

There is a wide range of symptoms that can vary from person to person

Breast lump (usually painless), hardness or thickening

Skin changes that include swelling, redness, pitting (skin of an orange), scaling or any other noticeable change

An increase in the size or change in the shape of the breast

Changes in the appearance of the nipple (s), peeling of skin over the nipple

Discharge from the nipple (other than milk)

Pain in any part of the breast

Lumps/ swelling in the arm pit

However, it is important to understand that early breast cancer may not show any of the above symptoms. You may not feel a lump at all. Only way to detect early cancer is by a screening method and currently the widely acknowledged approach has been screening mammography. By this screening method unsuspected lumps in asymptomatic women can be identified. Breast cancer screening using mammograms is a well- established program in the developed world. Women over 45-50 years of age are recommended for screening. The cut off age for screening can vary from country to country. If there is a strong family history of breast cancer (or any other significant risk factor) screening will be offered at an earlier age. Mammogram exposes the breasts to a small amount of radiation. Benefits of breast screening by mammogram are far too many. We do not have a national breast cancer screening programme yet, but it will come in to place in the near future.

There is a simple needle test (fine needle aspiration cytology technique) that can be done as a first line investigation for breast lumps. It is a minimally invasive procedure with hardly any complications. It is cost effective and the results can be obtained quickly. Needle test can give a clue as to the nature of the lump. Sometimes the needle test results can be inconclusive. In those instances, further investigations will be done to confirm the diagnosis.