October is InternationalBreast Cancer AwarenessMonth. DR. P. RAGHU RAM dispels the myths surrounding this disease.
In India, breast cancer has overtaken cervical cancer to become the leading cause of death among women in metropolitan cities, with over 1,00,000 cases being diagnosed newly every year. This is only the tip of the iceberg, as many cases are not reported to the Cancer Registry; many States do not have a robust Cancer Registry. More than 50 per cent of these cases are in the advanced stage; therefore, the death rate from breast cancer is also very high. Lack of awareness and absence of an organised national screening programme are the main reasons for this.
Myth: Most breast lumps are cancers.
Fact: Nine out of 10 breast lumps are not cancers. However it is important to investigate the lump to get a definite diagnosis instead of assuming that it is harmless.
Myth: Breast cancer affects only older women.
Fact: Although a majority of breast cancers occurs in women over the age of 50 in the western world, it can occur at any age. Breast cancer is increasingly being diagnosed at a much earlier age in India.
Myth: Breast cancer does not occur in men.
Fact: Both men and women have breast tissue and a small proportion of men do get breast cancer. Although there are no precise statistics in India, approximately 300 new cases of breast cancer are diagnosed in men each year in the U.K. (approximately one per cent of breast cancers).
Myth: We know what causes breast cancer.
Fact: We do not know what causes breast cancer. There are, however, well-recognised risk factors. Being a woman and increasing age are the two most important factors. Other known risk factors are: earlier diagnosis in the same or other breast; strong family history; early onset of menstrual period (before age 12); late menopause (after age 55); not having children and having first child after age 30; long-term use of hormone replacement therapy; obesity (particularly after menopause).
Myth: If you have a risk factor for getting breast cancer, you are likely to get the disease.
Fact: The risk of getting breast cancer is not a certainty, even if you have one of the strongest risk factors.
Myth: Family history of breast cancer is the most important risk factor for getting breast cancer.
Fact: The vast majority of women with breast cancer do not have a family history of breast cancer. Strong family history (genetic predisposition) accounts for only 5-10 per cent of breast cancers.
Myth: Breastfeeding prevents breast cancer.
Fact: Breast feeding does not prevent breast cancer, but reduces the risk.
Myth: Birth control pills cause breast cancer.
Fact: Modern birth control pills contain a low dose of oestrogen and progesterone. They are not associated with an increased risk of breast cancer.
Myth: Injury to the breast can cause breast cancer.
Fact: Injury to the breast does not cause breast cancer.
Myth: Breast self-examination is no different from Breast Awareness.
Fact: Breast self-examination (BSE) is a regular and repetitive monthly self-examination performed by a woman at the same time each month to a set method. The concept has not proven beneficial. Breast Awareness is about becoming familiar with the breasts and the way they change through a woman's life. It is a concept that encourages women to know how their breasts look and feel normally so that they notice any change that might help detect breast cancer early.
Myth: Breast cancer screening is effective for all age groups.
Fact: While it is important for women of all ages to be Breast Aware, screening is effective only in women over the age of 40. Routine screening for women under 40 and without symptoms has not proven to be effective.
Myth: Mammography is painful.
Fact: Mammography may cause momentary discomfort but is not painful.
Myth: Mammography is not safe. It causes radiation hazard.
Fact: Mammography involves a tiny dose of radiation; the risk from this is insignificant. The radiation dose delivered during mammography is the same as that from a dental X ray.
Myth: There is not much difference between a conventional mammogram and a full-field digital mammogram.
Fact: Full-field digital mammography has revolutionised early detection of breast cancer. Major advantages are less radiation, less discomfort and, most important, superior accuracy — particularly in young women with dense breasts — in detecting early subtle changes.
Myth: Breast screening prevents breast cancer.
Fact: Breast screening only helps find breast cancer, if it already there.
What to look for
Changes that one should be aware of:
A change in size. One breast may have become noticeably larger or smaller.
A nipple may become inverted (pulled in) or change position or shape.
A rash on or around the nipple.
Blood-stained discharge from one or both nipples.
Puckering or dimpling of skin.
A swelling under the armpit or around the collarbone (lymph nodes).
A lump or thickening in the breast that feels different from the rest of the tissue.
Constant pain in one part of the breast or armpit.
A mammogram (x-ray) is done to detect breast cancer in the impalpable stage when neither the woman nor the doctor can feel a lump.
It is advisable to have a screening mammogram annually from the age of 40. This is an effective way of detecting breast cancer early, many years before it shows up and offers the best chance of successful treatment, which translates to significantly improved survival.
Five-point awareness code
Know what is normal for you.
Know what changes to look and feel for.
Report any changes to your doctor without delay.
Have an annual screening mammogram if you are 40 years or more.