Ignorance and fear are the reasons why breast cancer, one of the easiest of cancers to diagnose and arrest, is often not detected until after it has spread beyond control. 252,700 breast cancers are diagnosed in the United States every year.
“Self-examination,” said a breast cancer diagnostic expert, “should be encouraged in girls, taught to them, perhaps, in school at the time they learn about menstruation and well before they reach the age when they become vulnerable.”
Dr Roderick McEwin, health reformer and head of NSW Health Commission, said he would like to see self-examination for breast cancer included in a thorough medical course for school children, along with other problems such as drugs and alcohol.
But while preventive medicine is becoming increasingly important in educating the young, the subject of breast cancer would have to be handled with extreme sensitivity.
“It could induce acute anxiety in some girls years before they are old enough to be at risk,” said Dr McEwin. Schoolgirls can be taught breast self-examination by their mothers in the same practical manner they should be taught to cope with menstruation.
Examine your breasts in the bath or shower. Wet, soapy skin makes it easier. Even if you’re under 35 (when breast tumors are rare), examine your breasts to become familiar with your own particular structures.
Look in the mirror to see if there are any irregularities – dimpling, puckering or indrawing of a nipple. Examine your breasts the day after your period finishes or the first day of each month if periods have ceased.
Leaflets on breast self-examination are available from hospitals and health centers. If you find the instructions complicated, ask your doctor to explain them and demonstrate what you should do.
The physician emphasized that a condition you may find irregular is not necessarily cancer. “9 out of 10 lumps prove to be benign, but consult your doctor. Only he can advise you.”
Breast cancer can be detected at a very early and curable stage by clinical examination plus mammography, a diagnostic method of low-dose breast X-rays.
A Sydney screening center endorsed this claim, announcing that 38 percent of breast cancer detected in the center by X-ray could not be felt by a doctor. But mammography is a controversial subject in Australia and overseas, although many doctors here believe profoundly in its value and would like mass breast screening available for all women between 40 and 60.
Because of a risk of radiation induced breast cancer, the National Health and Medical Research Council of Australia has recommended that breast X-rays should not be used as a preliminary check-up procedure on apparently healthy women who have no symptoms.
The only women who should be screened, the Council believes, are those referred by their doctors with symptoms, women with a genetic history of the disease, or women who have already had a breast removed.
Many top specialists disagree. They say that as long as the X-ray dose is low the advantages of mammography well outweigh a supposed risk. A doctor working in mammography told us of two recent cases where X-ray showed breast abnormality in women who had no suspicious symptoms.
“Two women in their early 50s came in for health check-ups,” the doctor said. “They had no symptoms. The physician who examined them could feel no lumps, but routine breast X-rays showed suspicious clusters of small dots in both patients. Both women had small breast cancers removed which had not spread and were potentially curable.”
A physician specializing in breast cancer at a Sydney diagnostic center says that modern breast X-ray finds more cancers than it could possibly induce.
He said: “If the cancer is detected early, before the lymph glands in the axilla (armpit) are affected, the growth can be arrested. Of patients treated early, with no involvement of the lymph glands, 95 percent are alive and well 10 years after surgery. Most of these women are immune from a recurrence.”
What of the risk of malignancy through radiation? Admitting that some doctors might not totally agree with him, the doctor said, “There is no proof that modern low-dose breast X-rays cause cancer. If radiation is low and carefully monitored it should be safe.”
Apart from genetic tendencies, why is it that some women seem more prone to breast cancer than others?
“For some reason,” the doctor said, “breast cancer seems more prevalent in some areas than in others. It is rare in Peru, Japan, Thailand.”
“Holland now has the highest rate in the western world, higher than Germany, her neighbor. Finland has a higher rate than Sweden, just across the Finnish border. Statistically, Australia, Britain and the United States are in the middle.”
Statistics indicate that women who have never had a child are at slightly higher risk but those who have become mothers in their teens or early 20s seem almost immune. On the other hand, young mothers appear more prone to cancer of the cervix in later life – a condition easily detected by a “pap smear.”
“Maybe one day we’ll discover a magic breast smear.” said the doctor.
Research goes on. Survival rate increases. Awareness of risk is terribly important. Never keep your fears about breast cancer to yourself. Remember that early detection means survival and every hope of a long and happy life.