Breast Cancer Awareness Month |06 October 2017

Between 2012-2016 the Seychelles National Cancer Registry recorded 155 cases of breast cancer, making it the second most common cancer in Seychelles during this period as well as the most common type of cancer among women during the same period.

On average, there has been one new case every month until 3 years ago when an increase in the number of cases was observed.

To commemorate Breast Cancer Awareness Month in October, the Ministry of Health (M.O.H), Cancer Concern Association (CCA) and Dr. H. Telemaque of the M.O.H share their knowledge and advice in an attempt to help in the fight against breast cancer.

What is breast cancer?

Breast cancer is a disease whereby the cells of the breasts grow out of control. These cells usually form a tumour which later can spread or metastasise to the surrounding tissue or invade other parts of the body. The tumour can often be felt as a lump and can also be detected with the use of X-ray imagery. The breast is made up of different tissue types and so there are different types of breast cancers depending on which cells in the breasts become cancerous.

Causative & protective factors of breast cancer

Below Dr Telemaque lists some common causative and protective factors for breast cancer.

Causative:

• Geographical: high in Western Europe & USA but low in East Asia & East Africa, however their incidence is also increasing
• Age: increase with age; especially those over 50 years of age and those older than 70
• Gender: disease of females but males do get it as well; 3 cases in males were recorded in the last 2 years in Seychelles
• Genetics: those who carry the two genetic markers BRCA 1 & BRCA2 are more likely to develop breast or ovarian cancer
• Obesity
• Smoking and alcohol
• Diet: saturated fatty acids, processed meat and red meat
• Sedentary life style / lack of physical exercise will increase the risk

Protective:

• Diet: a Mediterranean diet (rich in plant proteins, whole-grains, fish, monounsaturated fats and low in refined grains, red meat and sweets)
• Endocrine: pregnancy and breast feeding are protective against breast cancer as well as if you start your period at a later age or have early menopause

Statistics relating to breast cancer from the Seychelles National Cancer Registry

Detecting breast cancer and how to reduce your risk

Be ‘breast aware’

• Know what is normal for you
• Look at and feel your breasts
• Know what changes to look for
• Report any changes without delay

Your breasts may feel different depending on the time of the month and your stage of life. When you know how they normally look and feel, you will be more likely to spot any unusual changes.  Check yourself in a way that is comfortable for you, perhaps in the bath or shower.

What changes should I look for?

It is often women themselves who first notice their breast cancer. Most changes are not caused by cancer, but it is very important to report anything unusual to your doctor. Look for:

• changes in the size, shape or feel your breasts
• a new lump or thickening in one breast or armpit
• any puckering, dimpling or redness of the skin
• changes in the position of the nipples, a rash, nipple discharge 
• pain or discomfort that is new to you and felt only on one side

If you notice any of these or any other unusual changes to your breasts, it is worth seeing your doctor.

Self-breast examination

Conducting your own breast examination is easy to do. It is recommended that you check your breasts once every month, specifically one week after your menstrual period. If you do not see your period, choose a specific date to check your breasts each month.

1. Remove all upper garments and stand/sit infront of a mirror with your arms resting loosely at your sides. Check your breasts for any changes in size and shape; check for any puckering, changes in the position of the nipples and check the underneath of the breasts as well.
2. Turn to check both breasts carefully.
3. Lift your arms and check again, especially the nipples.
4. Place your hands on your hips and press until you feel the muscles under your breasts tightening. Check for any puckering.
5. Lie on a bed or a flat surface. Place a folded towel or pillow beneath your right shoulder.
6. Place your right hand behind your head. Visualise your breast in four quarters. Using the three middle fingers of your left hand, feel the upper quarter of your breast that is closer to your arm. Gently press this area to check for any lumps and thickening or puckering of the skin.

• Continue to feel this area until you reach the nipple.
• Feel around the nipple area as well.
• Repeat the same for all other quarters of the breast.

1. Put your right arm down and feel under your armpit.
2. Squeeze the nipple to detect any abnormal discharge.
3. To examine your left breast, repeat instructions 5 to 8.

Screening

Screening involves taking X-rays of the breasts (mammography). Breast screening can find cancers at an early stage when they are too small for you to notice. When changes are found early, there is an excellent chance of successful treatment.

Breast screening remains an effective way of detecting breast cancer at an early stage when treatment is most likely to be successful. However, it is not the only way to detect breast cancer early.  It is important that women get to know how their breasts normally look and feel, so that they can spot any changes more easily. If you notice any unusual changes to the size, feel or shape of your breasts, it is worth checking with your doctor.

According to Dr. Telemaque, the most common presentation is a lump in the breast but the great majority of lumps in breasts are benign (harmless), so a systematic approach is required to identify the malignant from the benign ones. Pain and breast discomfort is the presentation in less than 5%.

‘’We have a very well-run breast clinic in the SOPD fortnightly dedicated to breast cancer diagnosis, management and surveillance (follow-up). Generally people are presenting much earlier with their breast cancer and treatment outcomes are good, though we still see some occasional late presentations. The next step for further improvement will be the setting up of screening services for breast cancer but that will need a major injection of funds and resources both in terms of equipment and mainly personnel,” says Dr Telemaque.

Sources: Ministry of Health Seychelles, Cancer Concern Association Seychelles, Center for Disease Control and Prevention, American Cancer Society