BREAST CANCER PREVENTION AND SCREENING

This year has flown by in the most extraordinary manner. It seems like yesterday that certain events took place. It is true life can change in the blink of an eye. I wonder if James Allison felt the same about his life since the discovery of special receptors in the body responsible for helping the body harness its immune system to fight cancer. In case you live under a rock, smile, James Allison is one of the scientists who have just been awarded a Nobel peace prize in medicine for 2018 and his work is in the field of cancer. Please dig up the article earlier in the year where I highlighted immunotherapy. Remember it’s different from the immunotherapy of eating garlic and so on.

Back to the cancer of the month, breast cancer, today my words and your minds shall have a discussion on prevention and screening. As with most cancers, certain factors called modifiable factors put us at higher risk of developing a full blown cancer. Knowing these factors allows us to put certain measures in place, which reduce and sometimes eliminate this development.

Ordinarily people will think of breast cancer screening as mammogram and that’s it. However, you and I after this article will know that there is a lot more involved in this process and it is more than just a mammogram. There are so many guidelines and recommendations that each have their own pros and cons but in general drive to the same point. The best thing to do is to ask your doctor which guidelines they are following and be consistent and

Firstly it is important to know that there are two categories of the population when it comes to breast cancer. Those who are at heightened risk because of genetic predisposition (family history) and those who are not. The screening recommendations for these two groups vary.

The common preventative measure against breast cancer is having a healthy lifestyle. Exercise comes top of the charts. Regular exercise helps prevent breast cancer. It is not necessary to have a full gym work out lasting an hour with a dedicated trainer – but do go ahead if you are able to. Simple measures like walking deliberately and taking stairs instead of the elevator can do the trick if one has a busy lifestyle. Tackling obesity or increased body weight is another thing one can do to reduce their personal risk. Again the first steps are not to get to size zero, but even a 10 percent reduction in your current baseline gives you a head start. Not only for cancer but also for many other diseases like hypertension and diabetes.

If you are a smoker, the strongest advise is to stop. Smoking puts you at risk of many health issues and I think it has taken a back seat in fashion as well. Alcohol tends to fall the category of things I am comfortable in advising my patients to give up. Depending on one’s inclination a glass of wine of this and that does this or that. My take is if you are serious about improving your health status keep your consumption to the minimum.

Exposure to the female hormone oestrogen produced in the body also puts one at heightened risk. Excessive exposure can happen in obese individuals as the yellow fat produces extra oestrogen for the body. The results of studies for hormone replacement and infertility treatment are mixed as to whether they increase the risk.

For a layperson the message is even more confusing because for women classified as having a high risk of developing cancer or those post breast cancer treatment artificial oestrogen (tamoxifen and raloxifene) help prevent development of breast cancer. If you have particular interest, feel free to write me.

As mentioned briefly last week, when a mistake called a mutation in your genes has been identified the type of breast cancer that may develop is very aggressive, so the only way of preventing it is removing tissue where it develops. In this case it involves removing the breasts, ovaries and uterus.

The simplest form of screening for breast cancer is breast examination. The individuals themselves can do this and this is called self-breast examination. Or a trained medical person can do this and this is called a clinical exam. A big debate is happening in global meetings. In the west self-breast examination is being discouraged because it is felt more non-cancerous processes are found causing unnecessary anxiety, in less economically advantaged environment people feel it is still an effective way of discovering breast cancer. Self-breast examination is carried out the same time every month, if premenopausal about 10 days after menses. A clinical breast exam is encouraged annually.

The next screening method is mammography. This is only recommended for women above 40 years and for a good reason. The effectiveness of a mammogram depends on how dense the breasts are. Sometimes even in women above the age of the 40 years this can be challenging. Also breast cancer is not a disease for younger women so the justification for extra radiation exposure is not warranted. When you look at the numbers its understandable such as in a group of 1266 women between ages of 35-39 years only 16 cancers were detected by mammogram (Yankaskas et al, 2010). This number exponentially increases above the age of 40 years.

For those with a family history or a heightened risk like radiation exposure to the chest screening may be needed before this golden age of 40 years so what do we do?

The answer lies in the use of a special machine called magnetic resonance imaging (MRI) with a coil. It effectively sees small lumps before they can be felt. Unfortunately this may not always ne available so most clinicians make do with careful clinical examination and ultrasound methods.

In a wrap, the complexity of handling a cancer prevention, screening and treatment must be duly recognised. Prevention and screening must be done consistently. This month we will hear so many inspirational survivor stories and I can tell you being in the hottest part of the fire brings out the gold and diamonds in you. Stay blessed my countrymen.

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