I have always read articles concerning breast cancer initiatives in Rwanda. Based on my previous working experience in oncology clinics in our country, breast cancer cases are more predominant than other cancer cases.
But on a more positive note, it’s the easiest malignancy to manage based on the breast anatomical structure, clinical manifestation of the disease and the tools available for detection/staging.
In life I have always developed a principle that every problem or every clinical sign should be checked early in order to overcome adverse complications from the disease itself or sometimes aggressive modalities used in the treatment of the disease.
Tools used in the screening and early detection of breast cancer are accessible, affordable and available in many health centres or hospitals with in the country.
The take home advice from every breast cancer expert to his clients is usually to teach or show how to carry out a self-breast exam.
It’s always important for a person to know how her breasts are made. To do this, you have to inspect (look) and feel (palpate).
This will help you know how to differentiate normal breast tissue and abnormal breast tissue. This routine self-assessment can help know or detect any possible occurrence of a lump or a mass that might develop within the breast tissue.
One of the commonest tools used in breast cancer assessment is the mammogram. A mammogram is a special x-ray of the breast. This test helps to find tumors or masses that are too small to feel such as the ductal carcinoma in situ (DCIS). In the ductal carcinoma in situ, there are always abnormal cells in the lining of the breast duct.
Most of the DCIS develop into invasive cancer.
Mammograms are more recommendable in post-menopause or older women than in young people or pre-menopause women. One of the reasons is that younger women have denser breast tissue that might appear white on a mammogram as compared to the older women.
Tumors usually appear white on a mammogram film and become harder to interpret when there is a dense breast tissue.
The diagnosis of breast cancer is based on clinical examination in combination with imaging as well as the confirmed pathological assessment of the disease.
Clinical examination of the breast usually includes bimanual palpation of the breasts, loco regional lymph nodes and assessment of possible distant metastases in the bones, liver and lungs.
Most of the imaging essentials used in breast cancer clinics include bilateral mammography and ultrasound of the breast along with regional lymph nodes.
In breast cancer clinics, the magnetic resonance imaging (MRI) of the breast is not routinely recommended.
However, there are circumstances where you have to consider the use of this exam.
The MRI can be considered in cases of breast implants, lobular cancers, suspicion of multimodality/ multicentricity (particularly in lobular breast cancer) and to individuals with familial breast cancer associated with BRCA mutations.
The MRI is also used when evaluating the response to primary systemic therapy or when the findings of conventional imaging are inconclusive for example as seen in the positive axillary lymph node status with an occult primary tumour in the breast.
The new imaging techniques used in screening and diagnosis include the three-dimension (3D ultrasound), shear wave elastography, 3D mammography and contrast-enhanced mammography/spectral mammography.
These new techniques are one of the imaging recommendations in the latest imaging guidelines and are said to have the potential to increase diagnostic accuracy, especially in women with dense breasts.
Breast cancer patients usually need pre-treatment evaluation of the disease. This includes pathological evaluation of the primary tumour, cytology evaluation or histology of the axillary nodes, if the doctor suspects any possible involvement is suspected.
When a breast cancer patient visits the breast cancer clinic, initial assessments include; complete personal medical history, family history relating to breast cancer or other cancers. The physical examination is usually followed before other investigations and procedures are carried out.