In this interview, Dr Sharif Folorunso, a Consultant Clinical and Radiation Oncologist at the Department of Oncology, Federal Medical Centre, Abeokuta, shares with GODFREY GEORGE the risk factors and management of breast cancer
Is there any difference between breast cancer and having a lump in the breast?
Breast lump is the presence of mass in the breast which could be malignant (cancerous) or benign (non-cancerous). This means that feeling a lump in the breast does not mean one has cancer. Examination of the tissue under the microscope will confirm if it’s cancerous or not.
Does this mean some lumps are not cancerous?
Yes. Not all breast lumps are cancerous.
Over the years, what has the situation been as regards breast cancer with regards to awareness, research and treatments?
In terms of awareness, we can say awareness about cancer is improving in our society compared to what we used to have. However, there is still a lot more to be done for the awareness to translate into improvement in survival. For example, some people are aware of cancer but could not go for screening because they could not afford it. Rather than presenting early to the hospital, some breast cancer patients will rather seek spiritual care, only to come to us when the disease is advanced. There are still gaps in cancer research in Nigeria. A lot still needs to be done. There is a paucity of cancer researchers and facilities. Cancer research is quite capital-intensive. Brain drain is also not helping matters. The few ones we have around are leaving.
As regards treatment, things seem to be improving though at a very slow pace. At a point in time in Nigeria, none of the cancer treatment centres was functioning. However, we now have private centres, public-private partnership and government-owned cancer treatment centres. Some new centres will soon emerge. Having said this, I must stress that we still have a very long way to go.
Do women fully heal from these cancers or have there been cases where these cancers grow again in the breast?
We do have breast cancer survivors. Most of them present early, receive full complement of treatment timely and are free from the disease. They are presently on follow-up in our various hospitals. There is a chance that patients that are free from cancer after treatment could have recurrence of the disease. That is why we place them on regular follow-up. This will make us identify recurrence early and treat accordingly.
Have there been cases where women grow multiple cancers and what was the experience like managing that condition?
Individuals may develop multiple, independent primary tumours. It’s called cancer syndrome. Such usually have genetic basis as it can run in the family.
What causes cancer of the breast?
The actual cause of breast cancer is unknown. There are, however, some modifiable and non-modifiable risk factors that can increase the chance of an individual coming down with breast cancer. Modifiable risk factors are factors that can be changed such as nulliparity (not giving birth), having first childbirth after age 30, hormonal replacement therapy, obesity, physical inactivity and alcohol consumption. If an individual avoids these factors, the chance of having breast cancer will be reduced. Non-modifiable risk factors cannot be changed and include female gender, older age, family and personal history of breast cancer, radiation therapy to the chest, early menarche (first menstruation), late menopause. Individuals with non-modifiable risk factors are advised to avoid modifiable risk factors and also have more frequent screening for breast cancer.
Is there a difference in the way breast cancer present in white and black people?
White people are more likely to be diagnosed with breast cancer but black are more likely to die from the disease. Breast cancer in blacks tends to be more aggressive.
People still find it hard to believe men can have breast cancers, because, according to them, men don’t have breasts. How difficult does this make your job as an oncologist?
Breast cancer is not common in men. Male breast cancer accounts for less than 1% of breast cancer cases. When a man feels a lump in his breast, the least thing that comes to his mind is breast cancer. In view of this, most of them present late, making the treatment difficult and the chance of cure low.
Some people have said husbands sucking their wives breasts can help reduce the risk of contracting cancer. How true is this?
The claim that husbands sucking their wives’ breasts can help reduce the risk of contracting cancer is not scientific. It can, however, help in early detection, as it may help notice change in breast which could prompt further examination. Breastfeeding babies, however, decreases relative risk of breast cancer by 4.3 per cent for each 12 months of breastfeeding.
Does childbearing reduce the risk of having breast cancer?
The protective effect of child bearing at younger ages on breast cancer risk is well established. Women aged 20 to 25 have nearly a 50 per cent reduction in the relative risk of breast cancer compared to nulliparous women (women who have never given birth). Interestingly, for women whose first childbirth occurred over age 35, the risk appears greater than nulliparous women.
Does using skin lightening products and the like to enhance one’s complexion raise the chances of having cancer of the breast?
Studies did not implicate skin lightening products as breast cancer risk factors. Lightening creams contain different constituents which vary with the type of products. Some of these constituents can predispose to other forms of cancers and health conditions.
What are the risks of late detection of breast cancer?
Late detection is one of the factors that worsen the prognosis of cancers. Late detection can lead to late presentation. This will make the patients miss the opportunity to achieve good disease control and cure.
