As the month of October begins, we officially kick off our Breast Cancer Awareness campaign: “Let’s Talk Pink!” Yet, beyond the fundraising and donations, beyond the pink-themed events and paid content; it is educating our society about breast cancer that is critical, and perhaps the most important thing to do. It is estimated that by 2035, there will be 24 million cases of breast cancer worldwide. In Pakistan alone, 90,000 cases of breast cancer are reported every year and over 40,000 deaths are caused by the same. As compared to other types of cancer, breast cancer has over 90% chances of being completely cured if diagnosed at an early stage. Lack of awareness about breast cancer is the leading cause for people to go undiagnosed for years, until it is too late for treatment to have any affect.
The pink ribbon is the international symbol for the fight against breast cancer. It represents fear of breast cancer, hope for the future and charitable goodness of people and businesses who strive to support breast cancer awareness drives and movements. It is intended to evoke solidarity with women (and men) who currently have breast cancer, or have survived breast cancer.
We hope to create a pathway to communication with our annual campaign. Join in the conversation by using the hashtag #LetsTalkPink and sharing your thoughts and stories with us.
Back to Basics: What is Breast Cancer?
Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth and health of cells in the body. Normally, cells replace themselves through an orderly process; however, mutations can stimulate certain genes and switch off others, resulting in the changed cells gaining the ability to divide without control or order, forming tumors.
The breast refers to the tissue overlying the chest (pectoral) muscles. Women’s breasts are made of fat, connective tissue and (specialized) glandular tissue divided into lobes. These lobes are further connected to a network of ducts, which spreads out from the lobes towards the nipple. Usually, one breast is smaller than the other. Breasts might even feel different at different times of the month; it is common for breasts to feel lumpy or overly sensitive just before the menstrual cycle begins. Younger women have more glandular (relating to, or affecting glands) tissue in their breasts, as compared to those who are past the age of menopause. In the latter case, the glandular tissue is gradually replaced by fat, which is much less dense in comparison.
A – Ducts
B – Lobules
C – Dilated section of duct to hold milk
D – Nipple
E – Fat
F – Pectoralis major muscle
Enlarged Image: A – Normal Duct Cells
B – Basement Membrance
C – Lumen (Center of duct)
Breast Cancer refers to a malignant tumor that may have developed from the cells in the breast. Unlike benign tumors (that are considered relatively harmless), malignant tumors are cancerous. Left unchecked, they can eventually spread beyond the original area of the tumor to other parts of the body. Such tumor(s) can be seen through an X-Ray, or can even be physically felt as a lump.
While there are consistent improvements in treatment, Breast Cancer continues to be the leading cause of death by cancer in women, second to lung cancer. Cancer can be difficult to get rid of once it begins to spread, so most health professionals use a system of staging to determine how far the cancer has spread and how serious it is. It is also not uncommon for men to suffer from breast cancer.
Usually the cancer starts in the lobules (the milk producing glands) or the ducts (the passageways that drain milk from the lobules to the nipple). Less commonly, it can even begin in the stromal tissue (the connective tissue of the breast). 85-90 % of breast cancer instances occur due to genetic abnormalities resulting from the aging process. Only 5-10 % of cancers are due to an abnormality inherited from either parent.
Each person can take certain precautionary steps to protect themselves against the risk of breast cancer. These include eating a balanced diet, exercising regularly and making healthier lifestyle choices. While they may impact on your risk of getting breast cancer, they cannot completely eliminate that risk.
Stages of Breast Cancer
There are mainly four stages of breast cancer. We have compiled a table describing the different stages and sub stages of this disease for easier comprehension.
|Stage (s)||About Each Stage|
|Stage 0||Cancer cells develop and stay inside the breast duct, without venturing into adjoining breast tissue cells.|
|Stage 1A||The tumor measures up to 2cm. The cancer has not begun to spread outside the breast cells, and as yet no lymph nodes are involved.|
|Stage 1B||(i) While there is no tumor in the breast, small groups of cancer cells can be found in the lymph nodes. They range from being larger than 0.2mm to less than 2mm in size.
Or, in another scenario,
(ii) A tumor has developed in the breast (no larger than 2cm) and small groups of cancer cells (larger than 0.2mm but less than 5mm in size) can be found in the lymph nodes.
|Stage 2A||(i) While no tumor is found inside the breast, cancer cells are present in the axillary lymph nodes (the lymph nodes under the arm).
