It is Breast Cancer Awareness month and giving us insight into the disease today is Dr. Daniel Tumwine. Dr. Daniel shares with us what really breast cancer is, its causes, how to carry out self- examinations, signs that the lump in your breast may be breast cancer and what to do if it is.

A complicated family tale…

My female cousin- and, by extension, myself and my siblings- together with Angelina Jolie, have something in common. We share the same genes.

In early 2010, Angelina Jolie and my female cousin were tested for a set of genes. They matched.

My siblings and I have not yet tested. But because my cousin has the genes, my siblings and I may have them too.

The genes in question are the BReast CAncer Genes, or BRCA Genes for short. The BRCA genes prevent breast cancer by thwarting the uncontrolled multiplication of DNA, as happens in cancerous cells.

My cousin and Angelina Jolie have the ‘mutated’ version of the gene. This means that their BRCA genes fail to stop the uncontrolled multiplication of DNA. This leads to cancer.

Breast cancer and ovarian cancer to be precise.

Every eighth woman you know will get breast cancer.

Count your friends. If they are about 20 women among them, almost guaranteed, two or three will likely develop breast cancer.

After cervical cancer, breast cancer is by far the most common cause of cancer amongst Ugandan women. Even though only about 10 percent of all breast cancers are caused by the BRCA gene mutation, 85% of persons with the BRCA gene mutation will get breast cancer and 76% of females with the mutation will get ovarian cancer. Women with the BRCA gene mutation are therefore usually advised to remove their breasts as a precaution.


So what is Cancer?

All cells in your body undergo cell division of some sort. This division is tightly controlled.

To prevent over division, some cells undergo something called ‘apoptosis’ or ‘cell death’. This cell death is planned, is well regulated by the body, and is normal.

Generally cancer develops when the cells in your body fail to undergo ‘apoptosis’ and instead keep dividing, and dividing, and dividing.

Hence a hard lump develops.

The lump is almost always painless.

It is usually painless in the beginning. Until it impinges on nearby surrounding structure.

In medicine, conditions that are painless are usually deadly.


What of Breast Cancer?

With breast cancer, the cells inside the breast multiply to form a hard painless lump.

This painlessness is therefore what makes breast cancer so deadly. A painless hard lump is called a ‘malignant tumour’.

But what causes breast cancer?

We don’t know for sure what causes breast cancer, but we do know what increases your chance of getting it. We have already discussed the genetics of breast cancer. You have the BRCA gene mutation, you have 75 times more chance of getting breast cancer as discussed above.

But do recall, only 10% of those with breast cancer have a gene mutation. Therefore more common risk factors for breast cancer include;

  1. Being fat. You are 75% more likely to have breast cancer if you are fat or obese. Cancers -not just breast cancer- love fat people because of the distorted way the body works when one is fat. You are even more likely to get breast cancer if your weight was in adulthood rather than childhood. Fat on your abdomen is more likely to predispose you to cancers than fat on your thighs.
  2. Drinking alcohol. Even drinking as little as one glass a week increases the risk of you getting breast cancer. But generally, the more you drink, the greater the risk. So much so that each standard drink you take daily increases your cancer risk by 10%. Alcohol generally increases your eostrogen levels which in turns increases your chances of breast cancer
  3. Smoking. Smoking is probably the greatest man-made cause of death in the world. Long term smokers have a 50% higher chance of breast cancer. Simply put; do not smoke. Do not smoke. Do not smoke.
  4. Lack of physical activity. Being active generally leads to overall good health. Being sedentary and not physically active has been show to increase the chance of cancer of the breast by about 10%
  5. Oral birth control pills (hormonal contraceptives). Do not get too used to oral contraceptives that contain hormones. They may mess up your body, including messing the regulatory signals that prevent breast cancer. Hormonal pills increase your chance of getting cancer by between 8%-20% depending on the type and how often you use it. Eostrogen-containing pills are more likely to cause breast cancer than progesterone-containing ones.

Are all lumps Breast cancer?

Other lumps may also exist in the breast. In fact these non-cancerous lumps are much more common and tend to be present at an earlier age than the hard painless cancer lumps. Such lumps may be caused by;

  1. cysts which are really fluid sacs within the breast;
  2. solid fibrous tissue such as fibroadenomas;
  3. infection with pus filled inside a sac such as an abscess; or even
  4. clumped milk called galactocele.

So how will I tell that my lump is breast cancer

Breast cancer usually presents with a painless lump in the early stages.

In addition, it may cause dimples to cover the breast skin, something we call “Peau D’Orange” or “orange peel skin”.

Other signs that you may have cancer of the breast include a; change in how the nipple looks, or a “pulling in’ of the nipple; change in the skin color or texture. The skin usually becomes darker; a clear or bloody fluid leaking out of the nipple. If it has spread, you may have a swollen arm.


How do I do a self-check for a lump?

Although regular breast self examination (BSE) has now been shown to not be an effective method of detecting breast cancer, it is always advisable that every woman know how to do it. This will help women become more familiar with their breasts and quickly detect any changes. The best time to do a breast self exam is once a month, two to three days after the periods have ended. It is advisable that the armpits are raised, and that  fingertips used.

I have a lump, now what?

If you find a lump in your breast, the best person to see is a surgeon.

They will either ask you to do a mammogram or an ultrasound to visualize the lump.

These tests also help confirm whether lymphnodes in the armpit are involved. If there are hard lymphnodes in the armpit, the chance of spread of the cancer may be high.

The doctor may also ask for biopsy either using a small needle (fine needle biopsy) or a large needle (core needle biopsy). The objective is basically to take a sample of the lump and check it for cancer cells under the microscope.

Can breast cancer be cured?

If you are confirmed with breast cancer depending on the stage and type of cancer the best option is to remove the affected breast if there is no evidence of spread. Otherwise, if the cancer has already spread, then chemotherapy (giving anti-cancer drugs), radiotherapy (blasting ions on the breast) and hormonal therapy may help. Many surgeons prefer to give all three concurrently. Recently, immunotherapy (drugs that support the immune system) have been shown to be highly effective against some forms of breast cancer.

Most women will survive breast cancer, if it is caught early.


Do men can also get breast cancer

Although not as common one in every thousand men do will get breast cancer. The risk factors are generally the same as those of women.

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