Is the condition hereditary?
Breast cancer can be hereditary. Women with family history of breast cancer in first degree relatives (mother or sister) have 1.7 per cent to 2.5 per cent risk of having the disease. This may be explained in part by inheritance of a genetic condition that predisposes an individual to breast cancer development, examples of which include mutations in BRCA1 or BRCA2.
Are there types of breast cancers and how do they present themselves?
There are different types of breast cancers. Breast cancer can be classified base on site (left, right or bilateral), stage (I, II, III, IV), histology types (epithelial, non-epithelial), immunohistochemistry (triple negative, luminal A, luminal B, HER2-positive). Breast cancer can present with a palpable breast lump which could be solitary, hard and non- mobile. At this point the person will see it as no problem because it’s painless. As it progresses, the lump can become painful and ulcerated. There could be bloody nipple discharge, nipple retraction or dimpling. The cancer can spread to the armpit. Breast cancer can also spread to the lungs (causing cough, difficulty in breathing and chest pain), liver (causing yellowness of the eye, abdominal swelling), brain (causing headache, seizure) and bone (causing).
How can women and men examine their breasts for lumps and what should they look out for to make them visit a physician?
This is called the self-breast examination. After removing the shirt and bra the person stays in front of the mirror. Inspect the breast while the hand is down by the side, raised up and with hand on the hip. Begin by inspecting the breast for change in size, shape or colour of the breast and nipple. If you notice changes in shape, breast swelling, dimpling in the skin or changes in nipple, visit your physician. Lie down and place the right hand behind the head. With the flat surface of the pad of the three middle fingers gently but firmly palpate every part of the right breast. Take note of any lump, thick spot or other changes felt. This is repeated for the left breast. Any changes felt should be reported to the physician. Then sit up. Examine both armpits for any lump or swelling. Then gently squeeze the nipple checking for discharge. Abnormal nipple discharge, especially when bloody, should be reported.
Can children also have breast cancer?
It is not usually seen in children but in medicine we never say, never.
Is age a risk factor?
Yes. The risk of breast cancer increases with age. Most breast cancers are diagnosed after 50 years and rarely seen before 30 years.
Many have said using brassieres and the like may increase the risk of breast cancer. How true is this?
There is no good scientific evidence for this claim. Studies have shown no association between using brassieres and increased risk of breast cancer.
What would you advise women who suspect they may have breast cancer but are too scared to visit the physician?
I will advise such people to summon the courage and visit their physicians. They have nothing to lose by taking this advice. Since it is still a suspected case, the result of the investigation may be negative for cancer. Even if they are confirmed positive for breast cancer, the chance of cure is higher when treated at an early stage. Delayed diagnosis and treatment will make the disease difficult and more expensive to treat as well as increase the chance of death from the disease.
Is there anything you feel the government can do to alleviate the cost of treatment and management of the disease?
Cancer management is expensive worldwide. It is the responsibility of the government to make good health care affordable to its citizens. This can be achieved through health insurance. Presently some aspects of cancer care are covered by the National Health Insurance Scheme. There is a need to expand the coverage of the scheme. Governments also need to invest more in cancer care by building more cancer treatment (radiotherapy) centres as average Nigerians cannot afford private centres.
Stigma has always been a problem when it comes to breast cancers, especially when one undergoes surgery and loses one of both breasts. What is your take on this?
Stigma is a major issue in cancer care. It has a negative impact on diagnosis, early presentation and treatment. Some patients present late to the hospital because they believe they would be stigmatised by society. This is because many people in our communities still believe cancer is a death sentence. Also, some cancer patients turn down treatment because of fear of being stigmatised. Removing the breast affected by cancer has resulted in divorce for some women. Some husbands will threaten their wives if they consented to removing their breasts. All these add to the burden of cancer in those patients. That is why apart from taking care of the body, we also need to take care of the minds of cancer patients. We have psycho oncologists that are specialists in this area. They engage cancer patients to alleviate their fears.
How has the experience been for you as an oncologist treating breast cancer patients in Nigeria? What are the challenges?
Being an oncologist in Nigeria is really challenging. Breast cancer responds well to treatment when discovered early. However, many breast cancer patients in Nigeria will present to us at an advanced stage; at a point that there is little or nothing that can be done to improve survival. At times those that present early cannot afford treatment and those that can afford treatment may need to join the long queue because of limited radiotherapy facilities. Despite the challenges, we are still trying our best to put smiles on the faces of our patients.
Source: The PUNCH