Breast cancer: Why early diagnosis is key

Having early tests will help detect breast cancer and ease treatment. PHOTO | COURTESY

Breast cancer is the second most common cancer affecting women in Uganda after cervical cancer and, therefore, a public health issue. According to Dr James Kafeero, an oncologist at the Uganda Cancer Institute (UCI), this type of cancer is curable and Uganda has the capacity to treat it. 

Both men and women are at risk of suffering from breast cancer the reason it is important to know what a normal breast should look like. This can be achieved through monthly self-examination. However, Dr kafeero says, if one starts to feel pain in the breasts, then they should see a doctor immediately. 

Anyone can get breast cancer but it is also curable, especially if one gets early treatment,” he emphasises, adding that annually, out of every 100 people that come for screening, there is a man that presents with breast cancer. 

Screening and diagnosis

Since there is a big risk everywhere, there is a need for awareness and screening to help in early diagnosis. The testing begins with you, and once you suspect there is a lump in the breast, you can go to a health centre for examination and further guidance on what to do. The screening should be a painless procedure and done in one sitting. 

Dr Kafeero says: “Once you have a suspicious mass, you will have a non-painful exam and this screening is free in public hospitals. The screening can include an ultrasound scan which costs between Shs10,000 and Shs30,000 in a private hospital.”

There are several things that can cause a lump in the breast and these can include pus and breast milk (engorgement), among others. Depending on one’s age and how heavy the breasts are, one may also need a mammogram to help in the diagnosis of breast cancer and this costs between Shs100,000 and Shs120,000.

If the mass still looks suspicious, one needs a needle aided biopsy to remove sample cells that a pathologist closely examines to give a confirmatory result. The biopsy, according to Dr Kafeero, is free in the public hospitals except for those who prefer private services.

“There are times a doctor can confirm breast cancer even before the biopsy, especially in cases where there is ulceration, blood discharge from the breast, peeling of the skin, pain, change of colour, dimpling in the breast and change in the nipples,” he adds.

Counselling

From the results the pathologists give and the background information, a patient is oriented, counselled into receiving the diagnosis that she or he has the cancer. Thereafter, the patient needs to start treatment.

According to Dr Noleb Mugisha, an oncologist at UCI, when someone is diagnosed with breast cancer, they may be anxious, depressed, have pain, are immune suppressed, may be hypertensive, diabetic and all these should be managed first so that the patient stabilises enough to start treatment. 

Treatment 

One also needs staging investigations which would help determine the level of the disease as well as a classifying the type of breast cancer because different cancer types require different treatment combinations. Cancer is a painless disease and by the time a patient starts feeling pain, then the disease has progressed to some other parts of the body. 

“A patient will also need a chest x-ray, brain scan, kidney, liver and heart function tests, bone scan or muni-skeletal survey, which are usually offered at a subsidised cost. There is a committee that discusses the treatment plan for the patient depending on the type, background, size of the tumour,” he says.

Chemotherapy is part of cancer treatment that uses anti-cancer drugs that kill the cancer cells with a curative intent, or prolonging life or to reduce symptoms of the disease. This is usually given intravenously but comes with some side effects since it usually kills both the good and bad cells. The undesired effects include hair loss, nails turning black, poor appetite, nausea, vomiting and diarrhoea. 

This can also help to shrink the lump and depending on the assessment, one will require surgery to remove the breast. Dr Kafeero says, in developed countries, because of good health seeking behaviour and early diagnosis, some women are able to retain their breasts. 

“A number of the women who come to the cancer institute present very late when the masses are big and if we choose to only remove the lump, then the cancer cells will remain in the breast and one will definitely have a re-occurrence which could lead to death,” Dr Kafeero says.

Radiotherapy

The next treatment phase is radiotherapy where one gets low doses of x-rays to kill cancer cells and shrink tumours. This radiation therapy usually begins about a month after mastectomy (surgery); it is typically given once a day, five days a week, for a period of time specified by the doctor on an outpatient basis. The doctor can also choose that a patient gets it before the surgery.

If the type of breast cancer is hormonal, one will require hormonal therapy and even after one is cured from the disease at the end of the treatment plan, one needs constant review to catch any likely re-occurrence.  

Risk factors you can change

● Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.

● Being overweight or having obesity after menopause. Older women who are overweight or have obesity have a higher risk of getting breast cancer than those of a normal weight.

● Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.

● Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.

● Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she takes.