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Banishing breast cancer myths

Malcolm Crockford. Photo: Chris Sant Fournier

Malcolm Crockford. Photo: Chris Sant Fournier

He’s counselled and treated hundreds of women who find their lives blighted by the C word and is known for his con­inuous efforts to shatter the misinformation that surround this illness. Consultant radiologist Malcolm Crockford tells Alison Bezzina about the facts behind the fears.

When it comes to breast cancer, Malcolm Crockford does not beat aro­und the bush. Known for his constant campaigning to raise awareness about the illness that is probably the most feared by women, the consultant radiologist believes one of the major problems in dealing with the situation is that breast cancer and its prevention are shrouded in misinformation.

As former director of radiology for the Maltese health service, founder/director of the Bedfordshire and Hertfordshire breast cancer screening service in the UK, and the man behind The Radiology Clinic in Ta’ Xbiex, he would certainly know.

Breast cancer is, indeed, one of Malta’s most prevalent in women. However, early detection can spell the difference – and this can only be achieved once the shroud of misinformation is eliminated, he explains.

“There are two main reasons for this situation. The first is inaccurate information being given out by unqualified health workers. However, there is also the reality that women conveniently misinterpret information to convince themselves that they are not at risk and need not have regular check- ups. When it comes to health issues, especially ones that can kill, such as breast cancer, information should be precise and clear,” Dr Crockford insists.

He can’t stress enough the importance of mammograms, describing them as the most useful tool in the screening for breast cancer.

“They are capable of detecting cancer signs at a very early stage – a stage where most cancers are totally curable. Also, we must not underestimate the beneficial psychological effects that a normal mammogram result has on a woman. Mammograms are also the most effective way to carry out follow-up testing, because unlike a human physicist, a mammogram machine records all the minute details, including all the changes that a doctor may not remember from one visit to the next.

“So while mammograms do not prevent or cure breast cancer, for a minimal amount of discomfort, they could save your life,” Dr Crockford insists, before going on to dispel some of the most common myths he encounters.

Myth 1: Breast pain is a symptom of breast cancer

That’s rarely the case; breast cancer, especially early breast cancer, usually does not cause pain and may exhibit no noticeable symptoms. Most aches, pains or tenderness can be attributed to things like fibrocystic breast changes and the rise and fall of hormones, or a benign fluid-filled sac (a cyst), which can feel firm or squishy and can be aspirated by a doctor to withdraw the fluid causing the pain.

Myth 2: You’re only at risk if breast cancer runs in your family

Only five to 10 per cent of all breast cancers are hereditary due to mutations in genes associated with the disease.

These mutations are more common among certain geographic or ethnic groups, like people of Ashkenazi (central or eastern European) Jewish descent and people of Norwegian, Icelandic or Dutch ancestry. Because they have a shared ancestry over many generations, particular genetic changes can occur more frequently in these groups.

Myth 3: Monthly self-exams don’t make a difference

Despite recent advice discounting the importance of regular breast checks, many experts still believe in them. Mammography, clinical exams, MRIs: these are all reliable screening methods, yet none of them is perfect, so it’s wise to increase your chance of early detection by becoming familiar with your own breasts and reporting any changes, like lumps, swelling, dimpling or discharge to your doctor.

Myth 4: Tight, underwire bras cause breast cancer

This myth started with a husband and wife medical anthropologist team claiming that by wearing tight-fitting bras all day, every day, women inhibited lymphatic drainage, thus causing toxins to become trapped in breast tissue. But scientists discounted this theory in its failure to exclude confounding variables such as the presence in some women of known risk factors for breast cancer.

Myth 5: Only women get breast cancer

Although women do account for the vast majority of breast cancers, men are susceptible, too. With men, their cancers are usually linked to a strong family history or genetic causes and are usually seen in later stages, since men are not typically screened for breast cancer.

Myth 6: Older women don’t need to get mammograms

Since the incidence of breast cancer increases with age, older women should get mammograms indefinitely. The highest incidence of the disease is in women in their 70s. The risk is approximately one in 23 for a woman in her 30s; rising to one in eight by the time she is 85.

Myth 7: Wearing antiperspirant causes breast cancer

No recognised study has yet found a definite relationship between antiperspirants and breast cancer.

Myth 8: A lump is the only sign of breast cancer

While a lump may indicate breast cancer or benign breast conditions, there are other changes to keep an eye out for, like skin irritation or dimpling; swelling, nipple retraction or discharge (other than breast milk); redness, scaliness or thickening of the nipple or breast skin. A mammogram can pick up a cancer before any symptom is felt or seen.

Myth 9: Only your mother’s family history of breast cancer is important

Your father’s family history is just as important, especially the women on his side of the family.

Myth 10: Women with lumpy, fibrocystic, dense breasts are more at risk

Once thought a factor in increasing your risk, it is no longer seen as a connection. Lumpy breasts do, however, make it more difficult to differentiate normal tissue from cancerous tissue, so ask your doctor if you might be helped further by adding an ultrasound to your mammogram screenings.

Myth 11: Ultrasound of the breasts can be used instead of a mammography

Ultrasound is not recognised as a screening tool as it is not sensitive to picking up micro-calcification, the most common sign of early breast cancer. In fact, ultrasound only picks up 11 out of 100 early breast cancers while digital mammography now picks up 85-95 of them.

Myth 12: Mammography hurts and its radiation causes breast cancer

A well-carried out mammography should never hurt but simply create a sense of pressure. The radiation dose is near to nil and only 0.7msieverts per examination (0.35msieverts for a two-view study) which is half the dose we receive from background cosmic radiation each year and which typically works out at 1.4msieverts. The sun produces radiation of two mammograms each year in our life, so the maths is clear.

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