Breast Cancer

A professor of radiotherapy and oncology at the Lagos State University Teaching Hospital, Remi Adekigbe, talks about breast cancer and its treatments with DOLAPO AKITOYE

What is breast cancer?

Breast cancer is the growth of a tumour in the breast and when tested, the growth is confirmed as cancerous.

What causes it?

The cause of breast cancer is unknown but there are risk factors that can increase one’s chances of getting it. For instance, there are inherited genetic factors. Genetic materials contain coded messages that could include illnesses or diseases which may include cancer.  There are also environmental and social factors such as the food one eats.

What are its stages?

There are four stages. Stage I is the early stage. It is always advised that the cancer is detected early because the earlier it is detected, the more curable it is. After Stage I, the cancer would go to Stage II. If at this stage, the cancer is left uncared for, it would go to Stage III. From Stage III, it will go to Stage IV and if it gets to this stage, it means that the cancer has spread. This is called metastasis. The cancer can start from the breast and spread to the bone, liver, kidney and other parts of the body. At this point, the disease is now systemic.

How can the risk of getting breast cancer be reduced?

It is very important for women to be very aware of their breasts. Women should examine their breasts regularly so that as soon as they notice something unusual, they can go to the doctor. In fact, it should be done every day. The breasts should be felt for lumps and anything that seems unusual. Another thing one can check for is the areola – the black spot surrounding the nipple. When this is pressed, if anything should come out, one should take note of the colour that comes out.

There may not be a lump on the breast but there could be a discharge or blood that comes out of the nipple. This discharge matters. In the hospital, the doctor will clean the discharge with cotton wool and part of this discharge would be put on a slide and examined under a microscope. If there are cancer cells in the discharge, this would be seen. Breast self-examination is very important and it is a way to detecting breast cancer early. Ultrasound scan of the breast can also be done which is very safe as it does not have any radiation. If a woman is in doubt, the doctor would send the woman for an ultrasound scan. If the woman is 40 years and above, the doctor will recommend a mammogram for her. A mammogram is an x-ray of the breast tissue so that if there is anything in the breast, it would be seen. If the woman is below 40, the doctor would not order a mammogram for her. A woman that is in her forties can do a mammogram once in two years and a woman above 50 can do it annually. If a lump is noticed, it would be taken out and sent to the pathologist. The pathologist would determine if the lump is cancerous. The doctor will also check the armpits for nodes to see if whatever is in the breast has spread to the armpit. Breastfeeding protects against cancer of the breast. Women must breastfeed to help the child and help themselves from having cancer of the breast.

What are the signs and symptoms of breast cancer?

A lump in the breast is something to look out for. A milky discharge from the nipple – when one is not pregnant or nursing – is also something else to look for. If one has an itchy nipple or an eczema-like presence on the nipple, then one should see the doctor. If one ignores a small lump on the breast, it could grow bigger. As it grows bigger, it would attract the skin towards itself, which is caused by the mass inside the breast. It would also start attracting the nipple towards itself and retracting it as opposed to being prominent. This is called nipple retraction. With time, the skin covering the breast would be showing dimpling that looks like the skin covering an orange. This called peau d’orange. This means that the cancer is getting more advanced. Once the mass occupies the entire breast, it would become hard to touch as opposed to being soft. At this point, the cancer would most likely be inoperable. Later on, since blood is flowing through the cancer, it could take some cancer cells from where the lump is and carry it to the lungs – which are beneath the breasts. It can also carry it to the liver, kidney, bone, brain and every other part of the body. It could also affect the spine. As part of the brain goes through the spine and once it is affected, there may be no communication again between the brain and the spine. This would lead to paralysis and even uncontrolled bowel movement.

What are the treatment options?

There are a lot of treatment options. One of them is surgery. In law, it is usually said that one is innocent until proven guilty. But in medicine, it is said that a lump in the breast is guilty until proven otherwise. Once a lump is noticed in the breast, the surgeon would take it out and send it to the pathologist who will examine it and determine if it is benign or malignant. If the lump is cancerous, one could do a quadrantectomy which involves removing a quarter of the breast tissue around the breast. A mastectomy can also be done which involves removing one or both breasts. Afterwards, one may have to go for radiotherapy and chemotherapy. Unfortunately, there are not enough radiotherapy machines in Nigeria and there needs to be at least 200 machines in the country.

Can men get breast cancer?

Of course! Men also have breasts as well and they can get breast cancer. The only difference is that women have more breast tissue than men. But by the time a man has breast cancer, at least 100 women would have had it.

What are the misconceptions about breast cancer?

There are some people that self-diagnose themselves and this is not good. They might assume that it is a boil that is on their breast. When one notices anything unusual in one’s breasts, they should go to the doctor immediately. One should not go to the wrong people such as native doctors for diagnosis. It is the hospital that should be one’s first call as there are procedures for making the diagnosis.

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