Breast health is currently a much talked-about topic at this time, and being able to understand as a woman and a man (to a lesser extent really) how to appreciate breast health and what are the concerns, signs or complaints that you may have that require further attention is something that I believe we all need to know.
For comparison, we can all agree that the heart associations throughout the world have done an excellent job educating us on what are the signs of a heart attack. Easily, we can all say that symptoms such as crushing chest pains, sweating or racing heart are definitely not something to put off like a simple back pain, so they have achieved something with public education initiatives to be able to identify heart disease.
We are not quite there with breast diseases and therefore, public education initiatives are not only desperately needed but definitely has a long way to go. Nonetheless, it is important to become aware of breast health and what it means to get yourself checked. In this article, I thought I would explore some of the common signs and symptoms of breast cancer and debunk some of the myths that surround it as well.
For many countries that possess a screening programme, breast cancer is often diagnosed without any signs or symptoms. By that, I mean as women accept screening invitations for mammography examination and/or ultrasounds, often cancers are picked up from a very small size and most patients are unable to feel any lumps or have any symptoms at all.
However, recent research (World Breast Cancer Report 2012) in T&T has shown that screen detected cancers only make up five per cent of all cancers that we have diagnosed in the last five years. This is a very worrying statistic, as currently in the US and the United Kingdom screen detected cancers make up about 75 per cent or more, and it therefore means that cancers detected in these countries with screening programmes are smaller and less aggressive, and these patients have an even better chance of living a normal, fuller life.
For the benefit of Trinbagonian women, let us discuss what are the common signs and symptoms that would require urgent attention. The most common way for breast cancer to present itself is in the form of a lump. Very often, women would come to our practice with breast pain, and it is important to appreciate that breast pain by itself is not typical of breast cancer though many women may believe so.
Breast cancer presented as a lump are often painless and may lie in a woman’s breast for many months, if not a couple of years before becoming large enough to cause problems within the chest wall. Sometimes as the breast cancer becomes aggressive it can spread into the armpit, becoming very large and swollen and causing pain.
But over 95 per cent of all breast cancer presented as lumps do not cause pain. On the flip side, breast pain is very rarely associated with breast cancer and therefore, most causes of breast pain in patients is either hormonal or due to badly fitting bras, or due to a muscular or chest wall injury. These make up the most common causes of breast pain.
Very rarely, patients may have blood stained nipple discharge from one spot or both nipples, this requires urgent investigation. Often patients may be asked about itching in the nipples, not in the breast but rather in the nipples, and this can be a very early sign of ductal carcinoma in situ which is a very early form of breast cancer and is curable by surgery only.
It is very unusual for breast cancer patients to present with spread to different parts of the body. At present, this makes up about 16 per cent of all cases presented for diagnosis in Trinidad. This unfortunately is twice the incidence in screen detected populations such as the US and the United Kingdom.
It is important that patients become breast aware and are able to conduct a suitable self-examination to know what their normal breast feels like. Breast awareness, which is often something talked about, does not teach you what breast cancer feels like but is meant to teach you what your own breast feels like, so that if you were to feel something different you are able to identify and monitor it and seek treatment.
• Rajendra S Rampaul
Consultant oncoplastic
breast surgeon
Surgical oncologist
Pink Hibiscus Breast
Health Specialist