Prevention & Early Detection of Breast Cancer

By Dr. C. Farquharson-Deveaux, MD

October is recognized worldwide as breast cancer awareness month and in the Bahamas many people would have been affected by this disease either directly or have had a relative, friend or co-worker who may have been afflicted.  Breast cancer poses a significant threat to physical health but also effects emotional, spiritual and financial well-being.  It can take a vexing toll on families and lead to much sadness when a hard fought battle is lost. 

No one knows for sure who will or won't develop any type of cancer.  What is known is that for a specific type of cancer persons who have certain risk factors tend to have a higher chance of developing that particular cancer than someone who does not have similar risk factors.  However, just because these risk factors are present does not automatically mean the cancer will occur.  Similarly, people with no or few risk factors can still (rarely) develop cancer.  In the United States, the risk of breast cancer usually increases with age, with most occurring in women older than 60 years or after menopause. However, in the Bahamas we tend to see the opposite with more than 50% of breast cancers being diagnosed before age 50 years.  Additionally, 64% of these women tend to have some form of mutation to the BRCA1 and BRCA2 (breast) genes compared to only 10% in other populations.  Preliminary data suggests a high incidence of breast cancer in the Bahamas, with about 20% of women being missed during screening because of following U.S. guidelines.  These patients then present at an advanced stage with advanced disease already present.  Other risk factors for developing breast cancer include having a prior history of breast cancer, family history of breast cancer in a sister, mother or daughter, especially if it developed before age 40 years, presence of dense breast tissue, being overweight or obese after menopause, consuming alcohol, physical inactivity, being on combined HRT after menopause and having a first pregnancy at an older age.  Exposure to carcinogens can also increase a persons risk to developing cancer.  A carcinogen is a substance that is able to change the genetic structure of body cells and/or alter the cell's response to the body's natural defense system.  Carcinogens can be chemicals found in the environment that we breathe in, that make contact with our skin or are ingested in the food, liquids or water that we consume.  Finally, anytime the body's natural defense system is compromised, as with HIV/AIDS, this can also disrupt the orderly recycling of cells and prevent the body from fighting against cancer cells.

The breast is divided into three basic components ducts, glands and connective tissue.  Cancer cells can develop from any part of the breast and can invade and damage surrounding tissues and organs.  Some of the cells may break away from the tumour and travel by the bloodstream to other parts of the body like the brain and liver, take root and continue to grow and cause further destruction.  The process of these cells spreading is called metastasis.  During any person's lifetime, they will have cancer cells in their body.  For the most part these cells remain undetectable by routine tests because there numbers are very small.  The vast majority of times the body's immune system destroys these cancerous cells.  However, given the right internal and external environment, these cells will continue to grow and divide, overpowering the body's defense system until they become detectable and start causing symptoms.  Early symptoms of breast cancer include a change in how the breast or nipples feel or look with dimpling of the skin similar to the appearance of the skin of an orange or discolouration of the skin.  There may also be a change in the size or shape of one breast compared to the other and/or the presence of bloody nipple discharge.  Early breast cancer is usually not painful and may not have a detectable lump present.   

It is very important to note that some of the symptoms listed above may be due to other less serious conditions or diseases, but only a doctor or other healthcare professional will be able to determine this after doing a full examination and appropriate testing.  Also, because symptoms may not present until late in the disease it is very important to have a routine yearly health exam with your physician and undergo appropriate screening tests, especially if your risk of developing breast cancer is high, so that any abnormality can be picked up early when it is still treatable.  Yearly exams for women would usually include having a pap smear, clinical breast exam, screening mammogram, digital rectal exam with stool testing for blood, and a pelvic exam to detect abnormal enlargement of the ovaries or uterus.  If any initial abnormalities are present, your doctor will determine if further tests are needed.  This usually involves performing a biopsy where a piece of the abnormal tissue is taken and further examined in a lab.  You may also be required to do blood tests or other imaging studies such as an ultra sound scan, CT-scan or MRI scan.

Treatment for breast cancer usually involves surgical removal of the lump or breast along with chemotherapy or radiation therapy.  Whichever treatment the patient has is determined by the extent and aggressiveness of the disease, the patient's age and medical condition.  However, the old adage "prevention is better than cure" is advice to always live by.  As with most chronic diseases, it is possible that some cancers can be avoided if we practice healthy lifestyle practices.  The following are rules to live by for overall good health.

" Avoid smoking (including second-hand smoke) as it increases the risk for many cancers, including of the breast.  It is the most significant risk factor for cancer that can be reduced. 

" Eat healthy whole fruits, vegetables and whole grains especially green vegetables and yellow and orange fruits.  These are rich in antioxidants, vitamins A, C, E, dietary fiber, enzymes and other unknown nutrients that help heal damaged cells and build up the body's immunity.

" Limit meats especially smoked, salt cured and pickled as these tend to have preservatives that can be converted to nitrosamines which are known to cause cancer.   Charcoal-broiled (grilled) foods may be contaminated with tar from smoke coming off the coal.  Coal tar is carcinogenic. 

" Limit alcohol intake to one serving a day because overuse will increase the risk of certain cancers.  Also alcohol has a lot of empty calories and persons who consume a lot of alcohol tend not to have adequate nutrition.  Poor nutrition along with the direct toxic effects of alcohol leads to a weakened immune system and damage to cells.

" Exercise at least 30 minutes a day, at least 5 days a week as this helps to achieve or maintain an ideal body weight.  It also increases oxygen going to the tissues and maintains healthy cells.

" Know your personal and family history of cancer.  This information can help you make informed healthcare decisions.

" Avoid or minimize [work] environmental chemical exposure  to fumes and dust which may contain asbestos, gasoline, diesel exhaust, vinylchloride and coal products which are known carcinogens.

" Incorporate a healthy mind and spirit with overall health.  Have a proactive and positive spirit.  Anger, unforgiveness and bitterness puts stress on the body and increases stress hormones.  This reduces the activity of the body's natural defense system.  Learn a loving and forgiving spirit.  Relax and enjoy life.  This leads to release of endorphins and other healthy hormones which are known to boost happiness and prevent depression.

Above all do not be in denial about changes that may be occurring in your body, especially when you are at high risk for breast disease.  Learn to do proper breast self-examination, seek medical attention for any concerning issues, try to be prepared mentally, physically and emotionally for whatever outcome may happen and surround yourself with as much support as you can.