Breast cancer is the most common cancer in women both in the developed and less developed world. It is estimated that worldwide over 508 000 women died in 2014 due to breast cancer (Global Health Estimates, WHO 2013). Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries (GLOBOCAN 2008).
Incidence rates vary greatly worldwide from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 women in Western Europe. In most of the developing regions the incidence rates are below 40 per 100,000 (GLOBOCAN 2008). The lowest incidence rates are found in most African countries but here breast cancer incidence rates are also increasing.
Breast cancer survival rates vary greatly worldwide, ranging from 80% or over in North America, Sweden and Japan to around 60% in middle-income countries and below 40% in low-income countries (Coleman et al., 2008). The low survival rates in less developed countries can be explained mainly by the lack of early detection programmed, resulting in a high proportion of women presenting with late-stage disease, as well as by the lack of adequate diagnosis and treatment facilities
Breast cancer is the top cancer in women worldwide and is increasing particularly in developing countries where the majority of cases are diagnosed in late stages.
The Worldwide awareness of breast cancer
Breast cancer is the second leading cause of cancer death in women worldwide (after skin and lung cancer) and this month has been internationally declared as the “World Awareness of Breast Cancer”.
Our weekly health articles found tremendous interest by our readers with numbers of phone calls and we therefore invited Dr Hassan Azadeh a Senior Lecturer at the Medical School, University of The Gambia and Senior Consultant in Obstetrics and Gynaecology to focus on the important of this common life-threatening and deadly Cancer disease in The Gambia.
What is actually breast cancer?
Breast cancer is the uncontrolled growth of some breast tissues in one or both breast and is one of the most common types of cancer in women worldwide. Nearly over 200,000 women in USA are diagnosed with breast cancer in 2007 and already over 40,000 deaths been reported so far alone in USA during this year.
The incidence of breast cancer begins in early adulthood, with a sharp rise in to the time of menopause and decreases after menopausal age of the women. Although the African, Asian and African- American women have a slightly lower incidence of breast cancer after age 40 than white women, they have a slightly higher incidence rate of breast cancer before age 40. However the African women are more likely to die from breast cancer at every age in most African countries due to lack of awareness and also due to lack of facilities for diagnostic and treatment on this deathly disease.
Breast cancer is not just a disease that affects only women, one present of all breast cancer occur in men too. In 2005, it’s estimated that about 1,690 men has been diagnosed in the USA with a high death rate.
How does a Breast Cancer cell grow?
• Normally, the cells in our body grow and divide in a controlled manner to replace older, damaged cells.
• Sometimes cells begin to grow and divide in an uncontrolled manner and when this happens, they can develop from normal change to abnormal cells so called “malignant” tumours.
• Normal or benign growths will grow to certain size, but will not spread to other part of the body, and are generally considered harmless.
• Abnormal or malignant cells growth will not stop growing and may eventually invade into surrounding tissues, blood and lymph vessels or even travel to other organs which called “metastases”.
When hormone level changes during puberty in young girls who start with menstrual cycles, they develop some lumps in their breasts as well as during pregnancy and during breast feeding. These are natural development and are not abnormal. But any lump that dose not shrinks or disappears after one of these occasions should be assessed by health professionals. This in particular when there are any growths in the breasts of women with the family history of breast cancer or women in their menopausal or after menopausal age.
What is the individual risks f getting breastcancers?
Several risks have been identified as having a potential relationship to the development of breast cancer.
• Family history of breast cancer can have a significant impact as a risk, but you should not automatically assume that any case of breast cancer in your family means you are at a high-risk candidate. For example, if your grandmother was digested with breast cancer at age 70, this does not mean that your risk of the disease is increased as some old age diseases are not necessary inheritable from old age male and female such as old age high blood pressure, diabetes including some cancer diseases.
• Other patterns of family history may strongly suggest inherited Gene abnormalities that is independent of normal again, and is associated with a relatively higher risk of breast cancer.
