Not My Breast! Why Me?

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This is a question that I have been asked in the past when discussing the outcome of breast investigation with patients.
The breast in females is not just seen as an organ meant for feeding an infant, for some women it represents femininity,  it is seen as part of their beauty and such evokes different emotions when the mention of possible breast cancer comes up during a consultation.
Breast cancer is common in women all over the world and I would like to discuss how breast cancer might present, symptoms that should prompt early review by a physician and appropriate referral to a specialist breast clinic for further investigations. I will be using a case review today to help us address some of the issues encountered in everyday practice. It should be noted however that breast cancer is higher in older women above 50, however, it can present in women younger than 35 and men as well, yes Men are not exempt!
Case 1
Mrs. Adefunke K, 51yr old married woman with no children
-Previously fit and well woman, not on any regular medications
-does not smoke or drink
-works as a bank manager and lead a very busy life
-She noticed changes in her right nipple almost 2 years ago but did not think anything of it
-One year later, she noticed swelling to the right side of her neck, which was painless
-2 months before coming to see me, she started getting exhausted easily
-Noticed that she was not sweating as much on her right side and her right arm felt a bit weak well
-She also noticed right thigh pain for few weeks prior to seeing me
-She only presented to me as she was planning on going on holiday and wanted to check why she was always exhausted- which she had put down to stress at work
After taking her history, examination, and investigations, It was found that she had right breast cancer that had spread to most of her bones and she was very shocked initially as she never suspected breast cancer because she did not notice any lump in her breast, just nipple retraction
The symptoms that should be suspicious and warrant review
  1. Breast lump
  2. Nipple changes- inversion or retraction
  3. Blood stained discharge from the nipple
  4. Changes to the breast skin, rashes, swelling or dimpling of the breast
  5. Breast pain in the absence of trauma
What are the risk factors for breast cancer? This includes the following
  1. Previous history of breast cancer
  2. Female sex
  3. Age- common in those older than 50
  4. Previous history of ovarian or endometrial cancer
  5. Family history of breast cancer
  6. Obesity
  7. Use of alcohol
So what should you do if you are worried about your breast?
  1. Know what your breast looks like and see your family physician if there are any changes as mentioned above
  2. I am not sure if there is a breast screening program in Nigeria,  there are breast screening programs in most western countries, attend one if you fall within the age group
  3. Speak to your physician if you have a strong family history of breast cancer and find out what test are available in your local area.