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  • Ogun sensitises students on breast, cervical cancers

    The Chairman of Governing Council of Moshood Abiola Polytechnic, Abeokuta, Mr. Alaba Lawson, has urged female students of the institution to find out their status about breast and cervical cancers respectively.

    Mrs Lawson said raising the awareness of the two deadly cancers was an effort to consolidate on the campaign to checking cancer pandemic among young girls and mothers, adding that the institution has acquired some equipment for testing patients on cancer.,

    She spoke at the campus of the institution during a cancer campaign awareness jointly organised by the wife of Ogun State Governor, Olufunsho Amosun and the Medical Women Association of Nigeria (MWAN).

    The campaign was led by Mrs Amosun and Iyalode Alaba Lawson.

    Addressing the participants, Mrs Amosun gave cheery news that the state government would henceforth pick medical bills of cancer patients in the state.

    Mrs Amosun also said the Senator Ibikunle Amosun -led administration has pledged to pick up the medical bills of Ogun women undergoing surgery for breast and cervical cancers.

    Amosun’s wife was concerned that cases of ýbreast and cervical cancers appeared to be on the increase, saying experts have agreed that the two are leading deadly forms of cancer.

    “Understanding how cancer spreads is of importance to humankind because if we are fortunate enough at this very moment not to be affected by the disease, we would know somebody that is affected or we could, at least, share the information because as we say, early detection is the only prevention.

    “In the past, it has broken my heart that whený we do this screening exercise and awareness walks and talks, we do come across some sisters, daughters and women in general that do have cancer and each time I walk away without taking action.

    “I go back home and I say to myself, now that I’ve told this woman that she has cancer, what am I doing to help her further? That is why this year, we are taking the campaign a step further and His Excellency, Governor Ibikunle Amosun, has agreed to pay the medical bills of women who underwent surgery on cancer,” Mrs Amosun said.

  • Ogun sensitises students to breast, cervical cancers

    The Chairman of Governing Council of Moshood Abiola Polytechnic, Abeokuta, Mr. Alaba Lawson, has urged female students of the institution to find out their status about breast and cervical cancers respectively.

    Mrs Lawson said raising the awareness of the two deadly cancers was an effort to consolidate on the campaign to checking cancer pandemic among young girls and mothers, adding that the institution has acquired some equipment for testing patients on cancer.,

    She spoke at the campus of the institution during a cancer campaign awareness jointly organised by the wife of Ogun State Governor, Olufunsho Amosun and the Medical Women Association of Nigeria (MWAN).

    * The campaign was led by Mrs Amosun and Iyalode Alaba Lawson.

    Addressing the participants, Mrs Amosun gave cheery news that the state government would henceforth pick medical bills of cancer patients in the state.

    Mrs Amosun also said the Senator Ibikunle Amosun -led administration has pledged to pick up the medical bills of Ogun women undergoing surgery for breast and cervical cancers.

    Amosun’s wife was concerned that cases of ýbreast and cervical cancers appeared to be on the increase, saying experts have agreed that the two are leading deadly forms of cancer.

    “Understanding how cancer spreads is of importance to humankind because if we are fortunate enough at this very moment not to be affected by the disease, we would know somebody that is affected or we could, at least, share the information because as we say, early detection is the only prevention.

    “In the past, it has broken my heart that whený we do this screening exercise and awareness walks and talks, we do come across some sisters, daughters and women in general that do have cancer and each time I walk away without taking action.

    “I go back home and I say to myself, now that I’ve told this woman that she has cancer, what am I doing to help her further? That is why this year, we are taking the campaign a step further and His Excellency, Governor Ibikunle Amosun, has agreed to pay the medical bills of women who underwent surgery on cancer,” Mrs Amosun said.

     

  • ‘Prostate, breast cancers are preventable, treatable’

    ‘Prostate, breast cancers are preventable, treatable’

    Are you a man and over 40? If yes, you must go for  prostate cancer screening now. Also, women, from their teen are expected to engage in self-breast examination monthly and do mammogram once a year,  to detect cancer early.

    A consultant pathologist and lecturer at the Department of Pathology and Forensic Medicine, Lagos State University College of Medicine (LASUCOM), Dr. Soyemi Sunday gave the advice at the Public Lecture/Annual Dinner by Ivory League of Progress, a social club based in Lagos.

    Soyemi said prostate cancer, or carcinoma of the prostate, is the development of cancer in the prostate, a gland in the male reproductive system. It is the number one killer of black men.

    “Most prostate cancers are slow growing; however, some grow relatively quickly. The cancer cells may spread from the prostate to other parts of the body, particularly the bones and lymph nodes. It may initially cause no symptoms, but in later stages it can lead to difficulty urinating, blood in the urine, or pain in the pelvis, back or when urinating. An ailment, benign prostatic hyperplasia, may produce similar symptoms.

    Other late symptoms may include tiredness due to low level of red blood cells,” he said.

    He listed factors that increase the risk of prostate cancer to include older age, a family history of the disease, and race.

    Soyemi said: “About 99 percent of cases occur in those over the age of 50. Having a first-degree relative with the disease increases the risk between two to third fold. But if detected early, it can be treated. Then people can live with and die with it not die from it.”

    Soyemi suggested that screening should start as ageing sets in.

