Today is the last day before we conclude another Breast Cancer Awareness Raising month. Oncologists across the world have come together to pool their knowledge, skills and share some of the newest breakthroughs using available sophisticated technology.
While Sri Lanka has excellent health parameters in almost all aspects of women’s health the incidence of breast cancer continues to soar despite the tireless efforts of the health officials and other care providers. One of the main causes according to official reports is the delay in seeking treatment early, despite constant reminders that early detection and treatment is the definite way to save avoidable and unnecessary loss of lives when the disease has progressed to a stage where the entire body is affected.
 Dr. Hasarali Fernando |
In an interview with the Sunday Observer, Dr. Hasarali Fernando, Acting Consultant Community Physician, National Cancer Control Programme shared her expertise on the different causes that drive this disease and most importantly how they could detect lesions early and the importance of seeking proper treatment when a suspicious lump is detected.
Following are excerpts
Q: Breast cancer is one of the commonest if not most common cancer among women. Where does it rank among the leading cancers both in terms of mortality and morbidity among Lankan women according to your latest data?
A. The most common cancer reported among women in Sri Lanka is breast cancer which is around 25% of all the cancers identified among them. According to the National Cancer Registry 2019, 4447 new breast cancer cases were reported amounting to 12 new cases being identified daily with around 2 deaths occurring daily due to breast cancer.
Q: Compared to a few years ago, do you see an increase in the number of new breast cancer cases in Sri Lanka?
A. Yes, over the past 25 years there had been an increase in breast cancer cases in Sri Lanka.
Q: According to your recent data do you have an age specific incidence of common types of cancer in Sri Lanka?
A. Yes, there is an age specific incidence of common types of cancers with the peak age of breast cancer being diagnosed at 55 and 65 years.
Q: How will a person know exactly what type of cancer she has? What are the tests required?
A. The exact type of the cancer will be decided following histopathological examination.
Q: How will she know how big the cancer is?
A. The size of a cancer will be measured through imaging, that is via an ultra sound scan or mammography.
Q: Who makes the final diagnosis? An oncologist or a general practitioner? What is the procedure followed?
A. An oncologist will make the final diagnosis about the cancer. For the final diagnosis of breast cancer, she has to undergo a triple assessment which includes clinical assessment by history and physical examination, imaging via mammography or ultrasound scan and pathological assessment by a non-excision biopsy, fine needle aspiration biopsy or core biopsy. Depending on the result of each of these components the final diagnosis will be made.
Q: Recent discussions in the media and elsewhere have highlighted the importance of improving the knowledge of the cancer community and the public on Metastatic Cancer. What is Metastatic Cancer? How is it linked to breast cancer?
A. Metastatic cancer is when a cancer has spread to distant parts of the body from the site of origin. This could happen through blood or lymphatic circulation. Any type of cancer could metastasise to any part of the body.
Q: I understand there are certain factors that increase the chances of one getting cancer but can be modified with healthy lifestyle changes. What are they?
A. These are called risk factors. There are both modifiable and non-modifiable risk factors which increase the risk of developing the disease.
Q: Is being obese, overweight and leading sedentary lives with little exercise a cancer risk?
A. Yes, overweight, obesity and sedentary lifestyle are modifiable risk factors.
Q: Women with pre-existing non-communicable diseases like diabetes and hypertension – are they at risk?
A. Non-Communicable Diseases itself has no direct association with the development of breast cancer.
Q: It has now been found that long term exposure to hormone replacement therapy (estrogen and progesterone) can promote breast cancer? True or false?
A. True, long-term exposure to hormone replacement therapy promotes breast cancer as both these hormones favour cancer cell growth. For example, after using combined hormone replacement therapy for five years, the risk of breast cancer increases by 15%.
Q: There are also non modifiable risk factors of breast cancer which one cannot prevent. Could you tell us what they are?
A. Non modifiable risk factors are age, sex, personal history of breast cancer, family history of breast or ovarian cancer, presence of Braca1 and 2 genes, lifetime exposure to oestrogen and progesterone hormones.
Q: What about those with a family history of breast cancer? How vulnerable are they?
A. Having a family history from both paternal and maternal sides has an equal risk of developing breast cancer. Having a first-degree relative increases the risk by 2-fold while having two first degree relatives increase it by 3-fold.
Q: It has been said that 85% of women with breast cancer do not have family history. True or false?
A. True.
Q: What about early menarche (11 years), late menopause over (55 years) and never having children? Do these drive the cancer risk later on? If so, why?
A. Yes, these factors are non-modifiable risk factors that I mentioned above. The reason is, in above mentioned situations, as the woman has had more menstrual cycles, she has a prolonged exposure to oestrogen and progesterone hormones. These hormones favour the growth of breast cancer cells. Hence the risk is increased.
Q: Is it true that over 80 percent of all cancer occur among women aged 50+ years?
A. Yes, it is true. Ageing increases the development of breast cancer.
Q: Ideally at what age should a woman get tested for breast cancer?
A. Ideally a woman should start practising monthly self-breast examinations from the age of 20 years.
Q: At present there are Well Women Clinics where they can be taught to practise self-breast examination methods? How reliable are these tests done at home?
A. Self-breast examination is a method taught to be practised at home on your own. When it is practised routinely, a woman herself will have the ability to identify changes by herself. Well Woman Clinics, Healthy Lifestyle centres or any trained health professional can teach self-breast examination.
Q: What are the clinical symptoms that indicate the onset of cancer?
A. Any recent change in size, shape, symmetry or colour of the breast, lump, unilateral breast pain not related to menstruation, retroverted nipple, nipple discharge or an axillary lump could be a symptom of breast cancer.
Peau d-Orange appearance of the breast with non-healing ulcers are late presentations.
Q: What should be done if you suspect any recent change in your breast?
A. You must immediately contact your midwife in your Medical Officer of Health area or any doctor for further management.
Q: What are the services available in Sri Lanka?
A. For cancer screening and early detection, Cancer Early Detection Centers, Well Women Clinics, Healthy Lifestyle Clinics and special breast clinics are available.
All secondary and tertiary care hospitals have diagnostic facilities. There are 24 cancer treatment centers in the country.
Q: What is Cancer Early Detection Centre and where are they?
A. It is a walking clinic at Narahenpita, Jaffna, Matara and Ratnapura. Any client can attend the center and get the relevant examination done.
Q: Your message to all Sri Lankan women on preventing or minimising risks of breast cancer?
A. Breast cancer could be completely cured and life could be returned to normal if detected and treated early.
Hence, self-breast examination is highly recommended for every woman above 20 years.
Immediately seek treatment at the first instance you detect something suspicious in your breast.