Think beyond pink

With 2,500 women diagnosed every month, breast cancer in Sri Lanka is more than a pink ribbon issue:

Breast cancer has, in recent years, emerged as the commonest cancer in females, with the Sri Lanka Cancer Registry recording 2,500 diagnosed cases every year. This is one of the most preventable of all cancers that afflict women from 15 years and upwards, yet, due to the vast majority of women delaying early screening tests, which are available free in all state hospitals, or even spend a few minutes doing self examination of the breast, breast cancer has become a scourge haunting women of all ages. This Breast Cancer Awareness Month, Dr. Lakshman Obeysekera, Oncologist at the Maharagama Cancer Hospital shares his hands on experience in treating women with breast cancer, noting that Time is an important factor, especially for vulnerable women who already have higher risk factors than others. He also encourages all those with a family history of the disease to get themselves clinically examined, at least once a year for early detection and a longer life..

Excerpts…

Q: As the Maharagama Hospital is the country’s leading institute for cancer patients, have you seen a significant increase in female cancer patients compared to previous years?

A: There has been a change in the type of cancer women now have. In 1995, during my internship, most women who came here had cervical cancer. Today there are more women with breast cancer than cervical cancer.

A: One contributory factor was the health and awareness raising programs we conducted. The other, which helped reduce cervical cancer cases, was the pap smears regularly carried out on all females both in the hospital clinics and outside. If the same thing can be done for breast cancer, we can reduce the number of cases. Continued education of school girls also goes a long way in raising awareness on cancers that commonly afflict women.

Q: With regard to self examination, what is the best way to do it and what is the best time?

A: First it should be done regularly and five days after menstruation. Keep your palm flat and move it in a circular manner.

Don’t point your fingers to the breast and feel it as you will then feel small lumps everywhere, which could be alarming and misleading. Do this at least once a month or more. It will take only a few minutes. If you find any suspicious lumps, seek the advice of a trained professional without delay. Although this is such a simple test, we found that very few of our cancer patients had ever done a self examination.

A: Their partners or husbands can follow our guidelines and examine their breasts for cancer signs. But it should be done especially in vulnerable women to prevent early lesions leading to cancer.

Early detection is the best protection

The Sunday Observer also spoke to Consultant Community Physician, National Cancer Prevention and Control Campaign, Dr Suraj Perera on what the Campaign is doing for Breast Cancer Month.

Q: What is the message of this year’s World Cancer month?

A: We have three messages for the public this year: ‘Early Detection of Breast Cancer; Early Detection Saves lives’; Early Detection is the best protection.’

Q: Why are these messages so important?

A: Because, yearly 2500 breast cancers are detected.

Q: What are the programmes you have for early breast cancer detection?

A: Raising awareness among women of the disease, symptoms signs and risk factors. Telling them about the high survival/cure rates and quality of life they can enjoy if detected and treated early: Encouraging them to undergo periodic breast inspection and palpation and to seek prompt medical attention if any abnormality suspected. We also started awareness and training programs for all our health workers from grass root level up to detect different signs and symptoms of breast cancer among women at primary level and refer patients to a clinician. In addition, they are taught how to counsel patients and families

Q: What about self breast examination?

A: We have informed women through our well woman and maternity clinics and through specially printed flyers in Sinhala and Tamil, on the importance of self examination for breast cancer. All females from the age of 20 need to do the self breast examination every month.

Q: How often should a woman have a clinician examination of her breasts? Who will do this examination?

A: Every three years from ages 20 to 40. Yearly after the age of 40 years. The service providers will include: medical officers, Public Health Nursing Sisters, nursing officers, Public Health Midwives

Q: From statistics you have collected , the spike in cancer of all types in Sri Lanka has soared tremendously, with breast cancer said to account for 25 percent of all female cancers in the country, although the numbers of deaths has dropped due to awareness raising by the Health Ministry, and better intervention techniques. What is your vision for the future?

A: The NCCP is the national focal point for prevention and control of cancers in the country, responsible for policy, advocacy, monitoring and evaluation of prevention and control of cancers and conducting surveillance of cancers and facilitating research related to cancer.

It coordinates with all cancer treatment centres, national level institutes, and provincial health ministries to implement cancer control activities in Sri Lanka. NCCP activities are supported by the World Health Organization (WHO) Country Office Biennium.

The NCCP is further supported by the joint program of WHO, International Atomic Energy Authority (IAEA) and Program of Action for Cancer Therapy (PACT) for improving facilities for improving facilities for cancer care and capacity building.

A: I refer to familial cancer. If there is a family history of breast cancer, endometrial (womb) cancer or a colon cancer on the mother’s side and on the father’s side prostrate or breast cancer, it puts that person at very high risk of getting the disease later. So we have to identify these risk factors by identifying the cancer gene early.

A: A BRCA gene test. This is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited mutations in these genes face a much higher risk of developing breast cancer and ovarian cancer, compared with the general population. Inherited BRCA gene mutations are responsible for about 5 percent of breast cancers and about 39 percent of ovarian cancers. If this gene is identified in a healthy person early, before she gets the disease, that person has a very high chance (between 60-70%) of getting breast cancer - around eleven times a higher risk to breast cancer than other women.

A: Marry early and have your first child before 30 years. Refrain from taking hormones or birth control pills. Breast feed your child for as long a period as possible. We also give them the option of having skin sparing prophylactic mastectomy i.e. remove the natural breast and undergo plastic surgery where you implant a silicon implant to preserve the cosmetic appearance.

A: Obese women are at higher risk to breast cancer due to high animal fat intake. Working women in sedentary jobs and do not exercise, and take hormone replacement therapy drugs, which raise their estrogen levels are also at risk.

Q: Gaps you would like to see filled in the country’s premier cancer hospital at Maharagama, by way of equipment etc?

A: We need an MRI machine and a PET Scan. Both are very useful in identifying breast cancer in the early stages.

The MRI can identify cancer compressing the spinal cord. It can also help plan Radio therapy as it can show soft tissue delineation better than a CT scan. The PET Scan is needed to differentiate between active cancer cells in active area of those who had previous treatment for cancer. It is also important during the diagnosis clinical work up as it helps to detect the primary site.

A: To women my advice is: If you are between 30- 35 years get at least one proper breast examination by a clinician and thereafter every five years. Do self examination of your breast regularly.

My advice to education authorities is introduce primary prevention of cancer as a topic in the regular secondary school curriculum to raise more awareness.

To employers, make it mandatory that all new women recruits to your workplaces, undergo a breast screening test. If this is done it will be easy for us to identify potential breast cancer patients as well as those who already have the disease but are unaware of the fact.

A: We need to have a separate Palliative Care Hospital specializing in pain management, and giving cancer patients quality care till the end. A Hospice funded by the government, which looks after cancer patients who have no one to look after them is also important considering our ageing society