    “From age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age). After this discussion, those men who want to be screened should be tested with the prostate-specific antigen blood test. Digital rectal exam may also be done as a part of screening. If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.Assuming no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the prostate-specific antigen blood test.”

    He continued: “Men who choose to be tested who have a prostate-specific antigen of less than 2.5 ng/mL may only need to be retested every two years. Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher. Because prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.’

    For women, Soyemi said think pink, live green should be the mantra, “Think pink, Live green is a way of living that aims to help women reduce their risk of breast cancer or the disease coming back in survivors. It’s also a way for women living with advanced disease to make the healthiest choices possible. Good healthy lifestyle including exercise is recommended.”

    Soyemi explained that the term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast. Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor.”

    He advised that though studies have found that women have a 12 percent lifetime risk of developing breast cancer, “your individual risk may be higher or lower than that. Individual risk is affected by many different factors, such as family history, reproductive history, lifestyle, environment, and others. Self breast examination or mammogram screening is good way to be very sure in early detection.”

    The reasons? He explained, “Initially, breast cancer may not cause any symptoms. A lump may be too small for you to feel or to cause any unusual changes you can notice on your own. Often, an abnormal area turns up on a screening mammogram (X-ray of the breast), which leads to further testing. In some cases, however, the first sign of breast cancer is a new lump or mass in the breast that you or your doctor can feel. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But sometimes cancers can be tender, soft, and rounded. So it’s important to have anything unusual checked by your doctor.”

    He said any of the following unusual changes in the breast can be a symptom of breast cancer; swelling of all or part of the breast, skin irritation or dimpling, breast pain, nipple pain or the nipple turning inward, redness, scaliness, or thickening of the nipple or breast skin, a nipple discharge other than breast milk or a lump in the underarm area.

    “These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. It’s important to get any breast changes checked out promptly by a doctor,’ he said.

  • Breast cancer: Clinical anatomy and breast self-examination

    Breast cancer: Clinical anatomy and breast self-examination

    Breast Examination

    From the brief review of the basic Anatomy of the female breast, some important elements of physical examination can be easily followed. Recall that blood supply to the breast is more marked in the upper (Superior) portions, superomedial and superolateral.

    Every woman therefore has a thermogenic(heat generating) pattern in her breast, that is different from any other woman, with the probable exception of monozygotic twins. This is one of the principles on which PET (Position Emission Tomography) is based, but this vascular arrangement can be appreciated through the sensory modality of temperature (warmness, or hotness) and colour (Redness). In breast cancer or any other cancer, tumor cells express angiogenic factor, which produces neovascularization (new blood vessels) to feed the newly formed cells. This process is particularly rapid in pregnancy associated breast cancer and breast cancer occurring in males.

    The dense connective tissue ligaments are also very prominent in the upper portions of the breast; perhaps as contributory factors to the higher frequency in the upper portions of the breast and reflecting high levels of transcription and protein turnover.

    The critical elements of breast examination will therefore include

    1)            Appearance of the breast in sitting and lying positions

    2)            Percentage of breast cancer in the upper (Superior) quadrants

    It is most common in the left upper outer quadrant and least in the lower inner quadrant.

    3)            Appearance of the Nipple  Areola complex

    4)            Symmetry of one breast with the opposite one.

    5)            Findings on inspection (looking) palpation (feeling) and gentle squeezing of the nipple.

    6)            Location of findings on an imaginary clock face.

     

    Breast Self Examination (BSE)

    Though much anxiety and unnecessary biopsies can follow breast self examination, it remains the best option for majority of women in developing countries as the safest and cheapest way of prevention, early detection and participatory management of breast cancer. Beyond that breast cancer is discovered by the patients themselves in 90% of cases. The idea really, is for any young female from puberty  onwards to become familiar with her breast as she grows and develops into adulthood and through menstrual cycles, the inevitable perimenopausal period, menopause and the post menopausal periods to become young old, old and the old woman until death.

    There are various methods, but all  of them have the same underlying principles

    1)            In General, breast examination is best performed 5 to 7 days after menses when breast engorgement and tenderness is at it’s  minimum

    2)            Palpation is best performed with the patient supine (lying down face up looking at the ceiling).

    3)            Palpation (feeling with the fullness of the palm side of hand) of the Axillary lymph nodes is best done in the sitting position.

    4)            For very large breasts, the patient has to pay particular attention to areas of her breast within easy grasp and the axillary lymph nodes.

    5)            Breast self examination is never complete and can never be a substitute for more detailed history and physical examination by the Doctor who will in addition carry out general examination of relevant parts of the body in a systematic and comprehensive manner.

    Four positions are usually recommended

    Standing with arms by the sides or above head, or pressing down sitting; the hips Lying (Supine) with arms by the sides. Lying with pillows under upper back and arm to bring the nipple and lateral(outer) quadrants into prominence, repeat for the other breast.

    In clinical practice, the breast  the patient thinks does not have any problems is examined first.

    Examination is best performed with good lighting, before a mirror and in an un hurried manner. As a matter of convenience, best results are obtained with soap or moisturizing cream on the breasts. Imagine a clock face and divide the breast into four quadrants (portion across the Nipple  areola complex.

    In all the positions begin by inspecting (looking) at the breasts first before palpation (feeling). Look for obvious swellings, examine the contours of the breast, of the nipple levels, areola, pigmentation ulceration, dimples.