Or, in another scenario,
(ii) The tumor present in the breast measures 2cm or smaller, and has spread to the axillary lymph nodes.
Or, in another scenario,
(iii) The tumor present in the breast is larger than 2cm but less than 5cm, but has not spread to the axillary lymph nodes.
|Stage 2B||(i) The tumor is larger than 2cm but less than 5cm, and has spread to the axillary lymph nodes.
Or, in another scenario,
(ii) The tumor is larger than 5cm, but has not spread to the axillary lymph nodes.
|Stage 3A||(i) No tumor can be found in the breast. However, cancer cells are found in the axillary lymph nodes that are sticking together or sticking to other structures; or cancer cells may be found in the lymph nodes near the breastbone.
Or, in another scenario,
(ii) Tumor is found in the breast (can range in size). Cancer cells are also found in the axillary lymph nodes that are sticking together or sticking to other structures; or cancer cells may be found in the lymph nodes near the breastbone.
|Stage 3B||The tumor (can vary in size) has spread to the chest wall and/or skin of the breast. It may also have spread to the axillary lymph nodes that may be clumped together or sticking to other structures; or the cancer may have spread to the lymph nodes near the breast bone.
|Stage 3C||There may be either no sign of cancer in the breast cells; or a tumor (of any size) may have spread to the chest wall and/or skin of the breast. Also, the cancer will have spread to the lymph nodes either above or below the collarbone. The cancer may also have spread to the axillary lymph nodes or to the lymph nodes near the breast bone.|
|Stage 4||The cancer has spread (metastasized) to other parts of the body.|
Self-Examination: A How-To Guide
Regularly examining your breasts on your own to identify anything out of the ordinary can be an important way to find breast cancer early, when it is more likely to be treated successfully. Not every cancer can be found this way, but it is a critical step that you should and can take for yourself. The more you examine your breasts, the more familiarized you will become with them and the easier it will be for you to detect unusual occurrences. Before we go into detail regarding the different steps of Breast Self-Examination (BSE), here are some tips to help you understand the process better.
Familiarize yourself with your breasts and their “neighborhoods” (surrounding area, which can include the upper, outer area near your armpit, the lower half, or even the area under the nipple). Examine yourself several days after your period ends. If you are in menopause (no longer having periods) then choose a day in the month that is easy to remember for your self-exam. The most prominent lumps and bumps can usually be felt/found in the upper, outer area near the armpit. The lower half might feel slightly grainy, like sand at the beach. Another part of your breasts might feel like clumped up oatmeal.
You may want to start keeping track of your findings (not much different from calendars most women use to mark their menstrual cycles), so you can be sure if there are any sudden changes.
Don’t immediately go into panic-mode if you feel lumpiness. Not all lumps are cancers. It is not unusual for lumps to appear during certain times of the month and then disappearing (especially if you are still menstruating). Only changes that last beyond one full cycle or seem to get bigger or more prominent in some way need attention. What’s important is that you familiarize yourself enough to recognize if there is something out of the ordinary. Does something stand out as different from the rest, that wasn’t there before? Has anything changed (whether visually or by touch)? Share your findings with your doctor.
The Five Steps of a Breast Self-Exam:
Start by looking at your breasts in the mirror with your shoulders straight and your hands on your hips. You should look for the following:
- Breasts that are their usual size, shape and color.
- Breasts that are evenly shaped, without visible distortion or swelling.
If you see any of the following changes instead, call your doctor:
- Dimpling, puckering or bulging of the skin.
- A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out).
- Redness, soreness, rash or swelling.
If you don’t immediately see any changes to your breasts, change the pose you are standing in and raise your arms above your head. Now look again for the same changes.
While you are at the mirror, look for any signs of fluid/discharge coming out of one or both nipples (this could be a watery, milky or yellowish discharge, or blood).
Lie down and feel your breasts. Put one hand under your head and use the other to feel the breast (use your right hand to feel your left breast –keeping the left hand under your head- and use your left hand to feel your right breast – keeping your right hand under your head- to push the breast outward). Check to see if any changes to the skin, or any lumps have appeared since you last did a self-examination.
