Today we attended the 4th Annual Women’s Health Symposium at Clemenceau Medical Center (CMC), organized in partnership with Johns Hopkins Medicine International. Although the symposium was targeted mostly towards doctors and medical professionals, we benefitted greatly from the community lecture “Breast Cancer Update: What Every Interested Person Should Know” by Dr. Nagi Khouri.
The presentation started with a focus on the growing numbers of breast cancer cases around the world. Now although it may appear that there’s many more cases in Lebanon than other parts of the world, that’s in large part due to the smaller population ratio.
.. the percentage of breast cancer, even though by incidence is a lot lower, it appears to be that we actually see by percentages and by numbers a larger number of young women because there is so many more [by population]. It’s not that the risk is increasing.. That’s very important to understand.
The highest number of cases recorded were in North America, Western Europe and Australia. Numbers are however increasing in Africa, Asia and the Middle East. In 2010, 1.5 million cases were recorded worldwide – almost double what it was in 1990. It’s important to note though that the curve of survival has also changed in the past 20 years due to drastic improvements in treatment.
Turning then towards the risk factors leading to breast cancer, Dr. Khouri explained that:
One of the most important questions for any women is: Am I at risk for developing breast cancer? And who is at risk? Many women say “I’m not getting a mammogram.. We don’t have any predisposing factor”.. 75% of women who develop breast cancer [in fact] share two risk factors: Being a woman and increasing age – usually after the age of 40.. So basically, every woman is at risk for developing breast cancer.. When there’s a family history, it’s an added risk.
It’s recommended that all women as of the age of 40 do an annual mammography (and not every other year as other practices may advocate). Dr. Khouri stressed this point several times during the presentation. 60% (if not more, which is the goal) of breast cancers should be picked up without anyone actually feeling anything in the breast.
The density of breasts actually plays a major role in the detection process. Fat in the breast is actually “a blessing” that renders the breast transparent in the mammogram and revealing any abnormality more clearly than in denser tissues. Women with implants will need to take twice as many pictures and it’s also dependent on where the implant is placed with regards to the breast muscle (ie. in front or behind the muscle).
Mammography is not perfect and its sensitivity will differ by case but it’s the best thing we have so far.
How do we know that mammographies save lives? Remember, mammography is only for detection. If a woman detects breast cancer but doesn’t get treated, then we haven’t really achieved anything..
In the Arab world 80% of women diagnosed with breast cancer are not at the curable stages (stage 3 and 4) which was the case in the Western world 30 years ago. Why such a large discrepancy in the developing world? It’s due to a lack of awareness, education and early detection – and getting the full treatment of course.
Dr. Khouri also brought up a significant point regarding the importance of self-check exams for every woman:
A lot of the cancers are picked up by women in the shower.. I encourage women to be familiar with their breasts and start that education very early on, in their school [for example], so that a woman is not embarrassed to examine herself. I don’t like to say examine – I prefer to say “be familiar”. Get to know your breasts the same way you know about your nose.. It encourages a woman to be responsible and think about her breast health, including doing a clinical examination of the breast periodically.
If you spot a lump in your breast and you get it checked, never leave without knowing why. You need to get an explanation from your physician. Another cautionary point Dr. Khouri brought forward was that all biopsies should be done only with a needle and not through surgery. It actually harms the woman’s cancer treatment if the biopsy is done by surgery.
No surgical biopsies.. No – ZERO! All women should know that.
Patients-focussed breast care is key and should be accessible, timely, sophisticated, coordinated and comprehensive. Don’t be afraid to ask your doctor questions to better understand your condition. That’s where the right kind of awareness and education can also play a significant role in giving the patient options for their treatment.
Those were just a few of the many key points covered in Dr. Khouri’s presentation. All in all, the presentation was very informative but our only regret was that there weren’t enough women in the audience who could have benefitted from this wealth of knowledge. Hopefully the next symposium will attract even more public attention and further spread awareness from a medical perspective.