    Note the appearance  Orange peel?, – Nipple discharge?

    Raise both upper lubes above your head and see if any portion or whole of breast fails to life up wards.

    Bend slightly forward and normal breasts will more away from the chest wall as you do so. With both hands on the Hips and fingers on the thigh, attempt to arch the upper shoulders. This  will make any breast hemp stand out.

    Palpation is done with the pads of the fingers, quadrant by quadrant from the 12.Oclock position clockwise or anticlockwise, first by gently running the finger pads vertically upward and down wards and or in circular motions from the nipple out wards moderate and failing firm pressure can then be applied as you progress.

    Gently roll the breast tissues against the chest wall if any lump is found, gently roll it between the index finger and thumb, Right breast is best examined with your left hand and left breast with your right hand and left breast with your right hand. The armpit, area around the collar bone and the neck (front and sides of) should be felt for seed like swellings; taking note whether or not they are single, mobile, matted together or fixed.

    If any lumps are felt, note the number, size, location, shape and quickly visit the nearest health center, you should never attempt self medication.

     

    How often should breast examination be performed?

    For those at risk in terms of age, social and family history and those older than 30 and have not carried pregnancy to term, monthly breast examination is recommended 5  7 days after menses. Infact any young female from puberty  onwards should become familiar with her breast.

    Women who are post menopausal should pick dates in the year that they can easily remember ,to examine their breasts

     

    Mammography

    This refers to the study of the breast by the use of x-rays , an equipment which  utilizes low dose of radiation( about 1 mGy) glandular tissue per study.

    Only 25 out of every 100 women picked by the machine as positive (have non palpable legions) will actually be found to satisfy the  conditions  for  malignancy at biopsy.

    Conversely, as many as 15 out of every 100 women will have and feel breast lumps and yet the mammography machine will fail to detect the disease.

    However, irrespective of synchrony, or whether the lesion is  uni or bilateral. when a woman older than 30 years has a breast lump, good history, physical examination, and mammography should be done before biopsy; depending on available resources. With regards to mammography, your family physician will guide you on laboratory investigations if you have solid painful breast lesions

    The board of scientific counselors of the National Cancer Institute  suggests that women below 50 years discuss the indications for screening with their primary health care provider.

  • Breast cancer: Clinical anatomy and breast self-examination

    Breast cancer: Clinical anatomy and breast self-examination

    Causes of  breast cancer in women

    Though, a constellation of factors operate to cause the disease, it is relevant to note that the normal growth of breast tissue depends on certain hormones such as Thyroxin, Prolactin, Estrogen (ducts) Progesterone (glands), Growth hormones, HCG (Human Chorionic Gonadotropin) and HPL (Human placental lactogen)  amongst others.

    There are clinical and demographic overlaps, but in general, a woman’s risk of developing Breast Cancer has been linked, to a number of factors which include in order of clinical surgical importance.

    1. Female gender: It occurs mostly in women 99.9% as opposed to men 0.1%
    2. Age: It is the 2nd most important risk factor. Breast Cancer is rare before 20, but can occur in any age group. It is common in women between 30 60 years olds. More than 50% of Breast Cancer occur in women 65 years and older. PABC (Pregnancy associated Breast Cancer) appears to occur  most commonly in younger age groups.
    3. Family History: Striking family history of Breast Cancer is characterized by the presence of multiple first degree relatives

    – Mothers

    – Grand mothers

    – Aunts

    – First cousins with pre menopausal Breast Cancer

    – Bilateral disease

    – Family history of Ovarian Cancer

    1. Presence of Precursor lesions on Prior biopsy:

    90%of breast lumps are not breast cancer, but all breast lumps are presumed to be cancer until otherwise proven

    1. Women with fertility problems: These are often diagnosed with high doses of ovarian stimulating hormones
    2. Those achieving first Pregnancy and child birth beyond age 30 years and above.
    3. Genetic factors:

    Breast Cancer 1 (BRCA) gene and in males Breast Cancer 2 (BRCA1), RAP 80 and newer genes have been implicated. Population studies have demonstrated two (2) base pair deletions at position 185 and a single base pair insertion at position 5382 of BRCA2. For BRCA1, single base pair deletions at 6174 have been documented. These constitute most of the mutant alleles in AshKenazi Jews.

    Experts believe that in some cases,mutation in the genes controlling proliferation and apoptosis (programmed cell death) are responsible for Cancer. Mutations in the BRCA at 17 q 21 and BRCA2 13 q 12 Oncogenes have given support to the argument that cancer is a genetic disease, Estrogen and to a lesser extent Progesterone acting via the agency of heredity to promote neoplasia  in concert with other trigger factors.

    The P53 tumor suppressor gene(a transcription factor) operates by loss of function when activated, and is inherited in a recessive pattern, where as the oncogenes which are associated with dominant pattern of inheritance operate by gain of function when activated(proliferation)  ;others are bcl-gene associated with apoptosis and the metastasis gene for which the nm23 is a candidate gene. They are believed to operate in concert with growth factors in controlling activities of thyrosine kinase at the presynthetic(G1/S) and premitotic(G2/M) phases of the cell cycle

    1. Breastfeeding: Those who chose not to breast feed or whose husbands refuse to separate sexual breasts from reproductive breasts, are on their own at risk. Breast Cancer  having been observed to be relatively uncommon in primate and sub primate mammals, research indicates that breast feeding for about 36 months, throughout a woman’s reproductive life, offers some degree of protection against breast cancer. E3 (estriol) as opposed to E2 (estradiol) is protective,from the period of first term pregnancy and parturition throughout life. Women with gonadal dysgenesis (born without normal organs of sex/reproduction)may also enjoy protection which perhaps further implicates the ovarian factor in the concert of major events leading to breast cancer in women, as explained further hereunder,

    * The ovary do not secrete estrogen in experimental hyper prolactinemia.