Use a firm, smooth touch with the first few finger pads of your hands, and make sure to keep the fingers flat and together. Use a circular motion, about the size of a quarter coin. Cover the entire area from top to bottom – from your collarbone to the top of your abdomen and from your armpit to your cleavage. You can begin at the nipple, moving in systemically larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows. Be sure to feel all the tissue from the front to the back of the breasts using different types of pressure: for the skin and tissue just beneath, use light pressure; for the tissue in the middle of the breasts, use a medium amount of pressure; and for deep tissue in the back, use firm pressure. When you reach the deep tissue, you should be able to feel all the way down to your ribcage.
Finally, feel your breasts while standing or sitting. It might be easier to do this when you step into the shower, as most women find the easiest way to feel their breasts for any possible changes is when their skin is wet. Cover your entire breast, using the same hand movements described above in Step 4.
Breast Cancer: Myths vs Facts
Lack of awareness of the disease has resulted in numerous myths surrounding breast cancer. We decided to debunk the most popular of these myths for you.
- Most breast cancers run in families. While most women who have a family history of breast cancer are in the high risk group, the truth is only 5% to 10% of breast cancer cases result from an abnormal gene being passed from parent to child. The rest of the 90% to 95% cases of breast cancer are largely due to lifestyle and environmental factors (such as a sedentary lifestyle, or high consumption of red meat and a poor diet). Other factors that increase risk include if you have two or more first-degree relatives diagnosed with breast cancer at an early age; a personal history of endometrium, ovary or colon cancer; and/or a personal history of breast cancer before the age of 40-years-old.
- You cannot lower your risk of breast cancer. Studies show that 90% to 95% of breast cancer cases result from lifestyle choices and environmental factors, which means that you can play an active role in ensuring that your risk of breast cancer remains low. Being overweight increases your risk of breast cancer, especially if you are past menopause and/or have gained weight later in life. Regular exercise, maintaining a healthy weight and a health oriented lifestyle, along with limiting the amount of alcohol you drink can largely decrease your risk factors.
- Certain types of bras cause breast cancer. While it is commonly thought that underwire bras cause breast cancer, there has been no evidence found to support such claims. A scientific study of 2014 explored the link between bras and breast cancer, and the results showed that there was no real difference in risk between women who wore a bra and women who didn’t.
- Regular mammograms prevent breast cancer. Mammograms are useful in finding out if a person has breast cancer, but they are not able to prevent the disease from occurring. They can save lives by finding breast cancer as early as possible, when it is treatable.
- Mammograms can cause cancer to spread. Breast compression while getting a mammogram cannot cause cancer to spread or occur. The risk of harm from the radiation of a mammogram is very low, and mammograms remain the gold standard for early breast cancer detection. However, despite their important for screening and diagnosis, mammograms fail to detect around 10% to 20% of breast cancers. This is why clinical breast examinations, and also self-examinations, are crucial parts of the screening process.
- Men do not get breast cancer. On the contrary, breast cancer is men is usually detected as a hard lump underneath the nipple and areola. Lack of awareness is the reason why most breast cancers in men seldom get treated. Men should periodically check themselves by doing a breast exam and reporting any changes to a doctor immediately.
- Breast cancer is contagious. This is false. Breast cancer results from a gene mutation in the cells. You cannot catch breast cancer from a patient/survivor and you cannot pass it on to someone else.
- If the gene mutation (BRCA1 or BRCA2) is detected in your DNA, you will definitely develop breast cancer. According to the National Cancer Institute (NCA), not every woman with a family history of this particular mutation carries this gene. Also, not every woman who has this gene will develop breast or ovarian cancer. However, it is important to note that women who inherit this mutation are five times more likely to develop breast cancer, compared to those who do not have this particular mutation.
- Breast cancer always comes in the form of a lump. While a lump may indicate breast cancer, not all lumps are breast cancer and women should be on the lookout for other possible indications of the disease. These include swelling, skin irritation or dimpling, nipple retraction (going inward), breast or nipple pain, a discharge other than breast milk, and redness, scaliness or thickening of the nipple or breast skin. Breast cancer can also spread to the lymph nodes and cause a swelling there before a tumor in the breast is detected or is large enough to be felt.
- Fertility treatments increase the risk of breast cancer. Given estrogen’s connection to breast cancer, fertility treatments have come under suspicion; but several studies have found that expectant mothers are at no higher risk of breast cancer than other women. However, the risks of breast cancer increase if a woman has her first full-term pregnancy when she is over 30-years-old.
It is important to mention that women who have had early onset menstruation (from age 12-years-old) also have a certain amount of risk associated with breast cancer.