October is Breast Cancer Awareness Month; this disease kills nearly half a million women each year. Breast cancer comprises approximately 16% of all cancers in women, making it the most common form of cancer in women and according to the World Health Organization (WHO) its incidence is increasing. The majority of the women who die from breast cancer live in developing countries. In fact, survival rates vary tremendously, ranging from 80% or more in North America, Sweden, and Japan to below 40% in low-income countries. The main reason for the disparity is early detection, as women in countries where the survival rate is low tend to present with late-stage disease. There is also insufficient diagnosis and a lack of treatment facilities.
Who is at risk?
While several risk factors have been identified, it is important to know that most women who have breast cancer did not present with one of those risks. One of those risk factors is having a family member with breast cancer, which increases the woman’s risk by 2 or 3 times. Mutations, in particular genes, also greatly increase the risk, although the mutations are rare. Prolonged exposure to estrogen produced by the body, such as in early menses and late menopause, and having a first child later in life are other risk factors. Hormone replacement therapy and oral contraceptive use also increase the risk. One study found that 21% of all breast cancer deaths worldwide is attributable to alcohol use, being overweight or obese and physical inactivity. Notably, breastfeeding reduces the risk.
Prevention and Control
WHO advocates a comprehensive plan to control breast cancer, which includes prevention, early detection, diagnosis and treatment, rehabilitation and palliative care. With respect to prevention, WHO targets the modifiable risk factors, such as alcohol use, diet and physical activity. However, while prevention can reduce the risk somewhat, it will not reduce the majority of cases in the low- and middle-income countries. Accordingly, the cornerstone of breast cancer control is early detection to improve outcome and survival.
Early detection can be achieved in two ways. First, developing awareness of early signs and symptoms in a symptomatic population to allow for early diagnosis and treatment. The second method is implementing a regular screening program in a population, which is a far more involved undertaking.
WHO mentions early diagnosis, mammography screening and breast self-examination with respect to early detection. Other diagnostic tests include breast ultrasound, biopsy and breast magnetic reasonance imaging (MRI). Early diagnosis can be particularly effective in low- and middle-income countries where many of the women present themselves with late-stage cancer that is less amenable to treatment and resources are limited. WHO recommends for these countries strategies that promote awareness of early signs and symptoms and screening by clinical breast examination.
According to WHO, mammography, the only screening method proven effective, can reduce deaths from breast cancer by between 20 – 30% in women over 50 years of age in high-income countries if the screening coverage is over 70%. No research has been done in low-resource settings. Because mammography screening is expensive, it is recommended for countries that have a good health infrastructure and can afford a long-term programme.
WHO states that there is no evidence that screening through breast self-examination is effective, but recommends it for raising awareness among women at risk. Whether or not to conduct a self-examination is controversial and it is best to speak to your healthcare provider about what is best for you and your particular circumstances.
With respect to diagnosis and treatment of cancer in general, the goals are to cure the disease or extend life and to enhance the quality of life of cancer survivors. The first step is to identify the extent of the cancer. With respect to breast cancer, stages range from O to IV: O indicates that the cancer is small and noninvasive, while IV indicates that the cancer has spread to other parts of the body.
Once the extent of the cancer has been identified, treatment options are considered. According to WHO, treatment decisions “must be made regarding the most effective cancer treatment in the given socioeconomic setting”. Main treatments include surgery, radiotherapy and systemic therapy, as well as a combination of these therapies. For a more detailed explanation of various treatments, see the Mayo Clinic’s (a highly respected medical institution in the United States) website (see below). The Mayo Clinic also discusses alternative treatments and states that no alternative treatments have been found to cure breast cancer, but such therapies may help with the side effects of other treatments (see below).
The final part of WHO’s control programme is palliative care. WHO describes palliative care as “improv[ing] the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to end of life and bereavement” (see below). WHO notes that most cancer patients worldwide present themselves with late-stage disease and therefore the only realistic treatment for them is pain relief and palliative care.
When reading about the worldwide burden of breast cancer, one cannot help but see the enormous health disparities with respect to prevention and control, much of which appears to hinge on early detection. But for those living in high-income countries with access to early detection programs, mammography and other expensive detection methods and treatments, there is no guarantee on an individual basis that someone will heed medical advice. The grandmother of a dear friend of mine died of breast cancer when she presented with late-stage disease. She knew she had a lump in her breast for quite some time, but didn’t say anything because she did not want to worry anyone. So please sisters, become aware and help your family and friends to become aware of this deadly disease and what can be done to prevent and treat it.
Mayo Clinic: Treatments
In preparation for Breast Cancer Awareness Month in October, Klaudia Khan chats to a sister already dealing with cancer and then discusses the main things we should know.
J. Samia Mair has a master degree in public health from the Johns Hopkins Bloomberg School of Public Health and numerous publications in peer-reviewed literature. She is the author of five children’s books, most recently published a chapter book, The Great Race to Sycamore Street, and Zak and His Good Intentions (expected 2013). She is a Staff Writer for SISTERS Magazine and Discover, The magazine for curious Muslim kids and has published in magazines, books, anthologies, scientific journals and elsewhere.