From Colin Michie, Nicole Shaw of American University of the Caribbean School of Medicine, St Martin; Dingle Spence, Brittany Bromfield of the Hope Institute, University of the West Indies, Jamaica; Elizabeth dos Santos, Medical Oncology, British Virgin Islands.
Dr. Colin Michie has worked as a paediatrician in the United Kingdom, Africa, the Caribbean and the Middle East. He is specialised in nutrition, haematology and infectious diseases. Now the Associate Academic Dean for American University of the Caribbean Medical School in St. Maarten, his enthusiasm is training medical students and healthcare teams to ensure they deliver better value health care.
Many St. Martiners are walking and fundraising this month to increase awareness and support for families suffering from cancers, in particular, breast cancer. These events are essential for each of us. They slow us down and remind us how valuable life is. Cancers are universal; they disrupt and destroy.
My family was stalked by the monster of breast cancer, through generations in the highlands and glens of Scotland, then the plains of Africa. Some of our AUC students, young adults, are survivors of breast cancer and are studying to take this disease on once they qualify.
A great advance in medicine in the Caribbean over the last generation has been informing communities to ensure we all go to the doctor earlier. This means more check-ups, earlier treatment and more successful outcomes. Removing the fears of early presentation – a treasured part of the pink walks – will ensure better detection of breast cancer.
While my ancestors passed in their early adulthood, this is no longer the case here now. A sign of the success of our species is the advances made in science and medicine and understanding in families. On a global scale, we are getting better with cancer treatments. This finding was published earlier this year following a study run in 71 countries and territories.
What is breast cancer?
Breast tissues are amazing. They are designed to produce milk for an infant after a pregnancy. During lactation, lobules of breast tissue secrete large volumes of fluid, nutrients and immune factors that move into ducts. This ensures a suckling infant can attain optimal growth and tailored protection from its mother. When the infant stops feeding regularly, these tissues return to a resting state. Several hormones drive the cycling of these activities.
Rogue cells form in our bodies regularly, but more frequently in some tissues than others. They are usually removed by the immune system. Breast cancers are more common in the lobular tissues of the upper outer quadrant of the breast, near the armpit. No studies link breast size to cancer risk. If a collection of cells grows, it is important to find and check them early.
Finding breast lumps is difficult, though. It is usually less challenging in male breast cancers, which are rarer. If you think your breast has a lump, or has changed shape or feels different in any way, it is worth having a check. In younger women, this is particularly important. Once you are over 40 years old (and less than 70), a mammogram is the best way to check the breast.
Mammograms are X-rays. They can find a suspicious breast mass as long as a patient or a doctor can feel it. A number of breast masses are harmless too. These can form a lump, but do not invade or spread around the body. An example of a common benign breast lump is an adenoma. These can usually be picked up as benign on a mammogram.
What makes breast cancer more likely?
Why do breast cells become malignant? The most common reason is age; cancer is more common as we get older. Family history too – that is, genetics – strongly influences breast cancer. Breast cancer is seen more frequently in those with obesity, those on hormone replacement treatment, those exposed to radiation, those who drink alcohol and do not undertake much physical activity. This is why good health becomes really important: we need to reduce inflammation and support our immune systems as best we can. Substances such as tobacco and alcohol can increase the chances of developing many different types of cancer.
Why is early detection important?
Biopsies identify breast cancer cells. Breast cancers are classified according to the molecules on their cells. The molecules let a physician know with some accuracy how the disease will behave. Newer early treatments are now tailored to these molecules. Strategies to combat breast cancer vary depending on the age of the patient, her genes, whether she is post-menopausal, and if it has spread. Surgery, drugs and radiotherapy can all be employed in combination to allow specialists to coordinate an attack on malignant cells. Treatments can slow down multiplying cells, encouraging the immune system to work more effectively.
What should I do?
You are in charge of your health. Think regularly about your body and avoid cancer risk factors. As a society, we should talk about this problem more. Cancer is a big challenge and all of us face regular temptations with food and alcohol; avoiding healthy diets and exercise is easy! However, a healthy immune system is critical to preventing breast cancers.
Young women are of particular concern in the Caribbean and the United States. They are often presented with more aggressive forms of breast cancers that are larger and therefore less responsive to treatments
Breast cancer: A Jamaican perspective
Breast cancer is the most common cancer in Jamaican women and the leading cause of cancer death. The average age of women diagnosed with breast cancer in Jamaica is 52, which is eight years younger than the global average of 60 years. One out of every 21 women in Jamaica will be diagnosed with this deadly disease in her lifetime. The Jamaica Cancer Society (JCS) recommends regular mammograms, which can detect the presence of lumps and other breast abnormalities up to two years earlier than a person would be able to see or feel them.
Jamaican women shun getting their regular mammograms for several reasons: Fear of the actual test; fear of the result of the test; worry that they will be diagnosed with breast cancer, when they are not financially prepared to deal with it. Lack of education is problematic as many do not know what the test is, why it is necessary, or where they can go and get it done.
These women end up with very late-stage cancer, which could have been prevented. Jamaican women are central to the running of households, playing roles that no one can substitute, making the diagnosis of this disease all the more devastating.
Many Jamaicans turn to other remedies, such as dietary supplements, vitamins, minerals or herbs to treat this ailment. Dissatisfaction with conventional treatment, family traditions or “word of mouth” all contribute to this growing phenomenon. While alternative medical treatments may have benefits, they must only be taken as part of your treatment options after discussions with your medical doctor.
Talk about cancer to family, friends, those at work or those at the hairdresser’s. Reducing fear is a vital part of fighting cancer. St. Martin has good facilities for examination and mammography. Our Positive Foundation on St. Maarten has been very valuable in supporting women with questions about breast cancer in particular. You know your body best. If you are worried, see a doctor for a check-up.
Woman Work
Sun, rain, curving sky
Mountain, oceans, leaf and stone
Star shine, moon glow
You're all that I can call my own.
--Maya Angelou
Useful resources: The Positive Foundation, St. Martin
https://cbcfevents.org/
https://seer.cancer.gov/report_to_nation/
https://www.cancer.gov/about-cancer/coping/feelings/stress-fact-sheet
