Breast cancer continue to be most common cancer in women and ranks second among causes for cancer related death in women globally. Early detection, diagnosis and appropriate treatment of breast cancer are key to lower the burden of disease and better outcomes. When breast cancer is detected and treated early, the chances of survival are very high. Knowledge and awareness of breast cancer, skills of breast self-examination, confidence to detect breast changes and present promptly to a specialist, are key factors in the prevention, early detection of breast cancer. How-ever, women in many settings specially in rural areas, face complex barriers including social, economic, geographic and other inter-related factors, which can limit her access to timely, affordable and effective breast health care services.
Breast cancer is the most frequently diagnosed cancer in women globally. Early diagnosis of breast cancer may lead to more favourable outcomes and longer survival. Efforts to raise awareness breast cancer risk factors, benefits of screening, and treatment options remain necessary. To reduce the global burden of breast cancer, the transdisciplinary approach fall into these categories:(1) lifestyle modifiers of risk ; (2) early detection and risk reduction; (3) recent research in breast cancer prevention.
Age at menarche, age at first full term pregnancy and age atmenopause have a major impact on Breast cancer incidence in women. Early age menarche, late first full-term pregnancy and late menopause are associated with increased risk of breast cancer. Oral contraceptive causes only a small increased risk of breast cancer while hormone replacement therapy (HRT) has a powerful effect on breast cancer. The Women’s Health initiative (WHI) trial data showed that HRT in combination with oestrogen plus progestin for6-7 years nearly doubled the risk of breast cancer (Chlebowski., etal. 2009) [1]. While oestrogen without progestin in women with prior hysterectomy showed a slight reduction in breast cancer.
Early detection of breast cancer is challenging and the key factor to reduce morbidity and mortality of the disease. The capacity to effectively diagnose and treat clinically detectable breast cancer begins with clinical breast assessment (CBA) by taking a medical history and performing a focused physical examination including clinical breast exam (CBE). CBE is followed by diagnostic imaging and tissue sampling with pathologic evaluation, the so-called “triple test” of breast diagnosis [2]. Ultrasonography is more widely available and valuable in the assessment of breast masses. Ultra-sonography can distinguish between probably benign masses and suspicious masses. In contrast, mammography has high specificity but has reduced sensitivity in women with high breast density.
Screening is the single most important public health strategy to reduce mortality from breast cancer. Population based screen-ing modalities like, breast self-examination (BSE) or clinical breast examination (CBE) and mammography have been associated with early detection and reduced mortality of breast cancer [3].
Breast cancer survival is largely dependent on a woman’s access to timely, effective, and affordable care. Early detection is critical to breast cancer survival. When coupled with timely access to treatment, appropriate follow up, and survivorship care, there can be significant reduction in breast cancer mortality.
Bibliography
1. Chlebowski RT., et al. “Breast cancer after use of estrogen plusprogestin in postmenopausal women”. New England Journal ofMedicine 360 (2009): 573-587.
2. Ginsburg O., et al. “Breast cancer early detection: A phased ap-proach to implementation”. Cancer 126 (2020): 2379-2393.
3. Lauby-Secretan B., et al. “Breast-cancer screening--viewpointof the IARC Working Group”. New England Journal of Medicine