Women 'unaware' of breast cancer

More women are surviving breast cancer than ever before

Scottish women have an "alarming lack of awareness" about the symptoms of breast cancer, a charity has claimed.

Breakthrough Breast Cancer said it had carried out a survey which suggested one in six of those quizzed could not name any symptom of the disease.

Breast cancer is the most common cancer among Scottish women, with more than 1,000 dying of the disease every year and about 4,000 women diagnosed.

The Scottish Government said it would work to raise awareness of the cancer.

Breakthrough Breast Cancer said women needed to become more "breast aware" by carrying out regular checks and learning what signs to look out for, such as changes in the size or shape of the breast, changes to skin texture, or lumps.

The campaigners also called on women over 50 - who are more likely to be hit by the disease - to take advantage of breast screening.

Audrey Birt, the charity's director, said that while more women were surviving breast cancer than ever before, early diagnosis was key to achieving the best possible outcome.

She said: "Our message is show your breasts some TLC - touch, look, check.

"Do this by regular touching, looking for changes and checking anything unusual out with your doctor and attending breast screening if you are over 50, as these are the best ways to identify breast cancer early."

"If you find any unusual changes or are worried by anything, you should talk to your GP straight away."

The charity highlighted the case of Dorothy Denham, 52, from Bonnyrigg, Midlothian.

Ms Denham, whose mother died from breast cancer, noticed a wrinkle near her nipple but as she could not feel a lump did not believe there was a problem.

'Warning sign'

However, she later decided to get it checked out - and was diagnosed with breast cancer.

She underwent surgery and - as the disease was caught early - her long-term prognosis is good.

Ms Denham said: "I was lucky because, despite ignoring the first warning sign, when I did get diagnosed it was still early enough to remove the cancer before it could spread."

She urged other women to share any concerns with their doctor "no matter how small or trivial their worry".

The Breakthrough Breast Cancer research was carried out by pollster TNS System Three, who quizzed 542 women across Scotland over the age of 16 between 25 February and 4 March.

Health Secretary Nicola Sturgeon said: "It is important that people take every opportunity to take care of their health and wellbeing and I would echo Breakthrough's call to women to be more aware of the signs and symptoms of breast cancer.

"Information is available through the NHS and charities such as Breakthrough Breast Cancer Care, as well as advice and support.

"The Scottish Government and NHS Scotland will continue to work to raise awareness of breast cancer."

Breast Cancer

Breast cancer is the most frequently diagnosed malignancy in women. Consequently, women should become actively involved in routine breast screening. This protocol includes monthly self-examinations, a yearly examination by a healthcare professional, and an annual mammogram beginning at age 40. Women with strong family histories of breast or gynecologic cancer, a personal history of cancer, or other risk factors, may require earlier and more frequent examinations. Any abnormality identified on physical exam or mammography will require additional investigation. Often, your physician will order tests such as ultrasound or MRI to further characterize these findings.

When necessary, a tissue sample of the area in question will need to be obtained. If a lump can be felt in the breast, or if it can be seen on ultrasound, this area can easily be sampled in the office under ultrasound guidance using an automated core biopsy device. This requires no sedation or sutures, and is very accurate in acquiring tissue for the pathologist to examine. If the area in question can only be identified on mammography, then a sample must be taken either by a stereotatctic biopsy performed in the radiology department, or by a needle localized biopsy performed under sedation in the operating room. Your surgeon will discuss your options thoroughly, and assist you in making decisions regarding the type of biopsy best suited to your situation. The good news is that the majority of biopsies performed for suspicious areas in the breast prove to be benign (non-cancerous) lesions. The goal of breast screening is to identify breast cancer early, for early detection gives the best opportunity for cure.

If you are diagnosed with breast cancer, be encouraged that current treatment is very effective in producing an excellent opportunity for cure and improved survival. In most cases, the first step in treating breast cancer is the surgical removal of the cancer itself. In the past, the removal of the cancer necessitated removal of the entire breast along with the lymph nodes under the arm. This operation is called a modified radical mastectomy, and there are still conditions in which it will be the best option for a woman. Most women, however, are treated with a segmentectomy, also called a lumpectomy, in which the cancer is removed with a margin of normal breast tissue around it. This operation, coupled with radiation to the breast, gives the same opportunity for cure and survival as the mastectomy, but allows the woman to keep her breast. As a part of the surgical treatment of breast cancer, the lymph nodes under the arm must be evaluated for the presence of cancer cells, which may have spread from the breast tumor. The presence or absence of cancer cells in the lymph nodes is an important part of staging the cancer and in helping to direct additional treatment.

Again, in the past, most all of the lymph nodes under the arm were removed at the time of mastectomy, often leading to pain, limited shoulder movement, and the potential for lymphedema (swelling of the arm). Current techniques allow us to remove the few most important nodes under the arm through a small incision. These ‘most important’ nodes are called sentinel nodes, and their identification and removal is called a sentinel node biopsy. The presence or absence of cancer cells in the sentinel nodes accurately predicts the presence or absence of cancer cells in the remainder of the lymph nodes under the arm. Cancer cells identified in the sentinel nodes at the time of operation, generally necessitates the removal of the remainder of the nodes. Using these techniques of breast conserving surgery, the cancer can be removed and the nodes evaluated through two small incisions. This has become the ‘gold standard’ for the surgical treatment of breast cancer. After your operation, you will have an ongoing relationship with your surgeon, as part of your post-cancer screening protocol.

Women with early-stage breast cancer increasingly having double mastectomies

Researchers at the University of Minnesota have found that more and more women, diagnosed with the earliest stage of breast cancer, are choosing to have both breasts surgically removed.

Dr. Todd Tuttle, an associate professor of Oncologic Surgery, has observed that the rate of contralateral prophylactic mastectomy (CPM) surgery among U.S. women with ductal carcinoma in situ (DCIS) increased by 188 percent between 1998 and 2005.

“The 10-year survival rate for women with DCIS is 98 to 99 percent. Therefore, removal of the normal contralateral breast will not improve the excellent survival rates for this group of women. Nevertheless, many women, particularly young women, are choosing to have both breasts removed,” Tuttle said.

A previous study conducted by Tuttle and his colleagues found more American women choosing to have both breasts removed when cancer has been found in only one breast.

He says that his new study indicates the same attitude among women with DCIS, described as the earliest stage of breast cancer when the cancer is small and confined within a duct area of the breast.

At this stage, the disease is considered highly treatable with breast-conserving surgery and radiation or hormone therapy, points out the researcher.

Tuttle and his colleagues used the National Cancer Institute’’s Surveillance, Epidemiology, and End Results (SEER) database to evaluate information about 51,030 women diagnosed with DCIS in one breast between 1988 and 2005.

The researchers observed that about 13.5 percent of the women chose breast removal surgery for their DCIS treatment.

According to them, the rate of women opting for the surgery increased by 188 percent between 1998 and 2005.

The study has been published in the Journal of Clinical Oncology.