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The battle against breast cancer continues

By RONALD DELOS REYES, Ramon Aboitiz Foundation Inc.
October 3, 2013

By simply being a woman makes all women at risk of contracting breast cancer.

However, those who have had early menstruation (before age 12), those who went through late menopausal (after age 55), and women who did not have children or who had their first child after the age of 30 have a higher risk of developing breast cancer.

This is attributed to longer lifetime exposure to the female hormones estrogen and progesterone.

Just what is breast cancer?

It is a type of cancer that originates from a breast tissue. Lack of childbearing, sex, high fat diet, tobacco use, alcohol intake, obesity, and heredity are the other risk factors of the disease.

Breast cancer is the most researched type of all cancers. Published in various research papers, methods of early detection, prevention, and treatments have already been laid down by medical professionals. However, the incidence rate of the life threatening disease is still increasing over the years.

Globally, for every eight women, one develops breast cancer before the age of 75. In Third World countries such as the Philippines, in every three women diagnosed with breast cancer, one dies within the same period. In fact, breast cancer is number one in incidence and mortality rate in developing countries.

In Cebu, breast cancer is the leading cancer-related deaths among Cebuano women. Based on the population-based Cancer Registry of the Ramon Aboitiz Foundation Inc. (RAFI) Eduardo J. Aboitiz Cancer Center (EJACC), women ages 50 to 54 are the ones most likely to be diagnosed with breast cancer.

In 2003-2007, there were 657 recorded deaths out of 1,349 breast cancer cases. Of the newly-diagnosed cases in Metro Cebu, 70 percent were found in the later stages of the disease.

While women cannot do anything on their lifetime exposure to estrogen and progesterone, they can help reduce the risk through breastfeeding.

When mothers breastfeed their newborn, there is a suspension of the production of the hormones. A year of breastfeeding is best recommended, not just for the welfare of the newborn but also for the mother.

Cancer is always associated with despair and death. For women afflicted with cancer of the breast, death is just around the corner. The fear is the reason why it takes a lot of time for them to see a doctor and undergo treatments.

Financial constraints also prevent women from responding to symptoms as soon as possible. Another reason is lack of information. The more information about cancer she knows, the higher is the likelihood for a woman to act swiftly.

Less than 30 percent of all types of cancers, including breast cancer, have ďcommonĒ early detection. It is important to note what stage a personís cancer already is primarily determines the patientís survival, if not cure.

Breast cancer screening means is important because it detects cancer even before there are signs or symptoms of the disease. When abnormal tissue or cancer cells are found at an early stage, it is easier to treat the disease.

The three periodic screenings to employ are monthly breast self-examination (BSE), annual clinical breast examination (CBE), and annual mammography.

Beginning in their 20s, women must check their breast through BSE. This examination enables women to check their breasts and armpit area for possible lumps and changes or abnormalities in shape or size.

BSE should be performed five to 10 days after the monthly menstruation period. For women who no longer have monthly periods, they can do the examination any time of the month.

If during BSE you notice swelling of the breast, nipple discharge (not breast milk), nipple pulling inward, and unusual pain in the breasts area, see a doctor immediately. These might be early symptoms of breast cancer.

When women reach 40, they should start an annual CBE done by a trained and healthcare professional. The advantage of talking to your doctor is he can advise possible tests or interventions if malignancies are detected.

Another way to screen for breast cancer is to have an annual mammography for women ages 40 years old and above, especially those with large breasts. A mammogram is a low dose X-ray of the breast used to detect abnormalities, even when they may be too small yet for you or your doctor to feel or see.

If after three consecutive years of mammography the doctor detects no cancer development, it is advisable not to undergo mammography the following year.

These examinations should be done periodically even if a woman is not suspected with breast cancer. More lives will be saved if women will take advantage of the screenings.

Through the years, researchers and medical practitioners have developed life saving treatment advances for breast cancer. Treatment is the other determinant of survival in every type of cancer.

Aside from hormonal therapy, there are three conventional ways to treat cancer. These are surgery, chemotherapy, and radiation therapy. These treatments are evidence-based and scientifically proven medicine.

