Dr. Taghreed Almahmeed – Consultant General Surgeon, Al Zahra Hospital Dubai

This Breast Cancer Awareness month what advice would you like to give to women?

Breast cancer remains one of the most common forms of cancers. According to the chairperson of the Dubai Health Authority (DHA), almost 30 per cent of women diagnosed with breast cancer are in the third stage of the disease.

Pink October is observed every year to raise awareness about breast cancer and to remind women that they have the power to conquer the disease. In this regard, early detection and diagnosis is crucial. Screenings with mammograms or ultrasounds help in detecting the disease in its initial stage when it has not started showing any symptoms.

I would just like to say to all women, we understand and can relate to the anxiety and stress associated with breast cancer screening. But an early detection can play an important role in the successful treatment of the cancer. While Breast cancer screening with mammography does not help prevent the disease, it can lead to early detection and successful treatment.

While the woman of today has to juggle so many responsibilities at the same time, she must also be vigilant about her health. Most of the women have been postponing getting a mammogram due to the threat of Covid-19 and social distancing. However, it needs to be stressed that breast cancer does not pause and time is of the essence against this disease.

What age is most suited to start mammograms?

Regular self-examinations can help in the early detection and diagnosis of breast cancer. Furthermore, a clinical breast exam should be a part of your annual check-up with your doctor.

The recommended ages for breast exams and mammograms varies. For women between the ages of 25 to 39, it is advised to get annual breast exams and monthly self-exams. For women aged 40 and above, annual mammograms are advised.

What are the earliest signs of breast cancer and what are the red signals that every woman must bear in mind?

Regularly checking your breasts familiarises you with how they look and feel so that you can detect the early signs of breast cancer. These include:-

• Lumps, hard knots or thickening inside the breast or underarm
• Swelling of the breast, warmth, redness or darkening
• Changes in the size or shape of the breast
• Skin dimpling or puckering
• An itchy, scaly nipple sore or rash
• Nipple or breast inversion or retraction
• Sudden nipple discharge especially from one breast
• Pain in one spot that doesn’t go away

For those diagnosed with breast cancer, what dietary and lifestyle requirements should be followed?

Patients diagnosed with breast cancer should maintain a healthy diet and exercise regularly. It is important to eat vegetables and fruits, foods high in fibre, and avoid processed foods and foods that are high in calorie content and low in nutrition such as sodas, fruit-flavoured drinks and sweets. Exercise during and after cancer treatment can help reduce fatigue, weight gain, and loss of strength.

Are there ways to prevent breast cancer? If so, how?

Lifestyle changes can decrease the risk of breast cancer including maintaining a healthy weight, being physically active, avoiding alcohol, and quitting smoking.

It’s also important to breast-feed, if possible. The more you breast-feed the more it has a protective effect. Avoid birth control pills after the age of 35, especially if you smoke. Avoid post-menopausal hormones. Find out if you have a family history of breast cancer and don’t forget screening.

What are the main treatment options currently available for breast cancer?

There are two main types of surgery to remove breast cancer. Breast-conserving surgery or Lumpectomy, where only the tumour and some surrounding normal tissue is removed. This has to be followed with radiation therapy.

The other is mastectomy, where the entire breast is removed. Patients can have breast reconstruction after the breast is removed. There are also systemic treatments including chemotherapy, where the chemo can reach the cancer cells almost anywhere in the body; however, not every woman with breast cancer needs chemotherapy. Another treatment option is hormonal therapy which is a pill taken orally daily for five years. Again, it depends on the type of breast cancer. Immunotherapy may also be used to stimulate a person’s own immune system to recognise and destroy cancer cells more effectively.

Is breast cancer hereditary?

Inherited genetic mutations account for between five to 10 per cent of all breast cancer cases with BRCA 1 and 2 mutations being the most common. These mutations highly increase the predisposition to breast and ovarian cancer (45 – 65 per cent chance before age 70). Testing for mutations is only recommended for people at high risk such as those who have; breast cancer before age 45, one or more family members with breast cancer with one before age 50; a male relative with breast cancer and a family member with a BRCA mutation.

What must caregivers of breast cancer patients be informed about?

Caregivers, whether a spouse, family member, or close friend play a huge influence on how the breast cancer patient deals with their illness. They need to be educated on their responsibilities as part of the cancer care team. Breast cancer screening with mammography saves lives. It doesn’t help prevent breast cancer but can help find cancer early when it is most treatable. Caregivers may also give drugs, and keep family members and friends abreast of the patient’s condition.

Is palliative care for breast cancer or metastatic breast cancer helpful?

Palliative care or supportive care may be given for any type and stage of cancer, not only metastatic breast cancer care where the disease has spread in the body. People who receive palliative care along with the treatment for breast cancer have less severe symptoms, better quality of life and are more satisfied with the treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support and support for children or family caregivers.