Patients have to cope not only with physical, but also psychological changes, says Michelle-Marie Boffa of the Malta Medical Students’ Association.

Cancer – the word that sends shivers down the spines of many; a word many dread to hear for fear of what it may bring along with it; a word that goes far beyond a simple description of disease.

Breast cancer, like other forms of cancer, produces not only physical changes, but also poses a strong psychological impact on sufferers, especially when treatment requires mutilating surgery (mastectomy) and side effects from some other forms of treatment, such as chemotherapy that causes hair loss.

Breast cancer, the most widespread cancer in the Maltese islands, with 350 new cases every year, is a cancer that forms in the breast. The most common type is ductal carcinoma that involves the milk ducts of the breast. Another type is lobular cancer that begins in the milk glands (lobules). Invasive breast cancer has the potential to spread to other parts of the body.

Breast cancer produces a series of changes within the breast tissue. Claimed to be the most well-known sign, a lump in the breast tends to be one of the first detected in breast cancer, and is an important change that should be looked out for. However, it is important to emphasise that 90 per cent of breast lumps, the vast majority, are not cancerous. Cancerous lumps are made up of masses of cancerous cells within the breast tissue.

Breast cancer could bring about changes in the breast shape or size. Such changes may be caused by the masses themselves, or may include more specific changes, such as skin dimpling (due to the tightening of fibres running within the breast towards the skin) and a change in the nipple shape.

Changes in the nipple shape may include the transformation of a previously everted nipple into an inverted one, and distortion of the original nipple shape.

Unusual nipple discharge (sometimes blood-stained) may also be a sign of breast cancer, while skin changes in the breast may also occur and these may include redness (in a rare inflammatory form of breast cancer) and ulceration.

Lumps in the armpit may also be a sign of breast cancer as these represent enlarged lymph nodes that would have drained cancerous cells from the breast.

Lastly, breast pain is not usually a symptom of breast cancer. It is important to note that, contrary to what many believe, although more common in females, breast cancer may also develop in men, so they too should be on the lookout for any suspicious changes in the breast.

Though some of the above signs and symptoms are more tightly linked to breast cancer than others, medical advice should be sought if any of these appear. Although some of these changes may not be indicative of breast cancer, as is the case with the majority of breast lumps, professional attention should always be sought to be on the safe side.

When dealing with news of such grief, individuals may initially enter a stage of denial, followed by anger, then bargaining in hope of prolonging life expectancy, followed by depression and eventually acceptance

If, following investigation of any of the above changes, the diagnosis is cancer, it is natural for the patient to be overwhelmed by fear, shock, anxiety and uncertainty of what the future may have in store.

It is important to emphasise that despite being a serious disease, the vast majority of breast cancer cases, when detected early, can be treated successfully.

Nevertheless, when dealing with news of such grief, individuals may initially enter a stage of denial, followed by anger, then bargaining in hope of prolonging life expectancy, followed by depression and eventually acceptance.

However, even though it is only natural to go through this emotional rush, it is important to understand the exact type of breast cancer as this greatly determines the treatment type and outcome. Having said this, individuals coping with the news of breast cancer should seek psychological advice to help deal with the psychological aspect of the disease, while the physical part is being tackled.

The Breast Clinic at Mater Dei Hospital has evolved since the year 2000.

While emphasising the importance of effective surgical treatment, surgeons also strive to retain an acceptable aesthetic appearance of the affected breast.

Decreasing the mutilating impact of surgery is very important to preserve a good quality of life for the patient and her family.

The breast care team provides psychological support and also advice on the use of external prostheses and wigs,genetic testing and reconstructive surgery.

All the family is affected when a woman has breast cancer, and while they could help share the burden of the sufferer, they may find it too much for them as well, and they may also need to seek psychological help.

Several support groups are available for breast cancer sufferers and these too may help to ease the situation. A local example is www.europadonnamalta.org.mt. Reliable websites such as www.breastcancercare.org.uk and www.cancer.gov could also provide useful information.

In this way both the physical and psychological aspects of the disease – the two sides of breast cancer – should be managed simultaneously.

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