In many countries October is Breast Cancer awareness month. The pink ribbon is the symbol for breast cancer awareness and is worn by many to draw attention to breast cancer. Breast cancer is the leading cancer ailment in Ghana at 15% according to sources from Korle Bu Teaching hospital (KBTH). In a study at KBTH in 2007, Dr. Clegg Lamptey found that 57% of those who presented with breast cancer had advance cancers with average tumor size about 6x7 centimeters. Another interesting finding by his and two other studies- (Mammocare and Komfo Anokye teaching hospital) is that compared to a country like USA, the age of developing breast cancer was younger in Ghanaians- average age is between 40-49years compared to 60 years in the USA. In a joint Kumasi/USA study, the type of breast cancer found in Ghanaian women were similar to those found in African American women, however, the Ghanaian women had cancers which tended to be advanced. All this information shows that Ghanaian women need to take personal measures so that there is early detection and treatment of this terrible cancer. Everyone knows a relative, friend or coworker who has had breast cancer. Knowledge is POWER, and so it is important to be informed. All women need to know that early detection is the BEST PROTECTION. WHAT IS BREAST CANCER? (BC) Cancer is a disease which is causes by normal cells becoming abnormal and growing out of control. It can occur in every organ of your body and if it occurs in the breast it is called Breast cancer. Cells growing fast form a mass called a tumor. Not all tumors are cancers. Some are benign or not cancerous. The cancerous ones are also known as malignant because they can spread to other parts of the body. SYMPTOMS OF BREAST CANCER Early stages of breast cancer may not show any symptoms or signs. As it grows symptoms may include A new lump or mass in the breast. (That is why it is important to know what your breasts feel like!!) Changes in the skin, size or shape of the breast Discharge from the nipple not associated with breast feeding Flaky, red, or swollen skin on the breast A nipple that starts discharging blood, or is very tender or turns inwards- inverted nipples. (Some women have inward turned nipples all their lives so that is not worrisome for them) Unexplained pain in breast or nipple that does not go away. (Pain is not a common symptom of breast cancer unless it has spread) WHO GETS BREAST CANCER? All women are at risk but more so those above the age of 40years. There are also certain factors which affects your risk of developing breast cancer. Some of these one cannot do anything to change, but there are others that one can influence. WHAT RAISES A WOMAN’S CHANCE OF GETTING BC? (Risk Factors) Although these have been discovered, some women with some of these risk factors do not develop breast cancer, and some women who get breast cancer have no apparent risk factors. There seems to be a combination of inherited factors (genetics) and environmental factors that lead to this and many other diseases. Some of these factors include Being a woman Getting older (Over 50years) Have had previous breast cancer Have never had children or had your first child after age 30 years Started your period or menses before age 12years or reached menopause after age 50 years Having close family relatives- mother, sister, daughter who have had breast cancer or ovarian cancer Have been treated with radiation therapy to the breast or chest in the past Have used hormone replacement treatment for more than 5years (Used to treat menopause symptoms) You are overweight You drink alcohol daily Being physically inactive Have a genetic condition involving mutation of genes known as BRCA1 or BRCA2 genes. Some of the above conditions you cannot personally change but others you can influence by life style changes. For example to prevent breast cancer you can Stay healthy by maintaining a healthy weight for your height (BMI) Exercising regularly and staying physically active Avoid the use of Hormone Replacement therapy (HRT) if you can get relief of menopause symptoms from other medicines. If you have to use it, it’s better used in early menopause and for 5 years or less. Limit the amount of alcohol that you drink. No more than one a day. PRACTICE EARLY DETECTION You do this by taking CONTROL of your breasts’ health. When breast cancer is discovered early, the 5 year survival rate is more than 98%. Meaning 98% of patients will still be alive after 5 years. The American Cancer Society- a trusted organization- has