ASJ Anniversary

20 THE GLEANER | SUNDAY, MARCH 3, 2019 A SK ANY woman what con- cerns her about breast cancer and the questions are fairly consistent. WHAT IS MY RISK AND HOW CAN I PREVENT BREAST CANCER? Contrary to popular belief, a negative family history does not protect against breast cancer as the minority of cases, perhaps five-10 per cent, are hereditary. It is esti- mated that the lifetime risk for the development of breast cancer in a Jamaican woman is one in 21. There is nothing that one can do about age, genetics, or the presence of dense breasts on a mammogram (that makes detection harder), but in general, a healthy lifestyle is helpful. DO I REALLY HAVE TO DO A MAMMOGRAM? It was recently reported by the American Cancer Society in early 2019 that it was estimated that early detection using mammog- raphy, coupled with advances in treatment, has saved over 500,000 lives in the United States since 1989. The earlier that breast cancer is de- tected also means that there are more options of treatment, and the overall prognosis is better. Mammography can detect breast lesions long before they are palpable. For women with dense breasts, a combined ultrasound is recommended. Apart from learn- ing how to perform a breast self-examination and having frequent visits and clinical examinations with your physician, a mammo- gram and ultrasound examination done and examined by a quali- fied radiologist is the best way to detect early breast lesions including microcalcifications. We currently recommend that Jamaican women over 40 start screening mammography, and at an earlier age, should there be any family history or proven genetic risk. It is not unreasonable either to start thinking about screen- ing mammography between 35-39 years, and this should be discussed with your physician. If an abnormality is discovered on mam- mography, the abnormality may need to be biopsied, and there are several minimally invasive methods to do this. IS A MASTECTOMY THE ONLY OPTION? The earlier that one detects breast cancer, the more options are available for treatment. Many women with early breast cancer are candidates for breast conservation rather than a mastectomy. Breast-conservation surgery involves removal of a portion of the breast that contains the cancer and is usually combined with an assessment of the possibility of spread by sampling the lymph nodes under the arm using a minimally invasive sentinel lymph node biopsy technique. Typically, the whole breast is irradiated to lower the risk of a recurrence. The traditional mastectomy is being replaced by newer techniques such as nipple and areolar sparing mastectomies, techniques that have been practised in Jamaica since 2000. Immediate reconstruction at the time of mastectomy allows the oncological (cancer treatment) as- pects of the surgery to be combined with an acceptable aesthetic and cosmetic result. Not every woman diagnosedwith breast cancer needs chemotherapy, particularly in early stages. Certain tests will be done on the cancer, including standard pathological examination, additional receptor studies, and/or tumour genetics, and themedical oncologist will tailor the medications, including hormonal treatment, to the individual. IF I NEED SURGERY, SHOULD I REMOVE BOTH BREASTS? Since the advent of the newer more cosmetically acceptable techniques of mastectomies, and with some celebrities sharing their experiences with double mastec- tomies, more and more women are asking about this method. With proper treatment of the initial cancer, the risk of a second breast cancer is very low once there is no genetic risk. For some women, even this low risk is too much. The addi- tion of a second procedure to the in- itial curative surgery, however, does increase the risks of the surgery and may delay treatment. It is also obvi- ously an irreversible step. As such, Discussions have to be had where all the pros and cons are explored at length to arrive at the best decision for the individual patient. The dis- cussions are best held over several visits with an experienced breast surgeon and medical oncologist. Dr Mark S. Newnham, Senior Lecturer and Consultant General Surgeon, University Hospital of TheWest Indies Let’s talk about breast cancer ASSOCIATION OF SURGEONS IN JAMAICA 60TH ANNIV SARY FE TURE: T E SUNDAY GLEANER MAGAZINE | MARCH 3, 2019