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Cancer screening for women

A presentation by Dr. Luitgard Darko to the staff of The
British Embassy
1.0 What is cancer?

We want to talk about Cancer screening for women today.

We have all heard about cancer, but do we know what it is?

Cancer is the second most common cause of death in Europe and

America after cardiovascular disease and third most common
cause of death in Africa after infections and cardiovascular
disease.

Cancer is a condition where some body cells, the smallest

components that build up body tissues, get out of control and
start growing independently from the rest of the organism.
Cancer cells grow and multiply fast, forming lumps that put
pressure on their surroundings, destroying their surroundings and
growing into neighbouring organs thereby destroying healthy
tissue. Cancer cells do no longer perform the tasks that the
original cells of the organ used to perform (like producing milk in
the case of breast cancer).

Cancer cells can also affect the whole body by swarming into the
lymph and blood system like parasites. The blood or lymph
stream carries them to other organs, mostly the lungs, liver, brain
or bones where they can grow new lumps, which are called
metastasis, and destroy the surrounding tissues. This destruction
of vital tissues is the means through which the cancer that started
in a small spot in one organ can kill the whole body if it is not
stopped in time.

1.1 Most common cancers for women

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The most common cancer for women worldwide is the breast

cancer. It is also the most common cause of cancer deaths for
women worldwide. It is estimated that one women out of 9 in
Europe and America will develop breast cancer in her lifetime.

The second most common type of cancer for women in Ghana

is cancer of the cervix, which is the neck of the womb. In
Europe it is no more very common, thanks to the fact that the
majority of women go the cancer screening test called PAP
smear, that finds abnormal cells before they have reached the
cancerous state. Thus it has become possible to destroy those
cells by minor procedures before the actual cancer has
developed.

2.0 Breast cancer

Let us talk about breast cancer first. Breast cancer has best
chances to be healed if it is found in an early stage, that
means when the breast lump is still small (2 cm or less) and
has not developed any metastases.

Though screening tests are very helpful, most breast cancers

are found by the woman herself.

2.1 Risk factors

Who is at risk for breast Ca?

First and foremost it is women, though men also might get

breast Ca, but the risk for women is a 100 times higher than
for men.

What is the peak age for breast cancer?

In Europe and America it is around 55 years, but the risk

increases when the woman gets older. In Ghana,
unfortunately, the peak age for breast Ca is 35 to 45 years.
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Apart from these basic facts there are some circumstances

and conditions which increase the risk for a woman to develop
breast ca, which we call risk factors.

Some of them we cannot influence, others we can.

We know through large statistics, that those, who had their

first menses early and started having sexual relations at an
early age, have a higher risk, as well as those who have their
menopause later than the average, after the age of 55.

We also have markedly higher risk if a first degree female

relative, that is a mother, sister or daughter had breast ca.
This may be the hereditary type of breast ca. If your relative
has breast ca and you want to find out if is the hereditary
type, you can undergo a lab test for the breast ca gene and if
positive, opt for earlier and more frequent screening tests or
even subcutaneous removal of both breasts with subsequent
implants to prevent the ca from developing.

Those who had breast cancer before or where exposed to

radiation either by accident or as treatment for another cancer
have an increased risk as well.

There are other risk factors that we can influence:

- Obesity, which is excessive weight with a body mass index

above 27.

- Weight gain of 10 kg or more around menopause.

- Lack of exercise

- Alcohol intake of more than one drink a day

- High intake of red meat and fatty foods.

Large studies on thousands of nurses in England showed

clearly that these lifestyle issues increase the risk of a
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woman to develop breast ca as well as ca of the large

intestine and cardiovascular disease.

2.2 Signs and symptoms of breast ca.

The most common and earliest sign is a usually painless lump in

the breast. Breast ca only causes pain in advanced stages, when
it is very difficult to cure.

Painful conditions in the breast are usually harmless, but should

nevertheless be checked out.

