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Understanding breast cancer

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Of all the ways to go, cancer is arguably the most insidious. Your own body is rebelling against itself; cancer cells fighting to keep alive, at the expense of everything else.

As the most common types of cancer among women, breast cancer affects more than two million women each year and is responsible for the greatest number of cancer-related deaths among women. According to the World Health Organization (WHO), it is estimated that 627,000 women died from breast cancer — that is approximately 15% of all cancer deaths among women — in 2018 alone.

Not to mention that while breast cancer rates are higher among women in more developed regions, rates are increasing in nearly every region globally. This is because of an overall increase in life expectancy across all regions, an increase in urbanization, and the adoption of western lifestyles. As the world gets more developed, the likelier it is for cancer to strike.

So how do you prevent it?

The Continuous Update Project, an ongoing program to analyze global research on how diet, nutrition and physical activity affect cancer risk and survival, found that the risks towards developing breast cancer are manifold.

The panel found strong evidence that consumption of alcoholic drinks, greater birthweight and adult attained height are causes of premenopausal breast cancer. To protect against it, the panel judged that there is strong evidence that vigorous physical activity helps lower one’s risks.

For postmenopausal breast cancer, evidence pointed towards the consumption of alcoholic drinks, being overweight or obese throughout adulthood, adult weight gain and adult attained height as major causes. Physical activity and greater body fatness in young adulthood, meanwhile, protect against those risks.

In addition, the Panel judged there was strong evidence that lactation protects against breast cancer.

“Breast cancer risk doubles each decade until the menopause, after which the increase slows. However, breast cancer is more common after the menopause,” the World Cancer Research, which partners with the Continuous Update Project, Fund wrote on its Web site.

“Studies of women who migrate from areas of low risk to areas of high risk show that they assume the rate in the host country within one or two generations. This shows that environmental factors are important in the development of the disease.”

But risk reduction through prevention will not help the majority of breast cancers that develop in low- and middle-income countries where breast cancer is diagnosed in very late stages. Early detection is vital to improve breast cancer outcome and survival.

The World Health Organization wrote on its Web site, “Limited resource settings with weak health systems where breast cancer incidence is relatively low and the majority of women are diagnosed in late stages have the option to implement early diagnosis programs based on awareness of early signs and symptoms and prompt referral to diagnosis and treatment.”

“Population-based cancer screening is a much more complex public health undertaking than early diagnosis and is usually cost-effective when done in the context of high-standard programs that target all the population at risk in a given geographical area with high specific cancer burden, with everyone who takes part being offered the same level of screening, diagnosis and treatment services.”

How do you know you have breast cancer?

The most common symptom of breast cancer is a new painless, hard mass with irregular edges, but breast cancers can also be tender, soft, round, or even painful. Other symptoms include nipple retraction, swelling, skin dimpling, nipple discharge that is not breast milk, and swollen lymph nodes. The wide range of possibilities is why it remains important for women to regularly receive screenings from their health professionals, even before symptoms appear.

So far, the only breast cancer screening method that has proved to be effective is mammography screening. Though mammography screening is costly and is only feasible in countries with good health infrastructure that can afford a long-term organized population-based screening programs, low-cost screening approaches, such as clinical breast examination, are also available.

Mammography uses low-energy X-rays to identify abnormalities in the breast and has been shown to reduce breast cancer mortality by approximately 20% in high-resource settings. The WHO Position paper on mammography screening concluded that in well-resourced settings women aged 50-69 should undergo organized, population-based mammography screening if pre-specified conditions on program implementation are met.

“In limited-resource settings with weak health systems, mammography is not cost-effective, and early detection should focus on reducing stage at diagnosis through improved awareness. For women aged 40-49 years or 70-75 years, WHO recommends systematic mammography screening in women aged 40-49 years or 70-75 years only in the context of rigorous research and in well-resourced settings,” the organization said.

Clinical breast exams, meanwhile, are an examination of both breasts performed by a trained health professional, and are recommended for settings with limited resources.

Because both screenings requires substantial investment and carries significant potential personal and financial costs, the WHO recommends that the decision to proceed with a screening should be pursued only after basic breast health services including effective diagnosis and timely treatment are available to an entire target group; its effectiveness has been demonstrated in the region; and that resources are available to sustain the program and maintain quality. — Bjorn Biel M. Beltran

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