Alfred Dawes | The breast cancer lane

Every now and again when I step on people’s corns with my opinion pieces, I get an email telling me that I am like Ben Carson, brilliant when I stay in my lane, but an idiot when I weigh in on non-medical issues. I wonder if my fellow writers such as Dr Garth Rattray and Dr Michael Abrahams are subject to such comparisons. I am actually humbled by the “insult” though, as growing up I drew inspiration from Gifted Hands: The Ben Carson Story.

Ben’s fall from intellectual grace never came from stepping out of his lane. It came from being forced to defend indefensible political dogma because he was staying in a party lane and pandering to supporters. The beauty of being an unfettered opinion writer is that I can mash any corn without fear of losing the support of a base, because I had none in the first place. It’s a lonely place to be, not sticking to a lane. Only bike riders and goats are your company.

I do, however, realise that this platform is one that is useful to educate the public on matters of medicine. That medicine lane is quite useful today, as October is Breast Cancer Awareness Month. Breast cancer is a serious problem in Jamaica. It is the number one cause of cancer in women. It is also the leading cause of cancer deaths in Jamaican women. Approximately 300 Jamaican women die from breast cancer every year. The highest reports of breast cancer worldwide occur in the developed countries which have upwards of 90 cases per 100,000 of their population. The poorer countries, especially in Africa, have lower rates of around 27 per 100,000. Jamaica has an incidence in the middle of 43 per 100,000. Although they have lower rates of cancer in our population, developing countries are responsible for 58 per cent of the world’s breast cancer deaths.

SCREENING AND TREATMENT

Why is that so? A lot of it has to do with screening and treatment and some of it has to do with the biology. There may be socio-economic factors why our women are not seeking early treatment, or screening for cancer before signs and symptoms appear. Even then, in the developed world, you do find black woman having higher death rates from breast cancer over their white counterparts. Black women tend to have more aggressive forms of breast cancers. When you look at the tumour biology, women in Jamaica tend to have more aggressive disease and they tend to get it at an earlier age. It is not just the stereotypical older females nearing their life expectancy who are getting breast cancer, we are seeing younger and younger women developing the disease, and the tumours are very aggressive.

The average Jamaican breast cancer patient is a female in her mid-50s, compared to what obtains in the developed world, where it is a 60-plus-year-old. Not just that, but 40 per cent of these women present with advanced disease with very obvious signs. They took too long to seek treatment. This means that the medical, surgical and radiation treatments we use do not work as well. What is frightening as well is that one local study showed that while other countries were seeing more cancers, but their death rates were going down, Jamaica actually saw an increase in the death rate of breast cancer between the years 2010 to 2014. While other countries are discovering cancers earlier, and treating them more effectively, Jamaican women are dying at a higher rate from breast cancer, as we are seeing more of these cancers presenting later and with more aggressive disease.

MADE A DIFFERENCE

Screening is really what made a difference in these developing countries. You screen more, you pick up more cancers so your rates may go up. Screen more, you pick up more early cancers, so treatments are more effective, and the death rates go down. With screening, we pick up breast cancer at an early enough stage, where treatment would be easier, cheaper and more effective. Breast cancer has a natural history that is predictable, and if we intervene at an early stage, even at a precancerous stage, someone who would have died is converted into someone who can go on to live a full life.

Screening for breast cancer involves your own examination of the breast for any lumps, skin changes or abnormal nipple discharges. Lumps are usually painless but may be painful or tender. Once you find a lump, get it checked out. Chances are it is a cyst or noncancerous growth, but you can’t “watch it and see”. Let a doctor make that call. Skin changes may include the pores becoming more prominent, like an orange peel, or an eczema-type rash in the nipple area. Lightly squeezing the nipple may cause a slight clear discharge normally. A bloody discharge should be checked out as soon as possible. Feeling under the armpits might reveal what we call wax and canal. These are swollen lymph nodes. They be a sign of infection, or a sign of breast cancer even without a breast lump being present.

An examination by a doctor and an annual mammogram starting at age 40 is integral. If you have a family history of cancers, you may be asked to start screening at an earlier age. Consistency with screening can mean the difference between life and death. Play your part in breast cancer awareness this month and stick to the breast cancer lane when you run off your mouth.

Dr Alfred Dawes is a fellow of the American College of Surgeons, and CEO of Windsor Wellness Centre. Follow him on Twitter @dr_aldawes. Send feedback to columns@gleanerjm.com and adawes@ilapmedical.com.