Nine myths about Breast Cancer - by Mandy Collins

Breast cancer. Those two words strike fear into the hearts of most women. And yet, it’s one of the few cancers that are easily treated if caught early enough.

Part of the reason we fear cancer is the thought of a mastectomy – where we lose what to most is an essential part of our femininity. There is good news on that front, however (see below). Surgery is not always disfiguring , breast conservation and reconstruction now play a major role in management.

The other reason we fear breast cancer is because of the numerous myths surrounding the disease. Sometimes it’s hard to know what the truth is.

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Dr Carol Benn is a surgeon and breast specialist who is passionate about telling women the truth about breast cancer. She is the head of the breast clinics at the Johannesburg Hospital and Chris Hani Baragwanath Hospital, and also started a Section 21 company – The Breast Health Foundation – based on her concern for the ever-increasing number of breast cancer cases. This is run from Netcare’s Centre of Excellence at the Park Lane Clinic in Johannesburg. The aim of this company is to educate and reach out to South African women, and within five years, set up a national screening programme for breast cancer.

Dr Benn sees a large proportion of patients who present to the hospital when they already have advanced breast cancer. Often this is because of poor education about breast cancer, and lack of knowledge on how to conduct breast self-examination. But there are also a number of myths that abound, and which she hears on a regular basis.

1. Mammograms cause breast cancer
“Mammograms play an important role in diagnosing breast cancer, but one must not underplay the value of a good breast self examination, says Dr Benn. “ A mammogram simply reads the density of the breast, and should be used in conjunction with sonar in women with dense breasts. Also, women only need to start having mammograms between the ages of 35 and 40, not before.” In view of title I would also say mammograms do not cause breast cancer, the radiation exposure from mammograms is minimum.

2. A poor diet causes breast cancer
“There is no body of evidence that is statistically significant, which shows that diet causes breast cancer. It does play a role, but to what extent, we really don’t know. My gut feel is that we have become a take-away generation, and if you repeatedly fry food in the same fat, the fat becomes carcinogenic,” she points out. “But it’s so hard to tell how much of an influence this has on the rates of breast cancer, because there are so many variables.

“The other thing is that the survival rate from breast cancer is improving, due to early diagnosis and use of chemotherapy and hormonal therapy in conjunction with surgery so we have to keep everything in perspective. We can’t make wholesale statements that diet has a direct causal relationship with breast cancer, but embrace eating healthily.

“There is very good evidence, however, that regular, aerobic exercise in pre-menopausal women can decrease the risk of getting breast cancer by up to 37 percent. That is very significant.”

3. The oral contraceptive pill (OCP) causes breast cancer
Many people using the OCP worry about their breast cancer risk. Relax, says Dr Benn: “Hormones do play a role in breast cancers, but the OCP really only gives a minimal increased risk of contracting cancer . If you’ve been using the pill for more than 10 years, your risk if you are pre-menopausal increases by 1.2 percent, which is only marginally significant. And every year you are off the pill, decreases your risk back to that of the people around you.”

It has no impact on postmenopausal breast cancer risk.

4. HRT causes breast cancer
This is the other hormonal area of concern for most women. Dr Benn explains that hormone replacement therapy (HRT) should only be prescribed for women who have menopausal symptoms. HRT medications consist of a variety of medications grouped together as SERMS. Some may have a greater cancer risk than others and the trials that suggest that HRT causes breast cancer may  not be as accurate as we think, because the women on those trials are more closely observed than those who are not and certain medications may have a greater cancer risk than others (AKA Time magazine). They do get breast cancer, but the cancers they get are hormone-driven, hormone sensitive tumours. It’s also important to note that there’s no increase in the death rate among women on HRT. The key is to watch them carefully – there are medications they can take that are protective.

5. Breast cancer is painful
Many people don’t report lumps in their breasts because they aren’t painful. Nine out of 10 times, however, breast cancer is painless. Any lump you find in your breast should be investigated.

6. Only women with large breasts get breast cancer
Dr Benn explains that even some health care workers believe this myth, but breast size has nothing to do with whether or not you get cancer. There’s also no evidence to suggest that the right or left breast is more susceptible. “All women should be checking their breasts for lumps regularly, no matter what their breast size or their perception of their own risk factors,” she adds.

7. Breast surgery causes breast cancer
There is no relationship between previous breast surgery such as a breast reduction or augmentation, and your risk of getting breast cancer. Women who have this surgery may have problems breastfeeding, but they certainly need not worry that their risk of getting breast cancer has increased.

8. Underarm deodorant, perfume and talcum powder cause breast cancer
This is a great myth, as is the belief that excessive stimulation of the breasts will cause breast cancer. There’s simply no truth to any of it!

9. Treating breast cancer requires mutilating surgery
“Breast cancer is one of the few cancers which, if detected early, you can cure, so it’s imperative that any woman who finds a lump in her breast consults a doctor who has an understanding of breast management,” says Dr Benn.

“Patients will then be examined, have sonar or a mammogram, and a needle biopsy to ascertain whether or not the lump is cancerous. And then there’s no need to jump into a decision. Breast cancer is not flu – patients need to explore their options and find out what treatment is available to them.

“Seventy-five percent of patients overseas don’t have mastectomies, so get a second opinion if your doctor immediately suggests a mastectomy and doesn’t present any other options. You can have breast-conserving surgery in many cases, as well as reconstructions. You don’t have to be disfigured for life.”

Breast self-examination (BSE)
You should be examining your breasts once a month for lumps and other irregularities. If you are menstruating, then examine your breasts one week after your menstrual cycle. If you are not menstruating, choose one day every month for BSE.

First check your breasts in the mirror. They will probably be slightly different in shape and size, but not greatly so. If you see any of the following, contact your doctor:

	One breast looks hard and fixed.
	There is a large size discrepancy between your breasts.
	Puckering of the skin of the breast.
	One arm is more swollen than the other.
	Any obvious lumps or deformities.

Use your left hand to examine your right breast, and your right hand to examine your left breast. First check the nipple and areola for any of the following:

	Any skin changes.
	Retraction of a nipple.
	Spontaneous discharge – one that is there even when you are not squeezing your breast.

Now follow these three steps and examine your breasts and armpit area.

	While showering or bathing, check your breasts and underarm areas with your fingertips. Raise one arm and place your hand at the back of your head, then slowly move your fingertips over the breast and armpits in a circular pattern, feeling for any lumps or abnormalities.
	In front of a mirror, raise your arms above your head to check for changes in size, shape and contour of each breast. Check for any nipple discharge.
	Lie down with your arm tucked behind your head. With the other hand and your fingers flattened, feel the opposite breast.

Did you know?

	Breast cancer is now the number one killer of women in this country, having overtaken cervical cancer.
	Women have a one in nine lifetime risk of developing the disease.
	There has been a significant increase in the number of black women with breast cancer, and black women have the worst survival rate in relation to their Asian and Caucasian sisters.
	Breast cancer is being seen more frequently in women under 35.
	Most women only go for treatment when it’s much too late, instead of reporting the lump when it first appears, and is small and easily treated – Dr Benn says that between 60 and 80 percent of all the patients she sees at her clinics have advanced breast cancer.

For information about breast cancer or a referral to a breast specialist in your area, contact the Breast Health Foundation on (011) 480-4226.