Breast cancer is a pervasive disease that affects millions of women worldwide, including Sri Lanka. In fact, according to recent national data, it has been cited as the most prevalent cancer among both males and females in Sri Lanka, with over 5,000 new cases in 2020.
Due to its complex nature and multiple risk factors, some of which are yet to be identified, cancer specialists fighting to reduce the rising number of new cases in Sri Lanka are now appealing to all those who are vulnerable and at risk of developing breast cancer at some stage of their lives, to seek immediate medical advice. “Early screening and early treatment can either cure and or prevent its progress. Delaying identification of breast cancer for any reason can result in serious complications and even fatality”, is the collective message that the National Cancer Control Programme (NCCP) is sending to the community, especially those with risk factors, ahead of the upcoming Breast Cancer Awareness month on October 1-31.
 Dr. Dumindu Wijewardana |
Along with the negative impacts, Breast Feeding - an empowering tool to fight breast cancer and one which any new mother can do at no cost, is being vigorously promoted by the NCCP due to its potential protective effects against breast cancer.
With breastfeeding week about to commence from August 1-7, the Sunday Observer spoke to Medical Officer In-Charge of the Cancer Early Detection Centre, Narahenpita, Dr. Dumindu Wijewardana, regarding the connection between breast cancer and breast feeding , as well as the risk factors causing breast cancer, how they could be prevented, and current treatment measures available to all vulnerable mothers.
Excerpts
Q: Breast Cancer is currently pervasive both globally and in Sri Lanka. As many readers are still unaware of some of the basic facts of breast cancer, tell us what is breast cancer?
A. Breast cancer is a type of cancer that develops in the cells of the breast. It occurs when the normal, healthy cells in the breast undergo genetic mutations that cause them to grow uncontrollably and form a mass or a lump. These cancerous cells have the potential to spread (metastasize) to other parts of the body if left untreated.
Breast cancer can affect both men and women, but it is much more common in women. It is the most prevalent cancer in women globally and remains a significant health concern.
There are several types of breast cancer, but the two primary categories are: Non-invasive Breast Cancer: In this type, the cancer cells are confined to the milk ducts or lobules and have not spread to surrounding tissues.
Invasive Breast Cancer: This type refers to cancer cells that have broken out of the milk ducts or lobules and invaded nearby healthy breast tissue. From there, they can potentially spread to lymph nodes and other organs.
Breast cancer can present various signs and symptoms, which may include:
A new lump or mass in the breast or underarm area. Changes in breast size, shape, or appearance. Skin changes on the breast, such as redness, dimpling, or puckering. Nipple changes, including nipple inversion or discharge (other than breast milk).
Breast pain that does not go away.
It is crucial to note that not all breast lumps are cancerous. Many benign (non-cancerous) conditions can also cause breast abnormalities. However, if you notice any changes or abnormalities in your breasts, it is essential to consult a healthcare professional for proper evaluation and diagnosis.
Q: How is it caused? Can men get it? If so, who are more at risk gender-wise?
A. Various risk factors contribute to the development of breast cancer. Being female is the primary risk factor, with an increased risk of 100 times more in comparison to males.
Q: Who are the women most at risk?
A. Those who are above the age of 50 years as more than 80 percent of diagnosed cases are above 50 years.
Studies have shown that nulliparity, the condition of never having given birth, has been associated with an increased risk of breast cancer.
Women with a family history of breast cancer among close relatives are at a higher risk of developing breast cancer when compared to those without. Presence of a family history from both paternal and maternal sides are equally responsible for the disease while this accounts for only about 15 percent of the cases. The presence of BRCA1 & 2 genes are also known risk factors accounting for only around 5 – 10 percent of the cases.
Q: Does the age at menopause have any significant correlation with the risk of developing breast cancer?
A. Early menarche (before 11 years) and late menopause (after 55 years) is linked to a higher risk of breast cancer due to prolonged exposure to estrogen and other hormones, which favours the development of breast cancer.
Q: Any other risk factors that drive this disease?
A. Prolonged exposure to hormone replacement therapy, certain lifestyle choices (post-menopausal obesity, sedentary lifestyle, alcohol), exposure to radiation, and environmental factors are some of the other factors that drive the disease.
Q: So how can women prevent and protect themselves from this disease?
