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October is the breast cancer awareness month, a campaign to increase awareness of the disease. Many campaigns are in the pipeline to enlighten people on what breast cancer is. Despite the campaigns that have been conducted in the past decade, breast cancer treatment remains largely a technical area and most people do not understand it.
In an effort to demystify the disease, our features correspondent, Sharon Kavhu (SK) spoke to an oncologist, Dr Nomsa Tsikai (DT).

SK: What is breast cancer?
DT: Cancer is a group of diseases characterised by abnormal growth of cells in an uncontrolled manner.  This leads to the development of a lump or non-healing ulcer in any part of the body. The abnormal growth which occurs in breast tissues results in breast cancer. Most importantly, small parts of these abnormal cell growths can break off, enter into blood and lymph vessels and thus spread to other parts of the body.

SK: When and how is breast cancer examined in both men and women?
DT: There are a number of scenarios in which a person can be examined for breast cancer. It may be that the person has developed a lump which is usually painless or skin changes in the breast, which causes them to seek medical attention.  Some breast lumps are non-cancerous. Non-cancerous lumps occur especially in younger women. However, the older a patient is when they develop a breast growth, the more likely it is that the growth is cancerous.

However, there is no sure way of distinguishing between cancerous and non-cancerous breast growths. Any person, male or female, who has a lump or any other unusual change in the breast, should seek a medical opinion.

In this case their medical practitioner will examine the lump to see if it has any features that suggest breast cancer. The most common sign of breast cancer is a painless lump. At this point the cancer is usually of a lower stage and more easily curable. There are some features that are associated with cancer which is already at an advanced stage. Such features include a hard and fixed lump which may become painful, local skin turning peaud’orange.

In some cases the skin may redden, nipples may also start pointing inwards and a lot of spontaneous nipple discharge which can be bloody. One can also develop signs of spread.

These can be in the armpit or base of the neck, or spread to other organs far away from the breast such as the lungs, liver or bone.
The other procedure in which breast cancer is examined is called ‘screening’.

This entails actively searching for breast cancer in women who have no detectable breast changes. It is done using three methods which are self-breast examination, clinical breast examination and mammography.

Self-breast examination is the simplest and cheapest because it involves examination of one’s own breasts once a month to look for any changes that could point towards cancer. The clinical breast examination involves a health provider which could either be a trained nurse or doctor. It is recommended that this test be performed twice a year. Mammography is a breast examination process using special type of X-ray of the breast and this is recommended for women over the age of 50 years once every year.

SK: Can you explain how breast cancer is scientifically tested?
DT: This is done using a triple assessment which consists of clinical examination by a doctor, radiological tests which maybe an ultrasound scan or mammogram of the breast and a biopsy which involves an examination of the tissue under a microscope. The last step is the most important as it allows a definite diagnosis of cancerous or non-cancerous breast mass.

SK: What are the types and stages of breast cancers and how are they treated?
DT: Breast cancer is divided into stages one to four depending on how extensive it is. Stages one to three refer to cancer which is confined to the breast with or without spread to the nearby lymph glands which are the armpit and at the base of the neck.
Stage one has a better chance of being completely cured. Stage three is at the most advanced end of the spectrum, while stage two is intermediate between stages one and three.

Stage four breast cancer is one where there is spread to other organs.
Almost all stages one to three cancers are treated with some kind of operation.
Even though during surgery the operating doctor removes the breast lump and nearby lymph glands, there is still need for further treatment. This is because by the time a cancerous breast lump is half a centimetre in size it would have already planted small roots in other parts of the body.

These roots may grow and manifest even years later if they are not eradicated with further treatments.
A long time ago when surgery was the only available treatment for breast cancer, it was observed that the cancer reappeared on the site of the operation and other parts of the body almost in all women who were operated to remove cancerous cells.

Fortunately due to advances in medicine there are now treatments that eradicate the small roots that the cancer has planted and thus drastically reduce the risk of the cancer relapsing either at the operating site or further afield.
After surgery, a cancer specialist will consider all the factors related to a particular patient’s cancer. In some cases the specialist may recommend chemotherapy, radiotherapy or hormonal therapy.

Stage four cancer is different. Unlike the others, it is not curable. However, it can be controlled even for many years mainly with chemotherapy or hormonal therapy. However, radiotherapy or surgery may still have a role to play in a few special circumstances.

SK: Can you define radiotherapy and chemotherapy and explain how they are used to treat breast cancer?
DT: Radiotherapy is treatment with high energy X-rays which are directed at the areas where the cancer cells are concentrated. It is called a local therapy because it is directed to only a small limited area of the body. It is used to treat the operation site and the nearby lymph glands. It is painless and the patient will not feel anything while they are being treated. Its main effect is to reduce the risk of the cancer recurring in the local area. Chemotherapy refers to drugs which are mainly given as injections, but may also be in tablet form. It is a systemic treatment because it is not limited to one body site unlike radiotherapy.
Instead it travels in the blood stream to all parts of the body.

Therefore it works to eradicate small roots that the cancer has spread to other parts of the body in stage one to three cancers.
In stage four cancer it is used to reduce the size of and control the distant sites where the cancer has spread.

SK: What are the chances of survival after one has been diagnosed breast cancer?
DT: The diagnosis of breast cancer does not mean death. It is possible to receive treatment that has been mentioned in the previous section and survive for a long time after treatment. The most important factor in survival after a diagnosis of breast cancer is the stage at presentation. The earlier the stage for example stage one versus the other stages two to four, the better the outcome of treatment leading to longer the survival.