Contributed by Dr Raden Mas Jeffri Raden Mas Ismail, Consultant Medical Oncologist, The Brunei Cancer Centre (TBCC), Pantai Jerudong Specialist Centre (PJSC)
As we are fast approaching the end of the year, Brunei Darussalam is still recovering from the effects of the COVID-19 pandemic. For most Bruneians, life is slowly returning to normal – albeit with changes. But for some, especially those with chronic diseases, life still revolves around continued medical therapy at hospitals.
During the pandemic, many cancer patients had disruption in their diagnoses and treatment. The Sultanate’s national screening efforts were also affected as the focus and resources were shifted towards tackling the issues of the pandemic.
Numerous worldwide studies suggest the pandemic affected countless patients. Brunei too was affected.
A recent Ministry of Health (MoH) press release of deaths in 2021 showed that cancer was the second, only to cardiovascular disease, with 306 reported cases for the year. This meant that nearly one in five (19 per cent) deaths in the year 2021 was due to cancer.
The most frequent cancer affecting women in the Sultanate is breast cancer, with the number of cases increasing with time. Only a decade ago fewer than 100 new cases were diagnosed in a year.
Recently, between 100-120 new cases were diagnosed in a calendar year. Sadly, this number is projected to rise in the coming years.
According to World Health Organization (WHO) data published for Brunei Darussalam in 2020, breast cancer alone represented the 10th most common cause of death and represented 2.06 per cent of total deaths in that year.
The lifetime risk of getting breast cancer for a Brunei woman is 16 per cent or about one in six. Though a majority of sufferers are women, it is not limited to them; about one in 100 cases affects a man.
Though the rise in new breast cancer cases is anticipated in view of the ageing population (breast cancer incidence increases with age) and the increase in the prevalence of overweight and obese women, a particular concern is that most new cases in Brunei Darussalam are still diagnosed at advanced stages (stage III and stage IV) leading to poorer outcome despite intensive therapy, and reduced survival rate.
Breast Cancer Awareness Month is an opportunity to highlight these crucial issues and keep it high on the public agenda. It allows us to shed light on the challenges and realities of living with this condition.
‘Think Pink Take Action’ is the theme chosen by Pantai Jerudong Specialist Centre (PJSC) for this year’s campaign. It is about our continuing commitment to create awareness for breast cancer, supporting the warriors, admiring survivors, and honouring those we lost to the illness.
It is also about making progress together by encouraging women to take action by joining in meaningful discussions on breast cancer and taking up mammogram screenings.
WHAT IS BREAST CANCER?
Breast cancer usually begins either in the tiny breast glands (lobules) that make milk (called lobular carcinoma), or in the breast ducts that carry milk to the nipple (called ductal carcinoma).
Once breast cancer has developed, it can grow larger in the breast and spread to nearby lymph nodes in the armpits or neck or go further through the bloodstream to other organs.
The cancer may grow and invade tissue around the breast, such as skin or chest wall or bones. These are called breast secondaries and a feature of advanced breast cancer.
Different types of breast cancer grow and spread at different rates. Some take years to spread beyond your breast, while others grow and spread quickly.
WHO GETS BREAST CANCER?
Breast cancer may affect women from childbearing years and beyond to post menopause. As mentioned before men can get breast cancer too, but they account for less than one per cent of all breast cancer cases.
Fortunately, breast cancer is very treatable if spotted early.
Localised cancer (meaning it hasn’t spread outside your breast) can usually be treated effectively with surgery before it spreads. For many early breast cancers, the addition of chemotherapy before and after surgery will aid in eradication of the cancer and breast conservation (removing a portion of the breast rather than the whole breast). The main aim of treatment is to achieve cure.
Once the cancer begins to spread, treatment becomes more complicated. Though the chance of cure is much diminished, modern breast cancer treatment can often control the disease for years.
The best form of fighting breast cancer is through prevention.
HOW DO I REDUCE MY RISK FOR BREAST CANCER?
Risks for breast cancer are divided into modifiable and unmodifiable risks.
Unmodifiable risks are factors that are not controllable like gender, age and the presence of family history of certain cancers especially for breast, ovary or uterus in female family members or prostate cancers in male family members.
Modifiable risks are related to lifestyle habits which can be changed.
Research has shown that lifestyle changes can decrease the risk of breast cancer, even in women at high risk for same. Evidence has shown the following lifestyle changes to lower one’s risk for breast cancer:
– Maintaining a healthy weight. If your weight is healthy, it is advisable to work to maintain that weight. There is much scientific evidence for the health benefits of ideal BMI range of 20-25.
– Be physically active. Physical activity can help you maintain a healthy weight, which helps prevent breast cancer and be beneficial for your cardiovascular health. Most healthy adults should aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobics weekly, plus strength training at least twice a week.
A recent study published by the British Journal of Sports Medicine in August 2022, which looked at genetic predisposition for physical activity and breast cancer in the United Kingdom (UK) showed that sedentary lifestyle is associated with an increased risk in developing breast cancer.
– Breastfeed your baby. Breastfeeding may play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect.
– Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the risks and benefits of hormone therapy to treat hot flashes.
– Stop smoking. Smoking is a habit related to many cancers and kicking the habit may help greatly to reduce risk of many cancers.
– Stop passive smoking. If you are not smoking but your partner or household family member smokes, encourage your partner or family members to stop smoking. Multiple studies have shown that women with passive smoking have greater risk for cancer, especially breast and lung cancers.
BREAST CANCER SYMPTOMS
The symptoms of breast cancer include: a lump or thickened area in or near your breast or underarm that lasts through your period; a mass or lump, even if it feels as small as a pea; a change in your breast’s size, shape, or curve; nipple discharge that can be bloody or clear; changes in the skin of your breast or your nipple – it could be dimpled, puckered, scaly, or inflamed; red skin on your breast or nipple; changes in the shape or position of your nipple; an area that’s different from any other area on either breast; a hard, marble-sized spot under your skin.
WHAT DO I DO IF I FIND A LUMP IN THE BREAST?
If you feel a change or lump in your breast or nipple, please try not to panic or worry. Most lumps are not breast cancer, but are something less serious, such as a benign (non cancerous) condition.
Many lumps go away on their own with time. In younger women, lumps are often related to the menstrual periods and go away by the end of the cycle. Do avoid examination of your breast during menstrual periods.
If you find a lump or any change in the breast or the armpit under arm area, it is best to visit your nearest health clinic for a check-up.
IS THERE SCREENING FOR BREAST CANCER?
Mammography is specialised medical imaging that uses a low-dose X-ray system to see inside the breasts. Screening mammography is the use of mammography in women of a certain age group before women experience symptoms to detect early breast cancer – when it is most treatable. A mammogram is effective in women above 40 years of age.
In Brunei, there is screening mammography for breast cancer available under the National Health Screening Programme available to women aged 40-69. This is available to citizens and residents.
More information about the National Health Screening Programme and its criteria are available at www.ppkk.gov.bn.