Breast cancer is curable

Dr Tatenda Simango

This is the last day of breast cancer awareness month. I hope you have taken the time to learn more and teach others on breast cancer.

Breast cancer is curable if detected early. However, the symptoms are not always clear cut to:

– A breast lump or thickening that feels different from the surrounding tissue,
– Change in the size, shape or appearance of a breast,
– Changes to the skin over the breast, such as dimpling,

A newly inverted nipple,
– Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin,
– Redness or pitting of the skin over your breast, like the skin of an orange.

A few years back, a 50-year-old vibrant lady presented at our rooms with weakness and numbness in the right upper limb. Initially, I thought it could have been sprain from the teaching job that she had been doing for over a decade. I prescribed muscle relaxant medication and reviewed her after a week. She had no improvement so I asked her to have an x-ray of the chest, neck and shoulder and advised on a few sessions of physiotherapy. These did not give any obvious improvement in the disease pattern. Thinking it was a nerve problem, I asked for a second option from a specialist orthopaedic surgeon who started her on advanced investigations including CT scan.

This revealed cancer of the breast that was now at stage 4 (spread beyond breast tissue to other parts of the body).

The cancer had pressed against a nerve to the upper limb which now caused the pain, weakness and numbness in her hands and forearm. This was so unusual a presentation that delayed diagnosis and ultimately treatment.

The patient had to start chemotherapy; these are anti-cancer injections given to fight the cancer. They are usually given in doses (cycles) on different days as per instruction by the oncologist (cancer specialist doctor). The concept behind chemotherapy is to kill the fast-growing cancer cells while sparing the normal tissue.

Normal cells divide as many times as needed and stop. Cells become cancerous when they lose their ability to stop dividing, to attach to other cells, to stay where they belong, and to die at the proper time. This uncontrolled growth of cancer cells makes them more susceptible to chemotherapy. Unfortunately, chemotherapy is not able to differentiate a normal cell from a cancer cell, fast growing tissues of the hair and stomach are not spared.

The side effects of chemotherapy will cause hair to fall off, vomiting and diarrhoea, loss of appetite, weight loss and pain to mention the more disturbing.

Radiotherapy is another form of treatment that is given, this is commonly referred to as ‘burning’ of cancer. This modality targets x-rays to a specific point to help kill the fast-growing cancer cell. It is also given in cycles that are spaced to reduce side effects that include skin reaction, vomiting and pain. During radiotherapy, the area that is being treated is not bathed as this will cause sloughing of the skin.

The stress of accepting the reality of having cancer, then having to deal with the side effects tends to be rather challenging for the individual, the family and care givers psychologically. Family moral support becomes paramount to fight stress, anxiety, depression and fear.

The expenses are relentless; treatment cost, transport, feeding the patient and visiting relatives who come to see the patient. The stigma. Family will consider other non-conventional treatment methods including spiritual healing, prophet and traditional healer consultations in a quest for a cure.

All these are factors that the patient and their support structure may need to deal with as they fight the cancer.

Mastectomy (removal of the breast) may be offered as part of the treatment if the cancer is detected early. The cosmetic nightmare can be daunting. Fortunately, Island Hospice provides the necessary counselling for the patient and care givers. They also provide home visits to aid in the palliative care of the patient.

You should examine your breasts monthly from the age of 18 years onwards. The best way to do this is while standing up looking into the mirror, standing up in the shower or lying down on the bed.

Breast self-exam is done about three to five days after one’s period when breasts are less likely to be tender and swollen. Women at menopause should choose a particular day of the month to do breast self-examination.

The Cancer Association of Zimbabwe website has simple to follow self-examination tips.

What to look for during a breast examination:

On the breast itself:
– Dimpling or puckering of the skin surface
– Enlarged veins
– Lump or thickening which may be painless
– Unusual rash on the nipple or breast
– Persistent pain in the breast though this is not usual

On the nipple:
– Discharge or blood through the nipple
– Rash on the nipple or around the nipple
– Lump or thickening which may be painless
– An inverted nipple (turned in nipple)
– Change in the position of the nipple
– Lump or thickening beneath the nipple

On the arm:
– Swelling of the upper arm
– Swelling or lump in the armpit

One way of breast self-examination:
Stand before the mirror, inspect both breasts for any unusual discharge, dimpling, scaling or puckering of the skin.
Watching in the mirror, clasp hands behind head and press head against hands. This helps to identify any changes in the shape or size as the muscles contract.
– Press hands on the hips and bend towards the front or mirror while pulling shoulders and elbows forward.

The pulling of muscles helps to identify any abnormalities on the breasts.
– While in the shower, with soapy hands, lift arm and with four fingers of your right hand, gradually work from the outer edge of the breast in small circles towards the nipple. The circular movements will help identify any lumps or abnormalities.

Following the same process use your left hand to examine the right breast.

Early detection of abnormalities gives the doctor a better chance to offer effective treatment. Till next week stay safe.

* Dr Tatenda Simango can be contacted on [email protected] or follow him on Facebook@ 9th Avenue Surgery.