Breast Cancer Guyana: Get the help you need, it’s easier than you think!

Oct 24, 2021 Dr Zulfikar Bux, Features / Columnists

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By Dr. Zulfikar Bux in collaboration with Dr. Angelita Sue

Kaieteur News – Since the pandemic started, my primary focus has been COVID-19 because of the need to keep abreast with this rapidly evolving disease. I am taking a break from it today to help disseminate vital information on breast cancer that can help to save lives, especially those who are not aware of the positive changes that have been occurring locally. Today’s article was done by Dr. Angelita Sue who is a Radiologist at GPHC and was one of the first graduates of the RAD-AID sponsored programme to train Radiologists in Guyana. RAD-AID is the largest non-profit radiology organisation in the world. I had reached out to them many years ago and they have achieved far beyond what I had envisioned when I decided to ask them to come help us in Guyana. One of their many contributions was to help improve screening and detection for breast cancer locally. It is Breast Cancer Awareness Month and it was only fitting that I shifted focus to help my colleagues build awareness on this deadly disease.

Why breast cancer?
Breast cancer is the most common form of cancer among women worldwide, affecting one in eight women. It is the leading cause of death among women, specifically in low- and middle- income countries, due to the lack of preventative measures and education available to women in these areas. Guyana is no exception to breast cancer. A recent study conducted at the Medical Imaging Department at the Georgetown Public Hospital Corporation (GPHC) by Dr. Sue and Dr. Samantha Singh, revealed that out of 59 diagnostic mammograms, eight cancers were detected, and out of 599 screening mammography, five cancers were detected. This means that at the GPHC, 5 out of 1000 asymptomatic women presenting for mammograms had cancer and 135 out of 1000 symptomatic women had cancer. Many of these cases presented in its late stage.

What signs and symptoms are concerning for breast cancer?
Most frequent breast complains are :
1. Breast pain
2. Nipple discharge (secretion)
3. Palpable lump
4. Skin changes

Breast Pain
Breast pain is a common complaint for which women seek medical attention. However, all women at some point in their lives have experienced breast pain.
Non-cancerous causes of breast pain can be numerous and include the following:
● Hormonal changes (associated with menstrual cycle)
● Large breast size
● Unsupportive bra
● Lower levels of fitness or activity
● Duct ectasia (dilated breast ducts)
● Cysts (noncancerous lump)
● Referred nerve root pain from degenerative spinal changes
● Peptic ulcer
● Heart disease
● Herpes zoster (shingles)

When should you be worried about breast pain?
Breast pain that tends to be in one breast that is well localised and persistent in one area of the breast and not associated with your menstrual cycle. If you experience this type of breast pain, visit a doctor to discuss investigation options.

Nipple discharge (secretion)
Nipple discharge is common, and at least 80 percent of women will experience at least one episode of nipple discharge during their reproductive years.
There are two types of nipple discharge:
1. Physiologic (normal)
2. Pathologic (abnormal and associated with disease)

Normal nipple discharge usually arises from both breasts, from multiple openings from the nipple, and varies in colour such as white, green or yellow.

Misconception
Squeezing the nipple daily to clean the area, STOP! This is not necessary and can increase nipple discharge.

What type of nipple discharge should you be concerned about?
Nipple discharge that stains your shirt or bra (spontaneous), arising from one breast, from a single opening in the nipple with a clear or bloodstained colour.

Palpable Lump
What to do if you find a lump in your breast.
First: don’t panic! Many lumps in the breast are not cancerous. To determine it’s not cancer, a visit to a doctor for a thorough clinical breast examination along with imaging work up (ultrasound and mammography). A biopsy (tissue sample) may be necessary. Remember to examine under the arm when surveying for lumps.
What you should NOT do if you find a lump in your breast
Do not dismiss any lump in the breast as just a boil, insect bite or abscess.
Do not apply any form of poultice or antibiotic cream to breast lumps.
Do not squeeze or irritate a lump in the breast.
Do not ignore any lump in the breast out of fear, visit a healthcare provider to discuss further workup and investigation.

If you are 40 years old or older, and you feel a lump, a diagnostic mammogram and further breast ultrasound is usually recommended.
If you are in your 30’s or younger, and feel a lump, an ultrasound should be done to evaluate the lump. If any suspicion of cancer is seen on ultrasound, a mammogram may be recommended.

Skin changes
– Changes in skin texture
– Dimpling of the skin
– Scaly skin around the nipple and areola
– Skin thickening in any part of the breast
– Red, purple or have a bluish tint of the skin.
– Orange peel appearance of the breast.

What can you do to reduce your risk of breast cancer?

Early detection
Self-breast examination
Get to know your breasts.
The more you examine your breast it will become easier to pick up on changes and alert attention to your doctor.

MAKE IT ROUTINE, ONCE A MONTH
Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day monthly.

Screening Mammography
What is mammography? It is a type of imaging exam using low dose x-rays of the breast.
It is used to detect early signs of breast cancer even before you can feel it.

When should screening mammography start?
It is recommended to start the screening exam at the age of 40. Earlier for women with a history of first line family members (mother or sister) with breast cancer or history of radiation therapy. Screening mammography is done for women with no breast symptoms or complaints.

Diagnostic mammography
This type of mammography is performed on symptomatic patients or to work-up an abnormality found on screening mammography. A complementary targeted ultrasound is also done in some cases.

Targeted Breast Ultrasound
For patients in their 30’s or younger presenting with breast symptoms, always start with a targeted breast ultrasound as initial work up. In some cases, a mammogram may also be recommended by the reading radiologist.

Where can you access mammography and breast ultrasound services in Guyana?
At the GPHC, mammography and breast ultrasound are offered FREE of cost all year round. Take advantage of this service and book an appointment to have annual screening mammography done and diagnostic workup if presenting with breast symptoms.
This article is dedicated to Dr. Gillian Battino who started the mammography programme at the GPHC and championed the many RAD-AID initiatives in Guyana. Thank you and RAD-AID for the many lives that you’ve saved!

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