    * Prolactin appears to affect granulosa cell function in vitro(in the living), by inhibiting synthesis of progesterone. It also alters the normal Testosterone: Dihydrotestosterone ratio.  In this way, it decreases aromatizable substrate(amount of cholesterol /derivatives available in adipose and other tissues convertible to estrogen) and increases local concentration of anti estrogen.

    In non breast feeding women, there is a mean delay before the first ovulation of about 45 days.

    * The development of estrogen receptor at puberty is largely prolatin dependent(good and     bad sides of baby fat).

    * The nexus of paracrine interaction between the gonadotrophs and lactotrophs estrogen, ultimately impact on the breast.

    1. Blood group, Nutrition and breast cancer( Blood group A, AB,)

    Recent and ongoing research aimed at characterization of diseases has demonstrated increasing frequency of Breast Cancer among individuals in blood group A, and AB, though no blood group is totally immune

    1. Previous breast lumps
    2. Early menarche and late menopause : these leave the system awash with hormones

    Android obesity significantly and Gynoid obesity less so, lower the threshold for early menarche ,similarly, high levels of post menopausal Estrone (E) produced by aromatization, can lead to neoplastic changes

    1. HIV/AIDS and Breast Cancer

    Viral peptides have been found in tissue biopsies, from patients with early breast cancer. Studies have shown that retroviruses including HIV are capable of acting as cellular gene transcription factors. Even the presence of viral particles of HIV in the vicinity of Human T-lymphocytes have been known to produce transformed lymphocytes which apart from becoming the targets for Natural Killer CD 8 lymphocytes also become oncogenes. Some retroviruses (ART) encode MAP (membrane associated proteins). It is interesting to note that young T- lymphocytes are more prone to HIV induced transformation.

    On the other hand weakened and reduced T  lymphocyte population can hardly mount formidable viral attack. How ever, Breast Cancer is not listed by the CDC as one of the recognised  opportunistic infections (OIS) disease conditions

    1. Patients on HRT (Hormone Replacement therapy).

    The biochemical commonality between the female gonadal steroids and environmental carcinogens is the benzene ring. These agents which are being abused by women with fertility issues undergoing treatment from Herbalists can induce cancer any where in the body, either directly or through the intermediates  produced when they are metabolized,

    . Others

    Uncontrolled exposure to X-rays, use of breast firming creams, Alcohol recycled vegetable oil, Tobacco, flavouring and colouring agents in fast foods are all potential carcinogens depending on genetic constitution of the individual.

    Some symptoms and signs?

    Symptoms and signs of breast cancer may be concealed, masked or obvious . They  can also  be generalized or specific, depending on the stage of the tumor, location and extent of spread. Pain, yellow eyes, malaise, lethargy, thirst and weight loss are some of the non specific or generalized symptoms.

    Grave signs that should require serious action include

    1)            Painless breast lump

    2)            Breast oedema

    3)            Skin ulceration (not dimples) seen to be coming from a solid breast lump

    4)            Fixation of tumor to the chest wall muscles and even beyond

    5)            Presence of matted axillary lumph nodes or even a single axillary (Armpit) lymph node more than 2.5cm (larger than the breadth of an adult finger)

    6)            Arm oedema (pitting or non pitting) swelling of the Arm of the side where breast has a problem.

    7)            Sudden appearance of a painful hard lump in pregnancy is serious, more so if  unilateral (in one side).

    The most important single fact about the clinical features of breast cancer is that it is not like tooth ache or wound in the tongue; it can be silent at the onset and at any other time like partially extinguished fire only to come out stronger and deadlier.

  • Breast cancer: Clinical anatomy and breast self-examination

    Breast cancer: Clinical anatomy and breast self-examination

    Surface markings (outline) of the breast on the chest wall.

    The female breast is perhaps the largest cluster of glands located in the  skin, where anatomical and physiologic changes  that occur secondary to hormonal regulation can be seen and felt.

    The breast is enclosed between two sheets of body tissue (superficial and deep layers); the superficial fascia that lie on a deeper one which adheres to and covers the chest wall muscles.

    Remarkable variations occur, but the base (bottom) of the normal breast extends from the second rib up, and then down to the 6th rib below. From the middle of the sternum(breast bone), it extends to the mid point of the clavicle( collar bone) and side wards (laterally) to the middle of the axilla (arm pit). Usually, part of the normal breast tissue reaches out towards the region of the armpit by a tongue- like extension which unlike  the rest of the breast reaches down to the tissue covering the chest muscles (pectoralis major); this is the axillary tail of Spence

    Where as in a normal breast, the lower portion shows clear demarcation from the rest of the chest wall, (infra mammary fold), else where, edges of the breast proper, blend smoothly with neighboring chest tissues. Tissue from one breast may cross the middle (breast bone) in front, and can also extend downward below the intra mammary fold . this explains why cancer can spread from one breast to the other and hence it is good to know the contours and outline of your own breast.

