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Tracing the Killer

Cancer is a most deceptive killer. The disease is subtle in making an appearance, it remains illusive throughout treatment and its recurrence is equally stealthy. Bahrain Cancer Society helps us treat the most common form of cancer in women.

Breast cancer happens to be the most frequently contracted form of cancer among women in the region. According to the cancer registry maintained by the Bahrain Cancer Society (BCS), Bahrain tops the GCC list in the incidence of breast cancer.

This is ironic, given that breast cancer is relatively easy to deal with compared with other forms of the disease, observes BCS president Dr Abdul Rahman Fakhro.

“Compared with, say, pancreatic cancer, which is nearly impossible to detect early, breast cancer is much easier to work with. As an organ outside the body, surveillance and surgery can be conducted much better on breasts,” he says.

Push for screening
The BCS was established in 1993 with the goal of helping patients and families cope with cancer and creating public awareness for the same.

In 2005, the society launched an ambitious early-detection campaign targeting each of the 52,000 women above the age of 40 in the Kingdom. The BCS, in collaboration with Batelco, sent out 52,000 invitations to women residing in each of the five governorates in the Kingdom, inviting them to come for breast cancer screening at the local health centres. Around 16,000 ladies responded to the campaign over the next five years.

“Many women were fearful of screening because they couldn’t face the “what if it’s positive?” scenario. They’d rather remain in denial. What they don’t understand is that the sooner they are detected, the easier it is to manage the condition,” says Dr Fakhro. 

The BCS roped in family physicians at government health centres to check with women patients about whether they had been screened and to convince them to undergo the tests. Experts from Salmaniya Medical Complex  were invited for further investigation. Around 50 per cent of the targeted 52,000 women have been screened now.

The nationwide screening programme, which is a first in the GCC region, yielded a detection of 150 fresh cases of breast cancer. Coupled with existing cases from the Ministry of Health, this takes the total number of breast cancer cases in Bahrain to 620.

Who is at risk?
Women who are above the age of 40, those who get married late and have babies at a later age are more likely to develop this condition than others. Above all, women who have a family history of cancer also fall within the high risk group.

Basically, there is a direct correlation between the female hormone oestrogen and the incidence of breast cancer. “Women who do not marry until their 30s and do not have a child until late 30s have had prolonged exposure to high levels of oestrogen in every monthly cycle for decades. These women are particularly at risk of developing this condition,” explains Dr Fakhro.

Lactating breasts have proven to be less prone to cancer. Hence, mothers who do not breast feed their children for at least a year have higher chances of developing the disease.

“Hormone replacement therapy (HRT) is also found to have a direct relationship with incidence of breast cancer. Women nearing menopause often resort to HRT in order to delay the onset of the ageing process. The practice is very common among women in Bahrain,”observes Dr Fakhro. However, with the delay in menopause comes the continued exposure to oestrogen, which can spell more trouble for women, compared with the risk of ageing.

Things you can do
Regular self-examination of the breasts is essential for all women over the age of 30.

At the first sign of lumps, irregularity and discharge, you should consult your family physician and opt for a clinical examination.

If the condition warrants further investigation, you could seek triple therapy, which refers to diagnostic mammography, followed by sonography and biopsy. Pre-menopausal women in their 40s could opt for routine screening mammograms.

However, there’s no such thing as a “clean bill” with cancer. Mammogram being an imperfect tool for cancer detection, there is at least a 10 per cent chance that screening will fail to detect the condition.
 
“We never cease to remind patients that mammography can be fallible. It can’t be a replacement for breast self-examination and clinical examinations,” says Dr Fakhro.

Watching your diet and regular exercise also can help prevent this disease as research shows that fatty breasts are more prone to cancer than glandular breasts.

Managing breast cancer
The extent of the disease is perhaps the most important determining factor for physicians. “If detected early, that is, before it starts invading the surrounding tissues in the breast, chances of a cure are very good,” says Dr Fakhro.

While the first stage is easy to manage, stage four, when the disease is “metastatic” or spreading beyond the breast to other organs, can be very difficult to handle.

Breast cancer is managed primarily through surgery, followed by other interventions, such as chemotherapy, radiotherapy, immunotherapy or even bone transplant therapy. 

Management of breast cancer in Bahrain is quite the same as in further developed countries. The oncology department run by the Ministry of Health is equipped with international standard equipment and specialists.

Contrary to popular perception, breast surgery is not disfiguring anymore. With the advent of advanced procedures, such as skin-sparing mastectomy and modified radical mastectomy, a substantial part of the breast skin is saved, which causes less scarring than traditional surgery and offers the best chances for breast reconstruction. In case of women who have a strong family history of breast cancer and are perceived to be “high risk”, doctors could opt for bilateral mastectomy, or removal of both breasts. This is a drastic pre-emptive procedure to prevent incidence among the high risk group. However, the skin is conserved and the breast can later be reconstructed with plastic surgery.

Help from BCS
Bahrain Cancer Society arranges for diagnostic services for cancer patients free of charge.

It also organises transportation for those who cannot make it for screening or treatment on their own. The society provides a telephone support and cancer information helpline staffed by nurses, counsellors and psychologists.
 
It also organises educational programmes, workshops, seminars to raise awareness and holds events for raising funds.
At present, the BCS is updating its database, gearing up for screening a fresh batch of women in the Kingdom who are turning 40 now. “We’re here to help everyone, Bahraini or non-Bahraini. We want to tell people that this disease can be dealt with. While there is no avoiding cancer, the only mode of prevention is through educational campaigns and awareness building,” he says.

For enquiries, call 17285194 or write to info@bahraincancer.com

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