Introduction

The word “cancer” brings a shiver down our spines despite profound advances in cancer diagnosis and management. When a person is diagnosed as having a “cancer” the first stumbling block that we surgeons usually face is the mental breakdown of the patient. A sense of fear looms within the patient that the days of life are now numbered and he or she then proceeds to an unknown destination!
In this world of ever increasing pollution and changing environmental conditions coupled with the increased knowledge about cancer genetics, cancer as a diagnosis would be more frequent in the coming years: so let us not be afraid of it, rather let us understand what we, as common persons can do to face a complex “cancerous” situation.
In this section, I am going to discuss briefly about breast cancer. Breast cancer is one of the leading cancer diagnoses in women although it has a low incidence in men. In fact, when considering the number of new cancer development in women, breast cancer stands out as the first one with over a million cases occurring worldwide every year. In the US, more than 200,000 new cases of invasive breast cancer is detected every year while around 60000 localized breast cancers occur. In India, the figure is somewhat more than 80000 per year. It is important to remember that these figures are on the rise!

Risk Factors for Breast Cancer

Several risk factors for breast cancer are known. As mentioned earlier, gender is an important risk factor with most cases occurring in women. Advanced age is the next most common risk and as the aged population increases due to improved healthcare, the number of breast cancers would also be on the rise. For example, while 1 out of 50 women have a risk of developing breast cancer at age 50, the same diagnosis can be expected in 1 out of 10 men at age 80! Women who begin their periods early and who achieve menopause later in life have an increased risk. Bearing the first child after 30 years of age is also an additional risk. Breast feeding is protective so that women who do not breast feed are subjected to increased risk. There is also a small risk in women who are on Oral Contraceptives and on Hormonal Replacement Therapy after menopause but the advantages conferred by these are so profound that the small risk that they confer can be safely ignored at present. A history of breast cancer in the family also increases the risk so also is alcohol consumption.
So, what can the common person do to counter these risks? The only factors that one can modify are possibly bearing a child before 30 and breast feed the child as well as abstaining from alcohol; you cannot modify the other factors! However, keeping in mind that a small element of risk always remains, it is important that in susceptible individuals an effort is made to detect the disease when it is in the localized state and before it becomes invasive because the chances of complete cure is possible in the former condition. There are a number of strategies to achieve this aim and I will focus on Self breast Examination, a simple method of examination that can be done by most women on a regular basis. If done properly, coupled with breast examination by a surgeon done on an annual basis, the chances of early detection of breast cancer are maximized.

This method of examining your breasts may appear a bit cumbersome in the beginning but with time you will know what is “normal” and what is not. It is important to know that the feel of the breasts vary with the stage of the menstrual period with the breasts appearing more firm and slightly nodular at the time of menses. Therefore, for best results, I would advice you to do this examination a few days after your periods when the tenderness has resolved. Please note that you can detect lumps more often adjacent to your armpits: do not be alarmed as these are not cancers in most instances!



STEP 1


In the beginning, have a LOOK at your breasts in the mirror with your shoulders straight and your arms on your hips.
Things to look out for:
*compare the two sides to see if the breasts have their usual size, shape, and color
*if there is visible distortion or swelling in either breast.
If you see any of the following changes, bring them to your doctor's attention:
*dimpling, puckering, or bulging of the skin of the breasts
*a nipple that has changed position compared to earlier or an inverted nipple (pushed inward instead of sticking out)
*redness, soreness, rash, or swelling in either breast especially when adjacent to the nipple.

STEP 2


Raise your arms and look out for the same things as in Step 1.

STEP 3

While you're still in front of the mirror, gently squeeze each nipple between your fingers and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood or any other thick or thin clear fluid as well as greenish fluid). Please bring the same to the attention of the doctor.


STEP 4

Next, lie down and feel your breasts one at a time, using your right hand to feel your left breast and then your left hand to feel your right breast. While using one hand, keep the other below your head over a pillow for best results. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.
Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage.

STEP 5


Finally, feel your breasts while you are standing or sitting. You can do this while in a shower. Cover your entire breast, using the same hand movements described in Step 4.
If you discover anything abnormal, it is imperative that you make an appointment with your surgeon as early as possible! Do not neglect: time is a critical factor in treatment!


Conclusion

Lastly, I would like to say a few things about screening mammography. Screening mammography is literally an X-ray of the breasts that is done to note anything suspicious within the breasts. This can be important in cancer detection but it is also important to note that it can miss 1 out of 5 cancers. It is of less use in younger women because they have dense breasts and therefore women in the age range 40-49 years should resort to a 2 yearly mammography while women above 50 years of age should opt for a yearly mammography.
To sum up, self breast examination is the most important part of screening for breast cancer and should be done by all women regardless of age supplemented by annual clinical examination by a surgeon or when abnormalities are detected by the patient herself during self examination. This is much more important in women who have a family history of breast cancer. Screening mammography is of most benefit to women above 40 years of age although it has the propensity of missing quite a few cancers.