Battling breast cancer

COVER STORY

By designating October as Breast Cancer Awareness Month in 1985, the American Cancer Society launched its official campaign that aimed to raise public awareness about the disease, support those affected by it, and raise funds to help researchers find a cure. Later, the canvas was widened to encompass timely detection and disease prevention, leading to the need to engage the masses. The pink ribbon, which is now globally associated with the campaign, was first handed out by the Susan G. Komen Foundation in 1991, and has since come to symbolise the cause.

October is a time dedicated to raising awareness, and a series of reminders promote the need for early detection of the disease. While educating the community is the goal, the importance of screening, recognizing common symptoms, and making high-quality care accessible to all those in need is the most desired outcome. Focusing on October, however, can end up creating a sense that the coping and combating efforts to deal with this evil ailment are limited to one specific month. But the disease never ceases to affect lives, and the burden keeps on multiplying around the clock, throughout the year.

For 2024, “no one should face breast cancer alone” has been adopted as the theme for the campaign, signifying the combined efforts needed to counter the notorious malady. The theme also impels people to act proactively through prevention strategies, not only to help medics in identifying an individual's likelihood of developing the disease but also stipulating a holistic way out for the susceptible segment of society that comprise almost half of the community.

Scope of the problem

Cancer is a disease in which abnormal cells divide exponentially and grow out of control, forming tumours. If left unchecked, it becomes fatal. The earliest stage is curable if detected and treated in a timely manner. The earlier it is caught, the better the prognosis.

In 2022, there were 2.3 million people diagnosed with breast cancer and 670,000 deaths globally. The disease is prevalent across the globe, and affects all ages and factions of society. In Pakistan, over 90,000 new breast cancer cases are registered every year, while a huge number go undetected. The disease targets mainly women, but a narrow fraction of men suffer too; the treatment follows the same principles of management for both genders.

In Pakistan, breast cancer accounts for 21.4 percent of all cancers. The National Cancer Registry documents breast cancer as the commonest among women of all ages, and the highest tally in Asia. Statistics indicate that one in eight women in Pakistan is affected, making it the most common form of cancer in the country. The scarcity of screening programs and limited access to the available options accompanied by denial and stereotypical attitudes are major hindrances to timely detection and treatment.

The incidence of breast cancer is increasing in women under 50 years of age (premenopausal), and it poses a growing public health hazard. The increasing incidence in younger women is concerning because breast cancer in younger women is often more aggressive and difficult to treat, both physically and psychologically, as it tends to leave scars behind.

Symptoms

It is of paramount importance to be aware that most women do not experience any symptoms when the cancer is still at the initial stage. This is why screening and early detection are essential. It is important to seek medical advice as soon as possible for anything from even a minor change in “feel” to an eventual discovery of a lump.

Breast cancer can manifest differently in various individuals, and being aware of potential symptoms and signs can facilitate timely detection and treatment. Symptoms and signs vary from mild breast pain or discomfort to persistent breast tenderness or sensitivity. Unusual nipple discharge (clear or bloody) and changes in breast density or texture are significant clues. Other symptoms may include a tiny lump or thickening which is usually painless; subtle changes in breast size or shape; skin changes; ridging or dimpling, slight inversion or nipple retraction or deviation; redness; or scaliness (eczema-like symptoms). One should consult their doctor for an initial assessment as soon as possible instead of having panic attacks and should stay in touch with a health care provider at regular intervals.

Screening

Annual mammography should be offered to women in their 40s. However, due to financial constraints and a higher percentage of false positive or false negative results, mammography may not be feasible for the masses in countries with low and medium incomes, like Pakistan.

Clinical breast examination (CBE) carries high value and aids in making earlier diagnoses or prompting specific investigations selectively. A comparison of CBE alone with screening conditions is lacking and it is unlikely that a trial of CBE alone will ever be conducted. However, literature review suggests that CBE detects some tumours missed by mammography, although the fraction of detection amongst asymptomatic women remains small.

