The importance of appropriately working up lesions in young women is if there are cancers that happen in women under the age of 40 they’re typically very aggressive cancers. But oftentimes the diagnosis is delayed, delayed because these cancers can appear like non-cancerous lesions, like benign lesions. So if they are not worked up appropriately, despite the fact that the patient shows up to the doctor in time, the diagnosis does not happen at the right time. So by the time the patient comes back six months or a year later we’re dealing with locally advanced breast cancer.
Now, the importance of this early detection versus locally advanced is when it is detected early the five year disease free survival is excellent but when the patient reaches up to stage 3, which is locally advanced breast cancer, the five year disease free survival goes down dramatically to the extent of about 50% which means that at the end of five years 50% of these young women under the age of 40 are going to die. These are the women who are in their productive years of life, they have young families, young children and they have a high impact on how things work out differently for them. So identifying those cancers becomes very important.
The second part is even when we detect them, if they do not die, if they make it through the disease and the treatment, the morbidity associated after treatment for locally advanced breast cancer is very high. They typically have to undergo mastectomies, they typically have to undergo axillary lymph node dissection which leads to lymphedema. So oftentimes when these women come back for their follow-ups they will say, ‘I am cancer free, I am disease free but my life never got back to normal.’ So it has a very high impact either way so therefore detecting cancers in these young women in time is very important.
The second part that I notice is because of the difference in practices that happen between countries that have standardised protocols, like the United States, Canada, where there are screening programmes in place, where there are standardised protocols in place, such things do not happen. The incidence of locally advanced breast cancers in developing countries is as much as 50-60% and the incidence of locally advanced breast cancers in developed countries is 5-15%, that much of a difference. So the key factor is education and awareness; awareness amongst the public also but education of the physicians also. So this is a great meeting in that regard to bring about awareness amongst the physicians also about best practice guidelines.
What message do you have for other physicians?
Be aware; have standardised protocols; let’s collaborate, learn from each other and do things that are already done better in other countries. Let’s not try to reinvent the wheel; there are protocols in place, if we learn the right protocols and we are able to implement it and we are able to standardise it across the region and the country we can have the same outcomes and more lives will be saved.
What message do you have for patients?
Be aware; be aware about your own health. Don’t take your health for granted. The biggest advantage of screening programmes is awareness; every woman becomes aware. Because there is no pain in breast cancer women assume that if there is a new onset painless palpable lump there is no reason to worry. So by having these screening programmes in place somehow the general population becomes aware that if there is a painless palpable lump, if there is nipple discharge, if there are any skin changes they have to show up to the doctor, not wait until it becomes locally advanced breast cancer and then go to the doctor.
Do you have any other key messages from this presentation?
The big message is because these are painless palpable lumps, breast cancer typically presents as a painless palpable lump, women often assume that if there is no pain there is no problem. They don’t show up to the doctor until things get to stage 3 cancer which is locally advanced breast cancer. Therefore that awareness amongst general women that if there is any lump in the breast, even if it is painless, if there is any nipple discharge or if there are any skin changes on the breast they have to show up. They don’t have to wait for pain to become a presenting sign to reach the doctor.