A. Knowing about these risk factors will help in identifying those who are at a higher risk and facilitate screening for early detection, not prevention. While the factors mentioned earlier can increase breast cancer risk, there are also protective factors that can lower the likelihood of developing the disease. Regular physical activity, maintaining a healthy weight through a balanced diet and exercise are important measures to protect from breast cancer.
Following a nutritious diet rich in fruits, vegetables, whole grains, and lean proteins on a regular basis is very important.
Avoiding alcohol consumption will also benefit them. It is also advised to minimise hormone replacement therapy unless prescribed by a medical professional, undergoing regular screenings for early detection, seek genetic counselling if there is a family history, and reduce exposure to environmental hazards which collectively are powerful protective strategies. At the same time, breastfeeding has been shown to reduce the risk of breast cancer as it helps to lower lifetime exposure to estrogen, a hormone linked to breast cancer development.
Above all, knowledge and awareness about breast cancer risk factors are empowering tools for women.
Q: Since breastfeeding has been linked to lowering breast cancer risks tell us what are the benefits of breastfeeding to the mother?
A. The protective effects can be attributed to various factors. Breastfeeding helps suppress ovulation, reducing exposure to estrogen, which is associated with breast cancer risk. It also leads to structural changes in breast tissue, removing potentially damaged or cancerous cells. Additionally, breastfeeding promotes healthy body weight, which reduces the risk of various cancers, including breast cancer. Multiple studies have shown a consistent association between breastfeeding and a reduced risk of breast cancer. Research by the Collaborative Group on Hormonal Factors in Breast Cancer involving 150,000 women demonstrated a decrease in breast cancer risk by 4.3 percent for each year of breastfeeding. Another study across different regions revealed a 7 percent decrease in breast cancer risk for every twelve months of breastfeeding.
Q: What can be done to detect breast cancer?
A. Regular self-breast examinations, clinical breast examinations, and mammograms are essential for early detection and timely treatment of breast cancer. Early detection improves the chances of successful treatment and positive outcomes.
Q: What are the treatment options available for breast cancer?
A. Various treatment options are available for breast cancer, including surgery, radiotherapy, chemotherapy, hormone therapy, and targeted therapy. The choice of treatment depends on the type and stage of breast cancer, as well as other individual factors. Multidisciplinary approaches involving a team of medical specialists are often used to provide the best possible care for breast cancer patients.
Q: Where could a woman go to if she wants to get herself checked for suspicious breast symptoms?
A. A Sri Lankan woman has the opportunity to get checked for breast cancer through the state sector healthcare facilities including Well-Women Clinics, Healthy Lifestyle Centres, Breast Clinics within hospitals, surgical clinics, Cancer Early Detection Centres (Narahenpita, Jaffna, Matara, Batticaloa and Rathnapura), and any Out-Patient Departments in hospitals. The Cancer Early Detection Centre at Narahenpita currently undertakes mammography screening free of charge. These facilities could be available in the private sector as well.
Q: Have you a message to Lankan women on the empowering link between breastfeeding and breast cancer prevention?
A. The connection between breastfeeding and breast cancer offers an opportunity to empower women in their health journey. Educating women about the protective effects of breastfeeding and providing support systems can help them make informed decisions to reduce their breast cancer risk.
Breastfeeding not only fosters a deep bond with your children but also nurtures them while offering the added benefit of providing potential protection against breast cancer, making it a beautiful and health-enhancing experience for both mother and child.
Breast cancer is a complex disease with a significant impact on individuals and communities. Understanding the connection between breast cancer and breastfeeding highlights a potential protective mechanism that can empower women to make informed decisions about their health. Breastfeeding offers both immediate and long-term benefits, reducing the risk of breast cancer. Supporting and promoting breastfeeding can create a culture of empowerment and health consciousness, working towards a future with reduced breast cancer prevalence.
However, it is important to recognise that not all women can breastfeed due to various reasons, and they should not be stigmatised. Other protective measures and regular screening are available for early detection.
Q: Do you have a contact number where Sri Lankans could reach out for more information regarding breast cancer?
A. For more information, please visit www.nccp.lk and https://breastcancerdetect.health.gov.lk/ websites. You may also visit official Facebook page of the Cancer Early Detection Center & YouTube #cancer early detection centre. Cancer Early Detection Centre at Narahenpita under the National Cancer Control Programme, Ministry of Health which is situated at No.516, Elvitigala Mawatha, Narahenpita with the partnership of Rotary Club Colombo, established in 2004. Tel: 0113 159 227 email: [email protected]