Female Breast Cancer

Breast cancer is a major public health problem, which does not lend itself to primary prevention. Cancer of the breast appears to have overtaken cervical cancer as the most common cancer among women in South Africa.

Control of Breast Cancer

Management Objectives

• To encourage early detection of breast lumps and prompt referral
• To reduce the incidence of invasive breast cancer
• To reduce mortality associated with breast cancer

The following information should be given to all clients:

• Decrease calorie intake for overweight and obese women
• Decrease animal fat intake
• Increase fibre intake
• Encourage breast-feeding - the first three months seem to be the crucial period
• Pay attention to early warning signs of cancer

Warning signs:

Breast

• Changes in size and shape
• Dimpling of the skin (as the tumour gets larger, it pulls the skin inwards to produce a dimple)
• Lump or thickening
• Persistent pain or altered sensation

Nipple

• Discharge (rare) or bleeding
• Inverted nipple (turned in - which is normal in some cases; the tumour can cause the milk ducts to shrink, pulling the nipple inward)
• Lump or thickening
• Any suspicious change
• Rash on the nipple or surrounding area (rare)

Arm

• Swelling on upper arm
• Swelling in armpit

Risk Factors for Breast Cancer

There is nothing that can be singled out as a definite cause of breast cancer, only a number of what are called "risk factors", meaning that if one or more are present in a woman, they appear to increase the likelihood of developing breast cancer.

1. Family history

True hereditary breast cancer represents only a small fraction of breast cancer numbers (5%). It also appears at an earlier age (<55 years). But having a blood relative with breast cancer increases the risk of developing this cancer.

2. Age and Gender

Being a female growing old is a very strong risk factor. Early menarche, (first menstrual period) no children or first child after 35 years of age are suggested risk factors. Hormones have long been suspected of playing a role in the development of breast cancer.

3. Race

Breast cancer is less common in rural African females.

4. Dietary fat

It is suggested that a high fat diet (especially animal fat) in early life contributes to the risk of breast cancer.

Early Detection and Prompt Referral

1. Breast Self-Examination (BSE) (Annexure A)

Getting to know the feel and texture of the normal breast is the key to notice any change. If a lump in your breast is found early, it can be removed Quickly before the cancer spreads and does real damage. More than 90% of breast lumps are discovered by women themselves. Only one out of ten lumps in the breast is cancerous. Women must be encouraged to look and feel for lumps in their breasts.

Target Group

All women 20 years and older

• Once a month ± 10 days after the end of last menstrual period

Women in menopause or women not menstruating

• Any day of each month, but choose a specific day e.g. first day of each month

2. Clinical Breast Examination (CBE)

The real value of CBE in isolation is difficult to determine. Clinical Breast Examination performed by a skilled health professional is regarded as a tool in breast cancer screening.

Women should not just accept a CBE by chance, but demand it. It is a must.

Target Group (Not high risk)

Women 20 - 40 years

every 3 years

Women over 40 years

every 3 years

Women on Hormonal Replacement Therapy (HRT)

every year

3. High risk women
   • Women with a first degree relative with breast cancer e.g. mother or sister and/or with
   • previous breast cancer

should have specialist attention every six months to one year (breast clinic, breast surgeon or oncologist)

A lot of anxiety and stress can be created if an abnormality, not knowing whether it is benign (not cancer) or malignant (cancer), is detected.

It is important to ensure that these women are supported by community members, partners, health professionals or previous affected women.

Remember: Breast Self Examination and Clinical Breast Examination are not tools to diagnose cancer. They are tools to detect abnormalities in the breast.

Breast Self-Examination (BSE) - Annexure A

NORMAL	ABNORMAL	How to examine your own Breasts
		Stand in front of the mirror, with your arms at your sides.
		Raise your arms above your head and turn from side to side, looking at your breasts from different angles.
		Place your hands on your hips and push inwards, thereby tensing the chest muscles.
		Squeeze your nipple gently between your fingers to see if there is any discharge.
		Lie down on a bed or floor. Place a small pillow or folded towel under one shoulder. Put the arm back up above and behind your head. This spreads the breast tissue across the chest wall.
		Starting at the outer edge of the breast tissue. Use your fingers to gently roll the breast against the chest wall as the small circular movements allow the breast tissue to move under the fingertips so that any local hardness or lump will be felt. Repeat these movements on the other breast.