Dawn Images

October is Breast Cancer Awareness Month and this October we want to make sure you have all the knowledge you need on breast cancer. We’ve spoken to experts to debunk myths surrounding breast cancer and educate you on diagnosis and treatment of the disease.

According to the National Library of Medicine, breast cancer is the most prevalent type of cancer in the world and Pakistan has the highest rate of breast cancer prevalence in Asia. One in nine Pakistani women, at some stage of her life, has developed breast cancer. Hence, educating yourself on the matter becomes absolutely vital so you can keep a check on yourself and seek help if needed.

Myths related to breast cancer

Due to a lack of awareness, there are many myths surrounding breast cancer about the cause, identification and treatment. Doctors have stressed on the power of early detection, which can quite literally save lives.

Dr Abida Sattar, Head of Breast Surgery and Director of the Breast Surgery Programme at Aga Khan University Hospital, spoke to Images about false information about the disease.

Myth 1: Women who breastfeed or have given birth, and people with no history of breast cancer cannot get breast cancer.

Truth: Any woman can get breast cancer — 90 per cent of cases of breast cancer occur without any kind of risk factor. Only 10 per cent of breast cancers occur in patients who have a family history or a genetic disposition.

Myth 2: Bras and deodorants can cause breast cancer.

Truth: The colour or type of bra, and using antiperspirants have nothing to do with breast cancer.

Myth 3: Lumps in the breast are doodh ki ghutli.

Truth: Doodh ki ghutli (galactocele) is an entity that exists but it only occurs while a woman is breastfeeding. Once breastfeeding is over, these lumps go away. If you continue to feel a lump, even during breastfeeding, you should have it checked.

Myth 4: Biopsy leads to spread of breast cancer.

Truth: A needle biopsy is the first step in diagnosis, without which doctors cannot proceed with treatment.

The earliest detection of breast cancer is what is likely to save lives. People often think that breast cancer is going to kill them but it is completely treatable as long as it is identified and diagnosed early. The earlier it is diagnosed, the shorter the treatment and the better the outcome. A very important step for diagnosis is a biopsy.

Myth 5: Breast cancer will take away your life or your breasts.

Truth: Early diagnosis and proper and complete treatment can not only save lives, but also the breasts. The doctors will extract the tumour and in the best case scenario, save the rest of the breast and reshape it.

In cases where the breast must be sacrificed, despite trying everything to save it, reconstruction is an option.

Signs, symptoms and detection of breast cancer

A lot of people are unaware of the fact that detection of breast cancer can actually begin at home through a self breast examination. It becomes even more handy for those who cannot access medical facilities.

Dr Amina Khan, Consultant Surgical Oncologist at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, says the importance of self-examination is especially true in our society where facilities for screening are not readily available to everybody. “In that regard, we ask women to check themselves thoroughly once a month and the signs and symptoms to look out for become very, very relevant.

“If you notice a thickening or a hardness or a lump anywhere in the region of the breast or the axillary tail, the tissue that goes from the breast into the axilla, or the armpit itself, it is a cause for concern and should prompt everyone to go and seek medical help. Besides a lump, it can be a rash in the skin of the breast that does not go away, a sense of tethering or a change in contour, discharge from the nipple especially if it has blood and any significant size change in the breast should prompt everyone to seek medical help,” she explained, listing the signs to look out for.

She termed mammography for screening the most important test. “We advise mammograms to women as a baseline starting in between ages 35 to 40 years. After that an annual screening mammogram is advised once a year to detect legions which are small enough not to be palpable or which can’t be felt easily either by the patient or sometimes even by the doctor.

“Very, very tiny changes, early changes in the breast are picked up by these mammograms and are very helpful in the detection of cancer. Besides a mammogram, we complement this test with an ultrasound and ultrasounds are usually done where indicated in combination with the mammograms.”

Dr Khan noted that most of the lumps detected in the breast, thankfully, are not significant but the ones that are need to be evaluated, checked out and given due importance.

How to perform a self breast examination

If you don’t know how to perform a self breast exam, Dr Sana Zeeshan, Assistant Professor of Breast Surgery at Aga Khan University Hospital, has got you covered. A simple, two to three-minute test every month is all you need to do.

“A self breast examination is a very important procedure — it is a task that every woman should perform once a month. In our country, very few women have access to an annual mammogram, the women who live far off in rural areas or the women who can’t access a mammogram, it is especially necessary for them to pay attention to their breasts and armpits once a month. With this, the lumps that have been ignored can be picked up,” she said.

There are two steps to checking your breasts. First is noting any visual changes by exposing your breasts in front of a mirror and gazing at your breasts with your hands on your sides, on your back and on your head. They should look approximately the same. Any changes in the shape, size, skin or nipples should be noted.

Second is palpation or feeling the breasts. It is important to feel the breast you’re examining with the opposite hand (i.e. feel the right breast with your left hand) while keeping the other hand on your head. You have to feel your breast with the flat surface of three fingers, moving them in circular motion over the breast and nipple region. With the same hand, feel your armpit as well and check for lumps, hardness or any new change that wasn’t there before.

It is necessary to feel your breasts while standing and while lying down. Do not press or poke your breasts, only feel with flat fingers.

Taking out two to three minutes every month for this task is very important. If you feel any change, you must contact your doctor immediately. Dr Zeeshan explained the reason why it needs to be performed once a month instead of daily or weekly — so that new changes can be detected easily. Menstruating women should check their breasts and armpits after their period has ended while menopausal women can check their breasts on any day of the month.

Surgical approaches to treatment of breast cancer

People often equate breast cancer treatment with removal of the breasts. While that was the case initially, it is not anymore due to great advancements in the medical field that have enabled safe, breast-saving options. Dr Khan breaks down the processes involved in breast cancer treatment.

“As a surgeon, I can tell you that there have been massive advancements in how we’ve progressed with the treatment of breast cancer. We’re moving gradually away from major surgery to more and more conservative surgery. I’m happy to say that most of the cancers that we treat nowadays are offered and advised to have breast-saving surgery because it’s equally effective in the treatment of this disease,” she said.

Breast-saving surgery refers to a lumpectomy where the cancer in the form of a lump is removed. “In terms of what we do with the tiny lumps, we have imaging available, we have guidances available by radiology where these tiny legions can be localised and removed with small incisions. Mutilating surgery or big mastectomies are not warranted,” she added.

Similarly, for the armpit or axillary surgery also, there has been a shift to sentinel lymph node biopsy where the main, first draining lymph nodes are excised and the full axillary basin of lymph nodes does not need to be removed in patients.

There has been an advancement in reconstructive surgery as well, meaning that if the treatment absolutely requires breast removal, it can be replaced. These reconstruction operations are done at the time of the breast removal.

“Things have changed now, surgical techniques have improved, post-op care has improved. I’m happy to say that the surgical treatment of breast cancer now has made this particular kind of treatment very, very different from how it used to be years ago. Most patients deal very well with the surgery for breast cancer and recover extremely well,” said Dr Khan.