Breast cancer is one of the most common types of cancer in the world. There are significant numbers of women losing their lives to this. Considering the number of deaths in the world, the 5th place is due to cancer, in particular breast cancer. Taking the context in Sri Lanka, it is very similar to what it is in the rest of the world. Around 12 women a day are reported with breast cancer, and each day 2 women lose their life because of this. Unfortunately, the type of cancer associated with breast cancer is not something that can be prevented.

If so, what can we do about this?

If we are able to diagnose breast cancer, before it shows external signs in the breast, then we are able to cure it completely. Up till the 1980s, the quality of the treatments for breast cancer did not see any significant improvement, which meant as much as there were attempts to advance the cure, there was no way to save their life or heal them fully. However, after that once the treatments were improved in such a way to diagnose breast cancer head on, the rate of curing increased substantially. The biggest role played in this is the introduction of the Mammography Testing. After this, women had the opportunity to identify breast cancer even before they observed or felt any physical signs in their breasts and at the very beginning stages of the cancer. They were able to cure it completely through the standard treatments. From this we can avoid situations of removing whole breasts or going for treatments such as chemotherapy.

Which ages of women should do this Mammography? 

Women over 40 years old should do this testing yearly, or as the recommendation from a doctor here from Sri Lanka, at least once every 2 years. However, Sri Lanka does not have that privilege to do so. 

Then what can we do?

Even though it is not as effective as Mammography, we advise all women to self-diagnose the status of their breasts if they are above the age of 20. They can do so when 7 – 10 days have passed after their monthly period. Here, they should observe their breasts in front of a mirror by themselves, feel for any irregularities in the surface, unusual discharge from the nipple or other signs for   breast cancer, and seek immediate medical attention if needed.

There is the option of clinical diagnosing as well, where a professional would examine the woman’s breast. It is recommended that women in the ages of 20 -39 should get these clinical examinations done at least once every 1 – 3 years, and those above 40 should conduct these at least once a year. This is all relevant to women who have a normal risk of having   breast cancer. 

Nevertheless, there could be women with high chances of having breast cancer because of maybe the history of their mother, sister or a close relative who has undergone breast cancer before. We consider them as people with extremely high odds of having breast cancer, and through a proper assessment of the risk we may prescribe the Mammogram Testing even before 40. It should also be known that we do not recommend Mammography to women under 30 because the sensitivity of the test declines gradually under the age of 40. For them we conduct the Ultrasound scan and an MRI scan for the breasts. If we have a suspicion, then we take a small sample and diagnose accurately if it is a cancerous condition. In an instance that shows it to be true, we quickly check if it has spread in any way to the rest of the body, particularly by the PET-CT scan. This also can only be conducted for a very limited number, because there is only one machine each in the private and governmental sectors.

We go ahead with the CT scan and Bone scan testing to decide on the best treatment for this breast cancer patient based on the outcomes. We recommend surgery if cancer has not spread to distant organs yet. If it is in the early stages, we have the option to remove only the cancer without removing the breast completely – Breast Conservation Surgery. After such a surgery we proceed with radiation therapy for that breast. However, if the cancer is very large compared to the breast, then we will have to opt for removing the breast completely. Regardless, now there are ways to reconstruct the breast through maybe prosthetics or using their own tissue.

After all this, taking into account all the tests conducted and the related reports, we decided that, even though there were no signs that it had spread to the rest of the body, it has the potential to reach the insides microscopically. We would then continue to recommend more treatments. Chemotherapy, Immunotherapy, Targeted therapy for cancer, Hormone treatments and many others are such treatments. There are stories of women who have undergone these treatments and are fortunate to live a long and healthy life as a regular woman. But also we meet women who were unfortunate and who had this cancer spread throughout their body. Through standard methods of nursing, we do have the ability to give these women a long, healthy life. In addition to these standard procedures, there is also a vital type of treatment known as Palliative Care. There is a grave misconception that it is for people who are in their death beds. This Palliative Care should go hand in hand with the disease directed treatments when a cancer is diagnosed. The advantages for people in their very last stages of life, the effect of this care is priceless, and especially for someone who is at a point of incurable cancer, going through it without such comfort care is quite awful. The physical, mental, spiritual and social suffering that they and even their family members go through, could be benefited a lot through this care.

Being educated and aware of breast cancer is important because it could be your mother, sister, grandmother or someone very close to you who could be at risk. If women are attentive towards their breasts and will conduct regular testing to get to know this well ahead, they would be in luck to heal breast cancer fully!!

Dr. Shama Goonatillake
MBBS (Colombo) MD (Colombo) SLMC Reg No. 17334,
Consultant Clinical Oncologist
Head of Clinical Department
Asiri AOI Cancer Centre


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