• The followingsigns suggest that there may be an inherited gene abnormality in your family (These apply to either your mother’s or your father’s side of the family):
• Having a mother, sister, or daughter with breast cancer
• Having multiple generations of family members affected by breast cancer or
• Having relatives who were diagnosed with breast cancer at young age (under 50 years old)
• Having relatives who had both breast affected by cancer
Further risks are:
• Advanced age
• Menstrual periods beginning at an early age (before the age of 9 to 10)
• Never having children
• Obesity and being over weight
• Taking oral contraceptives for longer than 10 years
•Excessive alcohol consumption
• Smoking heavily for many years
I must emphasize that obesity and eating high fat foods contributes tremendously in the developing number of life threatening diseases including breast cancer. This is based on several large medical studies confirming the link between obesity and development of cancer disease. Avoiding high fat foods is a healthy choice for many reasons: it lowers “bad cholesterol” and increases the “good cholesterol” and certainly decreases the risk of developing not only cancer disease but also common diseases like high blood pressure and diabetes. A healthy diet and regular exercises help keep your weight at a healthier level and prevent you from developing life threatening and deadly diseases.
Signs and symptoms of breast cancer
Nearly all breast tumours are found by physical examination (either by self breast-examination or by health care professionals), mammogram (a special x-ray) or by scanning of the breast that can detect any normal or abnormal changes of the breast tissues before it is big enough to be felt during a physical examination.
Symptoms can vary based on the severity of the disease. There are specific factors that should raise suspicion of a growth in the breast. These include:
• A lump felt on one or both breasts by self breast-examination
• A painful thickening or swelling on the breast or nipples
• A discharge from the nipples
The most common initial signs of breast cancer can be diagnosed on mammogram and the abnormalities can often be seen long before a woman or a doctor detects any physical changes in the breast. However, breast cancer, when advanced, causes pain, redness and swelling of the skin. It is strongly advised that if a woman has been diagnosed with any kind of breast infection and that infection does not improve on treatment (approximately within 2 weeks) then the possibility of suspected abnormalities should be considered andadvise should be sought from health professionals.
What causes breast cancer?
Most current evidences indicate that “oestrogen hormone” (which is highly sensitive and found in breast tissues) is responsible for the cause of breast cancer. Fortunately, a blood test to indicate the high sensitivity of this hormone which can be inherited from immediate members of the family (mother to daughter or descendants) is available but unfortunately not available in The Gambia .
Tips on breast self examination
Women should give themselves a breast self-exam each month, beginning at the age of 20. This exam should be performed at about the same time every month.
Here are suggestions on what to look for during breast self exams:
•Any changes in an existing lump or a new lump that you have not felt before
• Abnormal thickening of one or both breasts
• Discharge from the nipples that is bloody of sticky
• Differences in the skin of your nipples especially dimpling or puckering of the skin
• An increase in size of one breast
Any of these warning signs should be investigated and diagnosed by a doctor or a trained medical professional as soon as possible.
How is breast cancer treated?
The care chosen to treat an individual with breast cancer depends on a number of criteria including the type and stage of the cancer. The care given may consist of surgery, radiation, chemotherapy or a combination of all.
Treatment regimens may be used to prevent the spread of breast cancer to the opposite breast and to reduce the incidence of spreading to other organs.
Breast cancer and pregnancy
Breast cancer is one of the most common cancers in pregnant women and tends to affect women in their mid thirties. Although only about one in every 3000 pregnant women get breast cancer, the disease can be devastating to both the mother and the child.
A major problem is that a lot of changes take place in women’s breast during pregnancy. This makes it harder to identify suspicious lumps. If a suspicious lump is found, you must seek advice from your doctor, midwife or trained nurse for appropriate diagnosis of a normal or abnormal growth in your breast.
Where in The Gambia you can seek advice?
Doctors, midwives and trained nurses throughout the country are happy to advice you on this common disease and are able to arrange for referral to specialists.
For further information please contact, EFSTH, poly Clinic, NGO and Private Clinics,
The FRANCIS De GAULLE Njie FOUNDATION (FDNF), Website www.fdnf.gm, e-mail firstname.lastname@example.org tel.8903104 where you can get information about Breast diseases and in particular the correct way of a self- breast examination. We are delighted to advice and help you for your worrying of this common disease. Also email email@example.com text 7774469 and 3774469. Call on West coast live Dr Azadeh health program every Tuesday from 6-7 pm
Author DR AZADEH Senior Lecturer at the university of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director Medicare Clinic.