Once a cancer diagnosis is confirmed, it is time to determine how to treat it. The three conventional ways to treat cancer are surgery, chemotherapy and radiation therapy.

Surgery is the mainstay of therapy for breast cancer. The choice of which type of surgery is based on a number of factors, including the size and location of the tumor, the type of tumor, and the person's overall health.

Depending on the staging and type of the tumor, a lumpectomy (removal of the lump only) may be all that is necessary or removal of larger amounts of breast tissue may be necessary.

Lumpectomy is utilized by many patients for breast-conservation cancer surgery. Another surgery is mastectomy where the entire breast with cancer, including the skin, areola, and nipple are removed.

Mastectomy usually takes two to three hours of operation.

Mastectomy doesnít eliminate the risk of breast cancer. It just reduces the risk of not contracting the disease by 90 percent.

If a patient wants to have a breast reconstruction (surgery to rebuild a breastís shape after a mastectomy) it may be made with the patientís own (non-breast) tissue.

On the other hand, chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells, or by stopping them from dividing. Chemotherapy can be taken orally or, more commonly, by means of intravenous injection.

The treatment gets rid any cancer cells that may be left after the surgery. Chemotherapy has an average of six cycles in a span of six months. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Chemotherapy can be a frightening prospect for anyone. It has many side effects because it targets multiple areas of the body simultaneously. Unpleasant effects include vomiting, nausea, hair loss, fatigue, and mouth sores, among others.

Lastly, the third common conventional treatment for cancer is radiation therapy. It uses high-energy x-rays, or other types of radiation, to kill cancer cells, to keep them from growing.

Radiation therapy damages the cancer cells, but this method can also damage or kill the healthy cells inside the body. The death of healthy cells can lead to side effects such as hair loss and thinning of skin tissue.

Conventional treatments are made available for patients to increase their survival rate and/or their quality of life. If patients do not undergo any treatment, cancer would cause complications inside the body.

Based on available records, most patients do not die of breast cancer; they die due to complications, such as cardiac arrest. Breast cancer can affect other areas of the body; this is called ďmetastaticĒ breast cancer. If there is metastasis, other parts of the body have already developed breast cancer cells.

A woman should not rely on the fact that the family does not have a history of the disease. Even at an early stage, she should observe her breast for early malignancies. One never knows when these damaging cells would develop.

In a study entitled, Mortality among offspring of women diagnosed with cancer: A population-based cohort study, a group of researchers composed of Helena M. Verkooijen, Joella X. Ang, Jenny Liu, Kamila Czene, Agus Salim, and Mikael Hartman evaluated the mortality risks in offspring of mothers with history of cancer in relation to timing of birth and cancer site.

From the Swedish Multi-Generation Register and the Cancer Register, the researchers identified 174,893 children whose mothers had been diagnosed with cancer between 1958 and 2001.

The study revealed that offspring of mothers diagnosed with cancer had no increased mortality risk. Increased mortality risks were found in offspring of mothers with tobacco-related cancers (head and neck, thoracic and cervical), in children born around the time of their motherís diagnosis, and in children born after their motherís hematopoietic cancer diagnosis.

However, exposure to (the effects of) diagnostic investigations, radiation therapy, and systemic treatment before and around the time of birth may have adverse effects on the child.

It is also important to note that before undergoing the mentioned treatments, patients must first discuss their treatment options with their doctors, especially if they are pregnant.

In its 10th year now, the Moonwalk, an advocacy campaign of RAFI-EJACC held every October, will again gather thousands of people for an awareness campaign on breast cancer. It is a time to call all women to act now.

EJACC also advocates exercise, a well-balanced diet, and healthy lifestyle to be the secondary prevention methods one should do.

Since its inception 25 years ago, EJACC has already served more than 50,000 people in Cebu province. Its services include cancer education, cancer screenings, diagnostics, and primary treatment, psycho-social support, linkaging and network, and the Cebu population-based cancer registry.

Though breast cancer can bring a womanís life to a standstill, there is ray of hope for them to fight it. While there is no primary prevention available for breast cancer, the best way to do is early screening and detection with corresponding treatment at an early age.