    The nipple (papilla mammaria)

    This projects from the areola, a darkened circular portion located at the summit of the breast. It is usually cylindrical or comical in a normal breast; it can also be invented or flat especially in the young.

    Contours of the two breasts are not always entirely symmetric(mirror image), but sudden or gradual appearance of new edges may indicate abnormal changes from inside the breast tissue.

    Sudden or recent inversion or flattening of the nipple is abnormal and calls for urgent medical attention.

    The fully formed breast consists of glandular epithelium embedded in fibrous connective tissue In a normal breast, it is located at the center of the grape-like lobes of the breast, surrounded by the fibrous connective tissues with fat tissue being outer most. The lactiferous (milk) ducts branch extensively in the connective tissues fame work.

    Considerable variations exist in the composition, consistency (feel), and size of the fibroglandular mass of the breast. This is responsible for the sometimes obvious differences between the corpus mamma (body of the breast) not only during the life spine of every woman, but also between women of the same age and even between the two breasts of an individual

    Each milk diet (Lactiferous duct) dilates as it passes under the areola to form a Lactiferous Sinus).

    The ducts are mainly estrogen(present in males and females but usually more in females) dependent but the glands are progesterone dependent.

    A mammary lobule is defined as a cluster of the ductules together with the duct that it drains.

    Most malignant new growth of the breast are carcinomas and they arise from neoplastic changes in the living cells of the milk ducts or their large extra lobular branches especially in cases of  ductal carcinomata.

    Connective Tissue Frame Work(scaffolding) of the breast.

    This extends from the skin to the deep fascia of pectoralis major (chest wall muscle). It is a combination of fat and dense fibrous tissue which makes up the corpus mammae (body of the breast)

    When placed between radiographic plates, x-rays will pass though fat and we say that portion shows translucency whereas the fibrous tissues, lobules and the ducts, don’t allow passage and show as opaque spots. The contrast is what is applied in mammography (x-ray study of the breast)

    The superficial fascia(skin cushion) in which the body of the breast is embedded(padded) has a limiting membrane at the base of the breast called retromammary fascia and is separated from the fascia over the chest ( pectoral fascia) by the retromammary space. This accounts for the free mobility of the breast; a very useful anatomical arrangement for breast examination

    In front (anteriorly) extensions of the fibrous tissue pass though the outer covering of the corpus mammer to attach to the overlying skin. These are known as suspensory ligaments. Claws of cancer can follow there strands as they sometimes contain glandular tissue. For women who are still menstruating (cycling), the breast feel lumpy. This is due to variations in size of ligaments and island of fat lobules present, even within the fibrous glandular masses leading to irregular surfaces

    Nerve supply:

    Arrangement of nerves in the breast determine how the pain of cancer is located and felt

    Cutaneous(skin) branches to the anterior and lateral (front and sides) arise from the upper six intercostals, principally 4th, 5th & 6th.Sensory fibers are particularly abundant on nipple for pain, pleasure and sucking  reflex path ways

    Blood supply

    The  pattern of vessels including blood vessels also determine the  routes or channels through which cancer spreads to bone, brain and other vital organs of the body. It also helps Clinicians  decide on treatment and pattern of surgery

    The lower and bottom areas of the breast are usually free from the blood vessels, particularly the arteries.

    Cancer cells can spread through blood in blood vessels (haematogenous spread) running mostly in the superficial fascia( under the skin); the principal arteries  are;

    1. internal thoracic via enlarged anterior perforating branches (first 4 mainly) but 2nd and 3rd are particularly prominent, which supply the breast as medial mammary artery.
    2. Axillary artery via its 2nd and lateral thoracic branches, which approach the breast from the axilla(armpit)
    3. posterior intercostals artery via its lateral cutaneous branches. It is important to note that the  lower portion of the breast has a blood less window, through which surgical interventions can be safely carried out for cosmetic (plastics surgery), investigative (biopsies) and limited therapeutic (lumpectomies).
    4. Venous system

    Drainage is from the Venous plexus underneath the areola, thence to the axillary vein in the armpit and also down wards to the internal mammary vein behind, to the internal mammary vein behind the breast bone.There are extensive venous channels involving Para vertebral plexus through which cancer can reach the vertebral column and the brain.  Though not common, complete paralysis of both lower limbs( from waist down) can occur in advanced(eg stage 4) stages of breast cancer.

    Lymphatic drainage

    Primary route for the spread of cancer is through lymphatic vessels.

    They begin deep down from networks in the lobes and ducts through the corpus mammae (body of the breast)  and spread to the following areas:

    1. The Armpit (axilla) where they can be felt
    2. Behind breast bone so they cannot be felt (palpated), but through here they can ferry cancer cells to the lungs and cause difficulty in breathing
    3. Nipple Areola complex
    4. Area under the areola skin
    5. End portions of the milk ducts
    6. The Axillary lymph nodes receive fluid from all quadrants
    7. The medial quadrants drain to the region around the breast bone (para sternal) and sternal (breast bone) region piercing the Pectoralis Major muscle.
    8. More than 75% of total lymphatic drainage of the breast tissue is to the axillary (armpit) group of lymph nodes
    9. The nodes are also interconnected

    In clinical practice, the breast is divided into 4 quadrants (portions). Lymph channels from the part of the breast underneath the nipple and the adjacent colored portion(  sub areola plexus) spread across the midline to join those from the opposite breast. It can also flow upwards above the clavicle (collar bone), and also down ward over the costal margin (lower border of the rib cage) to the abdomen. In this way cancer of the breast can spread upwards and down below to reach the abdomen and the contained organs e.g. Liver.