recommended the following screening methods based on the age of a woman. At Age 20 years: You can choose to do breast self-examination (BSE). It is good to find out how this is done by talking to your health provider, it is usually done in the shower, lying down or standing in front of a mirror. If you are taught, then you can be comfortable doing this by yourself. Between 20-39 years Have a health professional do a clinical breast exam (CBE) on you every 3 years or even sooner. This is a breast exam done on you by a trained health provider. Age 40 years and above: Have yearly clinical breast exams by a health professional, and also get a mammogram done. Most women with average risk of getting breast cancer can have one every 2 years. It takes about two years for a tumor/mass to grow big enough to cause symptoms for women in their 40s, but for women in their 70s it may take four years. You may have to take the initiative to ask your doctor to give you the requisition or prescription to go and have one done. Some doctors are so busy they may not bring up the topic. You have to take charge of YOUR OWN HEALTH by taking this initiative. WHAT IS A MAMMOGRAM? A mammogram is a low dose x-ray of your breasts that is able to detect small changes or lumps which are too small or too deep to be felt by you. They are safe, quick and may just be mildly uncomfortable due to the fact that your breasts will be squeezed between two plates of the machine. The squeeze is important to flatten the breast tissue and give a good picture. Adequate squeezing also causes less exposure to radiation. Although mammography is the best tool for detection, about 10% of all breast cancers may not be detected by a mammogram. If a mammogram is abnormal, or a woman has dense breasts, a doctor radiologist may recommend ultrasound or MRI of the breasts. Recently the FDA- which approves drugs and medical equipment use in the USA- approved the use of a special Ultrasound to be used to screen women who have dense breasts but negative mammograms. Usually, tissue which causes breasts to be dense shows up just like a tumor- as a white solid- on mammograms and so sometimes it is hard to distinguish between the two and so other studies are required. TIPS FOR A BETTER MAMMOGRAM EXAM When you go for the mammogram make sure you wipe off any powder, cream or deodorant from under your arms and your breasts as these may interfere with the mammogram quality or interpretation. Drink sufficient water to keep you well hydrated before the exam If your breast gets tender during your monthly period/menses, then the best time to have a mammogram done may be one week after your period ends. Let your doctor know of any symptoms or problems you have before the exam If your last mammogram was done at a different place or you have a copy of your previous mammograms, then take them with you so that the new one could be compared to the previous ones. If you previously experienced discomfort, then one can take ibuprofen about one hour before the test. MAMMOGRAMS LEAD TO EARLY DETECTION REMEMBER, MAMMOGRAMS LEAD TO EARLY DETECTION OF BREAST CANCER, AND EARLY DETECTION LEADS TO EARLY TREATMENT WHICH LEADS TO HIGHER SURVIVAL RATES FOR BREAST CANCER PATIENTS. WHY SOME WOMEN DO NOT WANT TO HAVE A MAMMOGRAM A few women have told me that they do not want to have a mammogram because they would rather not know they have breast cancer. This is comparable to acting like the proverbial ostrich who sticks its head in the sand but the rest of the body is exposed. When breast cancer is discovered late, it may have spread to other parts of the body and the cancer cells strangle the normal cells in other organs or body parts, causing a lot of pain for the individual. It is not a pleasant situation to be in. It is aslow painful death and unfortunately some doctors do not give cancer patients sufficient pain medicines for them to be pain free at the end of life. To avoid all of this and have your piece of mind, get a mammogram done. Then one can live long to enjoy one’s family, friends and pursue your dreams and aspirations. WHERE TO GET A MAMMOGRAM DONE There are several health facilities and free standing radiological imaging centers available in Accra, Kumasi, Cape Coast and other regional capitals. Let a doctor write an order for you to get one. GET A MAMMOGRAM DONE AND YOU MAY SAVE YOUR BREASTS AND SAVE YOUR LIFE. PREVENTION through SCREENING mammography is the way to take care of your breasts’ health. Dr. Barbara Entsuah (Nee Amoo-Lamptey) Family Medicine Specialist.