While breast cancer generally affects women over 40, around seven per cent of cases are diagnosed in younger women and two to three cases are diagnosed in Maltese men every year.

Awareness needs to be raised among all women; teenagers and older, to be breast aware and in tune with their bodies, a messaged stressed by well known media personality Nirvana Ciavola Azzopardi, who passed away this week at the age of 40 and Helen Muscat, co-founder of Action for Breast Cancer Foundation, who is fighting her battle against cancer.

“Trust your instinct”, is the advice Nirvana gave in a touching letter read out at her funeral service on Friday.

Despite not feeling very well, Mrs Muscat too continues to find strength in herself and give courage to others.

Early diagnosis allows for less invasive treatment and the survivors of breast cancer are many. Rowena Ciantar Enriquez, who leads the Europa Donna Malta young survivors group, is an example. She too is a mother of two young children and has fought the disease successfully.

Speaking to The Malta Independent on Sunday, Antoinette Attard, a breast care nurse and Europa Donna Malta spoke of the need for every woman to be conscious of how her breast feels. She advises that using the hands to feel the body rather than simply using a face cloth in the shower.

As for women who may feel things they cannot explain, Ms Attard suggests seeking advice from their GP or gynaecologist when taking a smear test, explaining what they’re feeling and asking whether this is normal.

She pointed out that while some risk factors of breast cancer have been identified (including having healthy diets and lifestyles, and a limited alcohol intake), the causes are not known.

Having children before the age of 30 and breastfeeding is thought to reduce one’s risk of getting breast cancer, but this does not mean that a woman who has had a child at 16 or 20, would not get breast cancer.

Asked about the need to seek a second opinion if one is not comfortable with the advice received, Ms Attard pointed out there is a fine line between one being fixated with something and feeling a lump or instinctively knowing something has been missed.

Mammograms are generally used to screen older women and, while not often used, ultrasounds can be used when one feels a lump.

Identifying a lump early makes a huge difference. Treatment is less invasive while one’s quality of life while undergoing treatment is better.

While emphasising that breast cancer in young women is not common, and that 90 per cent of lumps detected are non-cancerous, people must look out for discharge from the breast or a change in shape, which can be symptoms of breast cancer.

She highlighted that teenagers too should learn to be in tune with their bodies.

At an age when they are conscious of the changes taking place, it is important to start checking one’s breasts, making this something regular from a young age. This is not about checking for fear you may have something, it should simply become a routine.

Europa Donna Malta is often invited to deliver talks at schools and so do medical students on the subject.

The book ‘My Life, My Health’, which promotes healthy living, is also distributed by PSD teachers in schools.

Esther Sant, from Action for Breast Cancer Foundation explained the group continues to lobby for breast screening of first degree relatives of breast cancer patients (maternal side relatives including mother, sister or daughter).

For years, ABCF has also raised awareness on the need for the provision of an accredited breast unit in line with EU guidelines, which go into detail about the concept of a specialised breast unit, where all diagnosis, plans for surgery, and treatments would be discussed within a multidisciplinary team.

 “A breast unit at Mater Dei Hospital would help save lives; we ask the minister to act sooner rather than later,” said Helen Muscat, at a press conference in September last year.

While the building of the oncology centre at Mater Dei Hospital is at an advanced stage, it is still not clear whether this will include a breast unit.

“Patients treated at such a centre have higher chances of survival and better quality of life,” Mrs Sant said.

 

Risk factors of breast cancer

Breast cancer can strike at any age, and women of every age should be aware of their personal risk factors for breast cancer.

There are several factors that put a woman at high risk for developing breast cancer. These include a personal history of breast cancer or some non-cancerous breast diseases, a family history of breast cancer, particularly in a mother, daughter, or sister and history of radiation therapy to the chest before age 40.

Evidence of a specific genetic defect (BRCA1/BRCA2 mutation); women who carry defects on either of these genes are at greater risk of developing breast cancer.

Other risk factors include heavy alcohol use, obesity, high intake of red meat, dense breasts, and race. 

Some studies have suggested that recent use (during the past 10 years) of oral contraceptives (birth control pills) results in a very slight increased risk for developing breast cancer over those who have never taken them. Other studies, however, show no such effect. Researchers continue to study the conflicting results in these trials to determine if birth control pills and synthetic hormones (estrogen and progesterone/progestin) play a role in breast cancer.

However, hormone replacement therapy with estrogens and progestins has been linked to a higher risk of breast cancer development.

 

What is different about breast cancer in younger women?

Diagnosing breast cancer in younger women (under 40 years old) is more difficult, because their breast tissue is generally denser than the breast tissue in older women.

By the time a lump in a younger woman’s breast can be felt, the cancer may be advanced.

In addition, breast cancer in younger women may be aggressive and less likely to respond to treatment. Women who are diagnosed with breast cancer at a younger age are more likely to have a mutated (altered) BRCA1 or BRCA2 gene.

Delays in diagnosing breast cancer result in complications. Many younger women who have breast cancer ignore the warning signs – such as a breast lump or unusual nipple discharge – because they believe they are too young to get breast cancer.

Many women tend to assume a lump is a harmless cyst or other growth. Some health care providers also dismiss breast lumps in young women and adopt a ‘wait and see’ approach, which is not advisable.

A clinical breast examination can be done by a health professional if one is worried about something.

Breast implants do not change a woman's chance of getting breast cancer, so women with breast implants should also have regular clinical breast examinations.

 

Treating breast cancer in younger women

The course of treatment for breast cancer at any age is based on the extent of the person's disease (whether or not it has spread beyond the breast), as well as the woman's general health and personal circumstances.

Treatment options include surgery: either a lumpectomy, which involves removing the lump and some surrounding tissue, or a mastectomy, which is the removal of a breast.

Radiation therapy is generally used following a lumpectomy, and chemotherapy and/or hormone therapy are often recommended after surgery to help destroy any remaining cancer cells.

 

Walk to raise awareness today

Europa Donna Malta, in collaboration and with the support of OYSHO brand of female intimate wear, is organising the annual walk to commemorate Breast Health Day today. 

The walk starts from the piazza at The Point at 10am and finish in St George’s Square, Valletta at around 11.30am. Registrations for this walk open at 9.30am against a donation of €5.

“The average five year survival rate among European women, between 1995 and 1999 was 79.50 per cent which shows that awareness and early screening can save lives. In Malta, between October 2009 and July 2013, 46,000 women were invited for breast screening, of whom 27,000 accepted the invitation and 193 were found to have cancer. This means that 193 women and their families were saved from the trauma of finding the cancer at an advanced stage and that treatment will be less drastic with greater chances of survival,” explains Gertrude Abela, President of Europa Donna Malta.

“Lack of information and fear are still main factors that are fuelling the figures of cancer victims, especially breast cancer. From our contact with people, we find that fear plays a major role in whether women decide to go for cancer screening or not. Many still fail to understand that breast screening can detect cancer in the early stages when treatment is most effective and so is to be encouraged, not avoided,” added Ms Abela.

Europa Donna Malta’s message is clear – be breast aware!