  • Breast cancer: Clinical anatomy and breast self-examination

    Breast cancer: Clinical anatomy and breast self-examination

    The deaths in very recent past of prominent Nigerians, Professor K.D.K Koki, Dr. D. Fiberesima , Yinka Craig, Chief Gani Fawehimi and a host of others unreported, will have severed as a wake up call to experts and primary health care practitioners about the urgent need to look at cancer in Nigeria as a public health problem and no longer a diseases of the White race.

    No known curable drug for cancer has been discovered, and in resources limited countries like Nigeria, studies have shown that of all the several approaches towards healthcare, the most beneficial with regards to costs and benefits  is in the province of preventive health care.

    Surveys across the globe have shown that 7 to 10% of all cancer related deaths are attributable to factors  that  can be curtailed . These include

    –              Reproductive / sexual behaviors

    –              Diet and life style

    –              Environmental pollution

    –              Geographical features

    –              Genetic factors

    What follows hereunder contains materials suitable for the medical, academic, allied medical and other categories of people interested in or involved with the subject matter. The lay public can benefit  greatly by taking out what they can and then  seek clarifications where necessary.

    Amongst women, questions are being raised with regards to the changing patterns of cancer;  is cancer changing from the cervix to the breast? What trends are we seeing with respect to our environment and carcinogens. Do we now have a place for the old but rejected and disregarded BSE (Breast Self Examination)? How effective is Breast Self Examination in primary level care particularly amongst uneducated rural women compared to women in high socio-economic class in whom breast cancer is most common?

    In any case, the issues are worth considering;

    Cancer is Greek World for Crab, which arose, because of the need by Ancient Anatomist to define  a new growth, (neoplasia) that had gone beyond the confines of it’s tissues and developed the structures with which it can spread to distant sites,(usually un encapsulated). That scientific enquiry by Anatomist gave birth to the word cancer as it is known today.

    The smallest morphologically identifiable and functional unit of an organism is the cell. Cancer is said to have occurred when a group of cells arising from the same origin become selectively and abnormally favored in such a away that  the normal regulatory mechanism for  cellular growth, is lost, with the result that the cells  expand and invade neighboring tissues, neurovascular channels and then spread to distant sites.

    Breast cancer is now being referred to as the ultimate cancer in women, because the organ undergoes morphological (structural) changes throughout the life of a woman. According to SEER (Surveillance Epidemiology and End Results), the probability of a woman developing breast cancer increases throughout life  from birth to death.

    World wide 43,000 women out of reported cases die each year and on the average, 1000,000 women develop breast cancer each year. Studies in the US show an age adjusted rate of 27 per 100,000 deaths and Globally it has been estimated that 1 out of every 11 women will develop breast cancer in their life time.

    In Nigeria, breast cancer afflicts an estimated 12,000 women annually. About 5% of cases of pregnancy associated breast cancer have been seen and in most studies mortality is as high as 80  90% adding to the burden of care associated with perinatal and maternal morbidity.

     

    The Problem

    The form (morphology) function (physiology) and diseases (Pathology) of the human female breast are major concerns of  not only physicians, but families and  societies.

    The organ(breast) is located in an exposed part of the body, but sexual health is  taught sparingly in most Nigerian Schools, Cultural and religious barriers  forbid detailed conversations of the nature expected of that private part of the human body. In deed and in some parts of the Country and the world, only female medical practitioners are permitted to carry out detailed medical examination on women. More over, because signature symptoms and signs of breast cancer are subtle, emerge later or even absent from the onset, some affected women die without ever knowing what killed them. Breast cancer patients of the Nigerian African descent at the time of presentation, are on the average 10 to 15 years younger ,compared with women in the Western countries and it is in the younger age group that pregnancy associated breast cancer(PABC) though uncommon present with very challenging obstetric and gynecological situations.

    The whip lash of the economy cuts deepest into the underserved who live in abject poverty, have no access to radio and television and are too far away from primary health care facilities. How do we mainstream these vulnerable and under reported group? The answer is not far to fetch; we create awareness and encourage participatory health care delivery system, in the spirit of self realization because health education and health promotional activities yield better and sustainable results when you start from the known to the unknown.

    To ascertain health status of  the breast, detect and diagnose early abnormalities and treat or be treated. It is of paramount importance that, every woman(age not a serious barrier), first responders, paramedics, general practitioners, family Physicians and other specialists at various levels of the system understand the anatomy of both the glandular and connective tissue components of the breast, and of the inter relationship between these components..

    Research findings suggest that if there is increased awareness and improvement in the capacity of women to understand themselves and members of their families, to enable them cultivate risk avoidance  behavior and seek medical attention early enough, further substantial reduction in breast cancer and other cancer related death is achievable.  Awareness may not translate to knowledge all the time, but according to Ancient Chinese Public health practitioners,

    “When I hear about something I forget it”

    “When I see something,  I remember it,”

    “When  I do something,  I know it.”