Other important signs are:

• changes in the shape or size of the breast,

• dimpled skin that may look like the skin of an orange, called
peau d’orange,

• skin retraction,

• flattening or retraction of a nipple,

• rashes around the nipple that do not respond to treatment.

• Bloody or brownish/ greenish discharge from the nipple,

• Swelling and redness without pain or fever,

• Lumps in the armpit or above the clavicle.

2.3 Prevention and early detection of breast ca

How can we prevent breast ca?

By avoiding the risk factors as much as possible: keeping or

achieving a healthy body weight, regular exercise, healthy diet
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with low quantities of red meat and saturated fats, low or no

intake of alcohol.

Unfortunately, many women who have breast ca do not have any

obvious risk factors at all and others, who have the risk factors
never fall ill.

How can we detect it early?

Regular self examination, best monthly after the menses, regular

yearly examination by a trained health professional, yearly
mammography after the age of 40, earlier if you have a family
risk.

Why mammography? M. can see the smallest changes in the

breast structure that are not yet palpable.

3.0 Cervical Cancer

The second important cancer for women in Ghana is cervical

cancer or cancer of the neck of the womb.

What is cx ca? it is a malignant growth on the surface of the cx.

The cervix is the neck of the womb, that is the part of the womb
that is bulging into the top of the vagina. As it is a hidden part of
the body, changes there are not easily detected by the woman
herself.

3.1 Risk factors

Who is at risk?

Every woman who is or ever has been sexually active.

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There is no cervical cancer without an infection with Human

Papilloma Virus or HPV. There are different types of HPV, that can
cause different types of diseases, but those causing cervical
cancer are transmitted only through sexual intercourse. This
infection does not have any symptoms at all, unlike other STDs,
and over 90 % of women get into contact with it around the time
of their first sexual contact..

Additional risk factors that make it more likely to get cervical

cancer are the HIV infection and smoking.

The peak age for cervical cancer is above 55 years and the risk
increases with age.

3.2 Signs and symptoms of cervix ca

Unfortunately, this cancer makes only symptoms at a very late

stage, when cure is very difficult.

Signs:

• Irregular bleeding, especially bleeding in between menses

and after intercourse

• Restart of bleeding after menopause

• Bloody, foul smelling discharge

• Pain

3.3 Prevention and early detection of cervical ca

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The real preventive measure apart from never having

unprotected sex is the vaccination against the HPV virus. This
vaccine is on the Ghanaian market under the name Cervarix.

It is recommended to vaccinate all girls before the age of first

sexual contact, preferably between the ages of 10 and 15 years.
Older women may still be vaccinated up to the age of 30 years.
We do not have studies proving that it is of benefit for older
women yet.

Early detection:

Cervical ca undergoes a slow development of changes from

normal slightly abnormal to cancer cells. These changes of
cervical cells can be detectected by a simple test called PAP
smear. For this test a trained health person takes a swab from the
surface of the cervix, which is transferred either on a glass slide
or in to a special preserving liquid. Those cells can be stained with
special dyes and analysed under the microscope.

Thus very early changes can be detected and cured by minor

procedures such as cryotherapy, laser, LEEP or cone biopsy.

This is well established in Europe and America for many years and
for that reason the rate of cervical cancer has dropped
remarkably there in the last 50 years.

4.0 Cancer screening for women

What are our options?

To prevent or cure these cancers we should all lead a healthy life

style with low fat and low meat diet, we should exercise regularly
and achieve and maintain a healthy weight.

We should avoid smoking and moderate alcohol.

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And by all means we should vaccinate our daughters and

ourselves and practice and advocate safer sex.

We should learn the self examination of our breasts and practice

it every month after the menses. We should report any perceived
changes in the breast as soon as possible to a skilled health
provider.

We should go for yearly cancer screening with examination of the

breast and PAP smear from the age of 30 or even 20, if we had
our menarche at 12 or earlier and started our sexual life before
the age of 16.

We should go for a yearly mammogram from the age of 40 or

earlier, if our mother, sister or daughter had breast cancer.

And we should tell other women and our men about the need to
do all these things.