Breast Cancer Awareness

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1 Issue 27 October 2011 The E - Bulletin is a service provided from the in-house team of physicians (Specialists, GP s & the In-house Training Center) at the CEDARS Jebel Ali International Hospital in order to raise awareness about health issues. Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductar carcinomas; those originating from lobules are known as lobular carcinomas. In rare cases, breast cancer can start in other areas of the breast. Breast Profile A - ducts B - lobules C - dilated section of duct to hold milk D - nipple E - fat F - pectoralis major muscle G - chest wall/rib cage Enlargement Breast cancer does NOT always comes in the form of lump in the breast. Regular examination is recommended for early detection Anatomy of Breast A - normal duct cells B - basement membrane C - lumen (center of duct) FACTS Worldwide, breast cancer comprises 22.9% of all cancers (excluding non-melanoma skin cancers) in women. In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women). Breast cancer is always caused by a genetic abnormality (a mistake in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the wear and tear of life in general.

2 Page 2 1 in 8 women will be diagnosed with breast cancer Breast implants, using antiperspirants, and wearing underwire bras DO NOT raise your risk for breast cancer. Causes, incidence and risk factors Risk factors you cannot change include: Age and gender : increases as you get older Family history of breast cancer : higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer Genes : The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life Menstrual cycle : Women who got their periods early (before age 12) or went through menopause Other risk factors Alcohol use : 1-2 glasses of alcohol a day Childbirth : Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer. DES: Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s s Hormone replacement therapy (HRT) Radiation: If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a much higher risk for developing breast cancer Who need to be screened? All women aged years are recommended to perform periodic regular screening for breast cancer. Screening refers to the testing of healthy women for early detection of beast cancer You do not require a screening mammogram if you: are under 40 or over 69 years old have had a mammogram within the last 24 months are pregnant are lactating (breast-feeding) have removed both breast

3 Page 3 The breast self examination 1. Stand before a mirror. Inspect both breasts for anything unusual, such as any discharge from the nipples, puckering, dimpling or scaling of the skin 2. Watch closely in the mirror, clasp hands behind your head and press hand forward. See if there is any changes in the shape or contour of your breasts. 3. Next, press hands firmly on hips and bow slightly toward your mirror as you pull your shoulders and elbows forward. 4. Raise your left arm. Use 3 or 4 fingers of your right hand to explore your left breast firmly, carefully and thoroughly. Beginning at the outer edge, press the flat part of your fingers in small circles, moving the circles slowly around the breast. Pay special attention to the area between the breast and armpit, including the armpit itself. Feel for any unusual lump or mass under the skin 5. Gently squeeze each nipple and look for a discharge 6. Steps 4 & 5 should be repeated lying down. Lie flat on you rback,right arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes it easier to examine. Use same circular motion described earlier. Repeat on your right breast.

4 Page 4 Breast Examination Every woman aged 20 years and above should check her breasts for lumps, thickening or other changes every month. By examining your breasts regularly, you will learn how your breasts normally feel The best time for a breast self examination is between day 6-10 after the first day of your period, when the breasts are not tender or swollen. Women who are postmenopausal or post-hysterectomy should conduct the breast self examination on the same day of each month. You may choose any date but it should be one that you will remember. Symptoms Breast cancer stages range from 0 to IV. The higher the staging number, the more advanced the cancer. Early breast cancer usually does not cause symptoms. This is why regular breast exams are important Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus Signs and tests Physical exam -which includes both breasts, armpits, and the neck and chest area. Tests used to diagnose -Breast MRI, Breast ultrasound to show whether the lump is solid or fluid-filled. Breast biopsy, using methods such as needle aspiration, ultrasoundguided, stereotactic, or open. CT scan to see if the cancer has spread Mammography to screen for breast cancer or help identify the breast lump. Plan to have your mammogram between day 6th and 10th day of your menstrual cycle. PET scan Sentinal lymph node biopsy to see if the cancer has spread. If diagnosed to have breast cancer, more tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

5 Page 5 Prevention Tamoxifen Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy. This is the surgical removal of the breasts before breast cancer is ever diagnosed. Protect Your Mom Campaign is to make the students pester their Moms to do a mammogram or at least a self exam since awareness is very low in our world. Unless the kids pester their mothers, the mothers may not be inclined to do so. Although people do participate in walkathons, few actually do regular mammograms which are crucial for detecting breast cancer early. Once cancer spreads it is fatal but very few ladies know that even a 5 minute self exam which costs nothing could possibly help detect cancer early and save their lives. Medical Consultant for October 2011 Dr. Pankajam is a qualified and well experienced General Practitioner with more than 10 years experience in Clinical Practice. Dr. Pankajam Indirajit General Practitioner She completed her graduate Degree in the year 1996 from J.J.M. Medical College, Karnataka, India and later obtained a Postgraduate Diploma in Dermatology, Venerology and Leprosy from Fr. Muller Medical College, Rajiv Gandhi University, Bangalore, India in the year Her main areas of interest are Dermatology and Cosmetology.