CBE may be a valuable non-invasive tool for those who do not have access to costly investigations, and its contribution to women's health may extend beyond its ability to identify previously undetected palpable masses. Specifically, CBE presents an opportunity for medics to educate women about symptoms and risk factors, and help in early detection, as well as address any variability if it is encountered. It also lets clinicians discuss the benefits and limits of breast self-examination (BSE) and demonstrate BSE for women who elect to do it. If practiced effectively, women can notice any change and consult their doctor at the earliest. Educational interventions are required in Pakistan to encourage young women to perform BSE regularly to cope with the problem effectively and in a timely way.

Risk factors

Several factors influence the occurrence of breast cancer, such as age, weight and body mass index, lifestyle, activity level, and hormonal exposure.

The risk increases with advancing age, and there is a higher risk for those who are either underweight or obese and do not exercise. Early menarche or late menopause, hormonal contraception after the age of 35, age at the time of first childbirth, nulliparity, late first child, and hormone replacement therapy multiply the risk manifold. Characteristics like increased breast density accompanied by a sedentary lifestyle and practices like unnecessary radiation exposure add to the menace the disease is capable of causing.

Additionally, the risk of developing the disease is higher for those who have first-degree relatives (parents, siblings, children) who have suffered from the disease, have genetic mutations (like BRCA1 and BRCA2), or have a personal history of breast cancer.

The presence of these risk factors does not mean that a person will definitely get the disease, but given the extra risk, you should be extra vigilant and extra cautious.

Risk reduction tactics

Paying attention to your health and wellness and practicing healthy living can contribute to the reduction of your risk to develop breast cancer.

• Diet: Consume a balanced diet rich in vegetables and whole grains; avoid canned, sugary, and carbonated drinks; avoid deep-fried and factory-made food; increase omega-3 fatty acids in your diet (fish, beans, soybeans, chia seeds, flaxseeds, canola oil, etcetera are widely available options); limit saturated fats and red meat; and quit smoking or vaping. Avoid milk and other dairy products except yogurt, and make intermittent fasting a routine.

• Weight: Maintain a healthy body mass index; avoid being overweight, obese, or underweight. Nurse your infants for at least 18 months; it helps not only in weight reduction but also regulates hormones.

• Exercise: Exercise daily (walk at least 30 minutes) and make a routine of regular aerobic exercises, like brisk walking and/or cycling.

• Stress: Aim for seven to eight hours of calm sleep and consider improving sleep hygiene (refrain from watching television in the bedroom, keep your cellular devices silent or switch them off, and keep screens at a subdued glow). Practice stress-reducing techniques, like yoga and meditation.

• Toxins: Limit exposure to pesticides and herbicides (thoroughly wash vegetables and fruits before consumption); avoid unnecessary radiation exposure; use non-toxic household cleaners; and take antioxidants (like vitamins E, C, and D, oral glutathione, zinc, and magnesium) after discussing with your doctor.

• Hormones: Limit hormone replacement therapy and consider non-hormonal contraceptive options.

• Massage: Encourage regular massages (self-massage daily or twice weekly, and by a trained therapist or partner fortnightly or monthly) after consulting a health care professional. Massaging is beneficial and can help detect changes in the breast. It may also potentially reduce cancer risk through several mechanisms. It improves lymphatic drainage, and it regulates hormones, especially oxytocin and oestrogen, thus helping to manage anxiety and depression as well. It enhances immune function, drains out toxins, and improves breast tissue health by increasing blood flow and delivering oxygen and adequate nutrient supply. It is, however, not a substitute for regular screening or established risk reduction methods.

Additionally, genetic counselling is recommended for individuals with a family history of breast or ovarian cancer, known genetic mutation, or personal history of breast cancer; and chemoprevention (tamoxifen, raloxifene) is available for high-risk individuals.

By changing lifestyle habits and routine, we can reduce our risk of getting breast cancer and modify the outcome, because while treatment is essential and screening is instrumental, it is ultimately prevention that is paramount.