Dr. Shyam P Lohani

Cancer is a leading cause of death worldwide. In 2018, about 9.6 million deaths are attributed to cancer and around 2.09 million cases of breast cancer were detected (WHO, 2019). The figure relates to breast cancer being the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer. It has been known that breast cancer is one of the most common types of cancer also in Nepal. Most women diagnosed with breast cancer in the country are between the ages of 40-50 years, but younger women can also get breast cancer. This is in contrast to the developed countries where women with older age develop breast cancer.

Detection and treatment
It has been estimated that about 1 in 8 women are diagnosed with breast cancer during their lifetime. The chances of recovery and survival are good for women with breast cancer in the earlier stages. With early detection and treatment, the chance of deaths due to breast cancer has been decreased considerably over the last three decades.
The first noticeable symptom is usually a lump or area of thickened breast tissue although breast cancer can have several symptoms. Other symptoms include pain in the breast or in the armpits that does not change with the monthly cycle, pitting or redness of the skin of the breast similar to the surface of an orange, a rash around or on one of the nipples, discharge from a nipple possibly containing blood, an inverted or sunken nipple, a change in the size or shape of the breast, and peeling, flaking, or scaling of the skin on the breast or nipple.
Although most breast lumps are not cancerous, it is advised to have them checked. Cancer occurs when mutations occur in genes that regulate cell growth. The mutations lead to the cells divide and multiply in an uncontrolled way and spread to other parts of the body. The exact causes of breast cancer are not fully known and understood. However, there are certain factors known to increase the risk for the development of breast cancer. These factors include age, a family history of breast cancer, a previous diagnosis of breast cancer, a previous non-cancerous (benign) breast lump, being tall, overweight or obese, and drinking alcohol,
Breast cancer is often divided into either non-invasive breast cancer found in the ducts of the breast which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually detected by a mammogram and rarely shows as a breast lump. Invasive breast cancer is the cancer cells that have spread through the lining of the ducts into the surrounding breast tissue. The most common type of breast cancer, however, is invasive breast cancer. Invasive (and pre-invasive) lobular breast cancer, inflammatory breast cancer, and Paget's disease of the breast are other less common types of breast cancer.
Cancer detected at an early stage has better treatment success before it spreads to other parts of the body. Treatment will depend on several factors, including the type and stage of cancer, the person’s sensitivity to hormones, age, overall health, and preferences of the individual. Breast cancer is usually treated with a combination of surgery, chemotherapy, radiotherapy, and hormonal/biological therapy.
It has been recommended that women aged 40–49 years with an average risk of breast cancer should discuss the benefits, risks, and availability of screenings at the healthcare facilities. Between 50 and 74 years of age and women who have an average risk should undertake screenings every 2 years.
Despite the different recommendations, most experts agree that women should consult a healthcare provider about breast cancer screening from 40 years of age onward. It is important to seek medical attention for any of these symptoms such as a change in the size or shape of one or both breasts, discharge from either of the nipples which may be streaked with blood, a lump or swelling in either of armpits, dimpling on the skin of breasts, a rash on or around the nipple, a change in the appearance of the nipple or becoming sunken into the breast. Often mistaken, breast pain is not usually a symptom of breast cancer.
Awareness
There have been several studies that have looked at the link between breast cancer and diet. Although there are no definite conclusions, there are benefits for women who maintain a healthy weight, exercise regularly, have a low intake of saturated fat, and do not drink alcohol.
It has been suggested that regular exercise can reduce the risk of breast cancer by almost one-third. For the improvement of the outlook for people affected by breast cancer, regular exercise, and a healthy lifestyle are also recommended. For women with menopause, it is particularly important that to maintain a healthy weight as more amount of the female sex hormone estrogen is produced in overweight or obese women, which in turn can increase the risk of breast cancer. It is urged to all concerned health authorities to expand the regular breast cancer screening throughout the country. The comprehensive awareness programme on breast cancer is also important to detect breast cancer early, improve the outcome and increase survival.

(A Professor, Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)