    Indeed, physical examination of the breast by self, Sister, Aunt, Mom, is in fact a demonstration of its Anatomy, in a living subject. The same concepts apply as when a physician does breast examination in the consulting room.

     

    Clinical Anatomy

    The breast; nor Mamma is a modified skin appendage of appocrine sweat gland specialized for milk production. It is the major anatomic structure, by virtue of which modern humans as  Homosapiens are placed in the class Mammalia.

    Prepubertal male breast is nearly always the same as the female, and just like females males can develop cancer of the breast and die even faster from it’s complications. In the growing human, distinct anatomical differences develop soon after under the influence of gonadal (Ovarian) hormones. Indeed, the male breast can be made to enlarge and even produce breast milk, if the appropriate hormonal regulatory factors are supplied in controlled amounts.

     

    Embryology

    Development  of the breast begins by about the 4th week of intra uterine life, through the 8th  to the 12thweek . This falls within and a little  beyond the period of human embryogenesis .it is during  this period that  agents  which are capable of disrupting or aborting the  normal process or program of development are best avoided. By puberty, the human hypothalamohypophyseal gonadal axis becomes more active and releases it’s hold on Ovarian activities, leading to the growth and development of the female breast.

    At the appropriate time, pregnancy pumps estrogen and progesterone into the female circulation  reinforced by placental uterine , thyroid and adrenal hormones, all leading to enlargement of the glandular and connective tissue elements of the breast, changes which in most cases are only slightly but significantly reversible with cessation of lactation.

  • Breast cancer

    Breast cancer is a kind of tumor that threatens a woman’s life. But in order to understand the full meaning of the term cancer, we must explore the uses of the word tumor.

    A tumor is an abnormal enlargement of some part of the body. It is a mass of tissue composed of unusual cells that have multiplied more than they should; that are not part of the body’s normal design, and that serve no useful purpose.

    The breast is the most common site of cancer in women. It is very common for some women to find swellings in the breast which could start as a small lump in one breast usually without pains initially, but later the swellings could progress with enlargements, unbearable pains and pepperish sensations.

    Breast cancer is devastating in nature because it tends to spread early in the course of the disease, to distant parts of the body. When the cancer is detected early, before colonies of cancer cells have migrated to other parts of the body, the natural intervention is quite successful. The use of chemicals (chemotherapy) has not proven helpful in the primary treatment of cancer of the breast proper; thus necessitating surgical removal of the breast and possibly some of the tissues in the chest wall and the armpit, in the conventional medical practice.

    In some cases, there could be resurgence of the cancer in the second breast, in which case, the patient may need to undergo another surgical operation like the first one, to get the other breast removed. There could be attacks on some internal organs like the heart, lung, kidneys, bones, etc., and very commonly, the patients suffer severe lower back pains, general weakness, giddiness, pepperish sensations and swellings (oedema) all over the body. In extreme cases, the affected breasts may develop gangrenous open sores, which discharge fluids and pus with offensive odours.

    Prevention and Control: Women are becoming aware of the possible tragic outcome of a “lump in the breast”. By reporting this finding at once to her physician, a woman can receive the benefits of early treatment. Not all lumps in the breast are cancerous. So, it is necessary to differentiate between a benign tumor (which is relatively harmless) and a malignant one (which is deadly).

    In an older woman, past the menopause, any discharge from the nipple, especially if bloody in nature, is a serious omen and should be reported promptly. It may be the first indication of a beginning cancer.

    The holistic natural remedy being suggested for Breast Cancer is a combination of natural extracts of herbs such as Ekebergia senegalensis.

    Lycopersicum esculentum, Olax subscorpioidea and Vernonia amygdalina.

    For further information and consultation on Holistic Lifecare research and services, especially on Blood Infections, Infertility, Sexually Transmitted Diseases, Chronic Debilitating Conditions as well as mental and social problems, please call  on: 0803-330-3897 or visit: Mosebolatan Holistic Lifecare Centre, Adeyalo Layout, Ogbere-Tioya, Off Olorunsogo Express Bridge, Ibadan. Website: www.holisticlifecare.com. Distance is no barrier, we can send remedies by courier if need be.

     

  • A walk against breast cancer in Coal City

    A walk against breast cancer in Coal City

    Medical practitioners, Nollywood stars, other celebrities as well as students have mounted a campaign against the scourge of breast cancer in Enugu. Part of the campaign involved walking through the Coal City.

    It was to create renewed awareness on breast cancer, an initiative of the MTN Foundation (MTNF), the corporate social investment vehicle of MTN Nigeria.

    The MTNF Breast Cancer Awareness Campaign took place in Enugu amidst fanfare to commemorate the annual global awareness on the scourge. It is held every October.

    The Executive Secretary, MTNF, Ms. Nonny Ugboma, who was represented by Manager, Health Portfolio, MTNF, Mr. Victor Orie-Ononogbu, said that breast cancer is the number one cancer scourge afflicting people, and one in eight women is at risk of having breast cancer in their lifetime.

