There are experiences in life which simply brush by us like a soft breeze; others which, like a rainy day, mark us to a certain extent but which still allow us to cope with our daily life. But then there are those life events which, like a hurricane, shake our foundations to the core leaving us groping for some steady ground to stand upon hoping to find at least part, if not all, of ourselves again.

Breast cancer is one such experience for any woman. It is the most common carcinoma of the female sex, the incidence rates having increased by more than half in the last 25 years. It is also the most common cause of death in women between the ages of 35 and 55. Worldwide, more than a million women are diagnosed with breast cancer every year. Locally, more than 200 women pass through this frightening experience every year, while almost a hundred others pass away usually after years of excruciating suffering and heartache. For those who survive it is usually a tale of shattered dreams and body images, disrupted family lives and careers and of agonising physical and psychological pain. But it is usually also a story of great dignity and pride, of deep love and of strength to survive against all odds. In fact 80% of women diagnosed with breast cancer survive the disease every year.

There are many factors that can increase one’s risk of developing breast cancer but having any one or several of them does not mean that one is booked to get it. There are different kinds of risk factors. Some factors, like a person's age, sex or race, can't be changed; simply being a woman increases the risk of developing breast cancer due to the higher density of breast glands and their higher exposure to female sex hormones especially in women with more menstrual cycles and who take long term exogenous hormones. The older one is, one's race, the genetic make-up and a positive family history also puts you at a greater risk. Others are linked to cancer-causing factors in the environment. Still others are related to personal behaviours, such as smoking, drinking, diet and absence of breast-feeding. Some factors influence risk more than others, and one’s risk for breast cancer can change over time, due to factors such as aging or lifestyle.

The human female breast is made of several milk forming glands segregated into lobes by fibrous tissue. Each gland ends in a ductule which collectively form a series of ducts channelling the milk formed to the nipples. The breast has a rich blood and lymphatic drainage system.

Ninety per cent of breast cancer arises from the cells lining of the ducts, the rest in the glandular tissue. An aberrant genetic mutation will, at a certain point in time, give rise to rapidly dividing cells which literally hijack the normal cytoarchitecture of a specific location of the breast usually the upper outer quadrant. In no time there will be no option for the targeted mammary gland but to raise the white flag and surrender.

Breast cancer causes varying degrees of damage at the site of origin. However its most destructive properties lie in the way it spreads to all regions of the body mainly through the lymphatic and the circulatory system. The most common sites of metastatic spread are usually the liver, bone and the central nervous system. A distinctive feature of this disease is the formation of micrometastasis, microscopic niches of cancerous cells which can lie dormant for years in different locations of the body, only to come inadvertantly to life sometimes even after ten years of remission from the disease.

The most common presentation of the disease is an irregular rock hard lump usually tethered to surrounding structures namely the skin and underlying chest muscles; the invasion to the overlying skin usually leads to skin dimpling or peau d’orange which, if in the nipple area can cause the nipple to invert. Enlarged lymph nodes will usually be palpable in the axillary area at the time of diagnosis. Breast cancer can also manifest itself with an abnormal discharge from the nipple or through a sign from an invaded organ usually bone pain, an abnormal fracture or an aberrant neurological sign.

Surgery is the primary form of treatment with a partial or radical mastectomy depending on the degree of local spread and spread to adjacent axillary lymph nodes. Radiotherapy is often used after surgery to destroy any remnant cancer cells but may occasionally be used before, or instead of, surgery. If part of the breast has been removed, radiotherapy is usually given to the remaining breast tissue, to reduce the risk of the cancer coming back in that area. Radiotherapy to the chest wall may be given if there is a risk that any cancer cells have been left behind. Chemotherapy is resorted to if the initial investigations indicate that the tumour has already spread to distant organs. Any one or all of these treatment rationales are used depending on the type of tumour, its stage at diagnoses and the woman’s medical history. A prosthesis is sometimes inserted and breast reconstruction carried out to minimize the psychological trauma.

Listing down the properties of the tumour, its mode of presentation and the treatment options after 12 years in the medical field is as easy as citing the two times table, and as cold and clinical as an operating table. Attempting to put down in words what goes through an afflicted woman’s head and heart getting to know about the diagnosis of the disease and actually going through all the treatment rationale is like asking a two year old to re-write Chaucer’s Cantebury Tales.

What words can ever manage to convey the anguish of knowing that there is a death sentence hanging around your neck when you are still in your mid-thirties or forties and your youngest child is still in early school; the pain of acknowledging that half your body will be invaded and mutilated by the surgeon’s knife no matter how dedicated and professional the hand holding that knife might be; the despair on becoming aware that the skin on your breast will no longer be soft and silky but hard and leathery following the assault of radiotherapy rays; the agony in realising that another crowning glory of your womanhood would start falling off in tufts by the end of your second shot of chemotherapy. The answer is none.

The importance of awareness, education and screening cannot be stressed enough. All women above the age of 35 should start examining their breasts regularly, both to get to know its texture and to look out for any abnormality. A more thorough manual breast examination should be carried out at least yearly by the woman’s doctor.

There is a lot of controversy around the frequency and age group for breast screening and the validity and cost-effectivenss of having a national organised screening programme. Some argue that organised screening results in earlier diagnosis and treatment of the disease and thus in lower mortality rates. Others, however, believe that a national breast screening programme would result in over-diagnosis and over-treatment with a disproportionate amount of unnecessary radical mastectomies for early breast cancer.

Lance Armstrong had something to say after his ordeal with cancer: “When you think about it, what other choice is there but to hope? We have two options, medically and emotionally: give up, or Fight Like Hell”. There are currently two NGOs supporting breast cancer patients in this ordeal, the Breast Care Support Group which focuses on practical information and support and the Action for Breast Cancer Foundation, a pressure group which lobbies for national breast screening and free chemotherapy besides offering educational support and training. If our national wish for these women is for them to hope and why not survive breast cancer, let us not let them fight alone, let us support them to fight like hell not in it.