    ‘’This initiative, which underscores the essence of the Foundation to positively impact the lives of Nigerians, will be providing free breast cancer screening at MTN Mammography centers located at the, General Hospital, Marina, Lagos State; Federal Medical Centre, Lokoja, Kogi State; Federal Medical Centre, Nguru, Yobe State; Usmanu Dan Fodiyo University Teaching Hospital, Sokoto State; University of Nigeria Teaching Hospital, Enugu State and Specialist Teaching

    Hospital, Irrua, Edo State,’’ he said.

    As part of the awareness walk, students, medical practitioners and Nollywood celebrities like Cynthia Okereke, Chidinma and Chidiebere Aneke (the Aneke Twins), Stan Amandi,  participated in a road-show which kicked off from the old site of the University of Nigeria

    Teaching Hospital, Enugu and terminated at Nnamdi Azikiwe Stadium. The walk will be replicated in beneficiary states which include Edo, Sokoto, Yola and Kogi, included sensitizing the public about breast cancer with medical practitioners and specialists on ground to

    enlighten people and encourage women to get screened at designated points.

    During the event, Dr. Georgie Affam, Founder Breast Care Foundation, said breast cancer kills one in every 25 Nigerian women and urged women, to get screened every year to prevent untimely death.

    “The incidence of breast cancer is one in 25, but because we don’t screen our population, it’s actually a death sentence. Here in Nigeria, most of the diagnoses are made when it is too late, thereby leading to several needless and painful deaths of our beloved mothers, sisters, aunts, friends and colleagues,” said Affam.

    She further demonstrated how breast self-examination is done to check for lumps, thickenings and nipple discharge.

    Medical practitioners were also available to perform clinical breast examination and offer free advisory services.

    The Nollywood celebrities present lauded the initiative whilst challenging other corporate bodies to do more in the fight against breast cancer.

    This comes as MTN Foundation is said to be currently executing various projects in 341 locations across the 36 states of Nigeria, including the FCT. MTN representatives further disclosed that the Foundation has spent over N10.5 billion on social projects in the areas of health, education and economic empowerment.

    Recently, the Foundation deployed state-of-the-art Mobile Clinics stocked with medical equipment and drugs to states across the six geopolitical zones. These mobile clinics have helped to reduce the incidence of maternal and child deaths, especially in rural communities.

  • Foundation battles breast cancer in Kwara

    Foundation battles breast cancer in Kwara

    Worried by the incessant cases of cervical and breast cancers and their debilitating effects on women, th wife of Kwara State Governor, Mrs. Omolewa Ahmed, has led members of the LEAH Foundation, a non- governmental organisation (NGO), to campaign against the ailments. Members of the foundation took to the streets and some communities in the state to sensitise women on the harmful effects of the diseases.

    The campaigns, during which leaflets were distributed, began at the foundation’s GRA office in Ilorin, the state capital. They visited the Ero-Omo Primary Health Centre and the Egbejila Primary Health Centre, both in Ilorin West and Ilorin South local government areas.

    Mrs. Ahmed, the founder of the NGO, advocated periodic breast and cervical screening for early detection and treatment of the diseases.

    She urged women to use the facilities which the foundation had provided to ensure that they are free from the ailments, adding that breast and cervical cancers do not respect any one, irrespective of her class or status. She noted that all sexually active women are susceptible to the diseases.

    Mrs. Ahmed allayed any fear of financial constraints in accessing the facility, saying the centres in their respective areas would charge a token of N200 which, she said is the fee for speculum, an apparatus with which the screening is conducted. She added that the speculum could only be used on one person.

    She said: “I advise women to make maximum use of the opportunity. We are just starting. We hope to have screening centres in all nook and cranny of the state.

    “I encourage all our women that have been screened to go out there and talk to others about the 16 centres we have already established. With concerted effort, we can reduce, if not bring to an end, the scourge in our midst.

    “I received the vision about this programme after I had a personal experience. The response of our people to the foundation has been very encouraging. In February, we began the massive sensitisation of our people about the danger of these two diseases.

    “I am optimistic that if we educate our people they will comply. Ever since the sensitisation programme started, the response has been overwhelming. That time, we went to about nine local government areas across the state. After our sensitisation campaign at Baruten Local Government Area, the following day, women from that area came for either breast or cervical cancer examination.”

    Mrs. Ahmed said her advocacy drive was borne out of the alarming rate at which breast and cervical cancers affect women, a situation she attributed to lack of adequate awareness and lack of periodic screening.

    The NGO has opened 13 more centres. They are General Hospital Lafiagi, Cottage Hospital Tsaragi, General Hospital Share, Comprehensive Health Centre Shao, Cottage Hospital, Ajikobi, Maternity Dispensary, Oke ogun, Comprehensive Health Centre Ekan meje, Cottage Hospital, Iloffa, Primary Health Centre, Babanla, Basic Health Centre, Oke Oyi, Comprehensive Health Centre, Okelele, Okesuna Ward Clinic, Okesuna and General Hospital Okuta.

    The impressive turn out of women in all the communities where the screening centres had been inaugurated encouraged Mrs. Ahmed to include 10 additional centres to the initial 15. This brings to 25 the number of cancer screening centres which are spread across the state.

    In each of the communities visited for the inauguration of the centres, the mobile clinic team of the foundation was on hand to give free drugs, perform eye tests, check blood pressure and on-the-spot treatments of minor diseases while complex cases were referred to general hospitals for proper handling.