We speak to breast cancer specialist about the need for screening
Time Out Bahrain staff
As Breast Cancer Awareness month rolls around again, we spoke to Dr Iris Brune Erber, surgeon and breast cancer specialist about the need for screening and the hot topic of BRCA gene testing.
Gene testing hit the international headlines in a major way earlier this year after actress Angelina Jolie announced she’d undergone a double mastectomy and breast reconstruction after testing positive for the BRCA1 gene mutation.
But though, in theory, the publicity was a good thing, according to Dr Iris, the results have not been all positive.
She explained: ‘One of the effects was that women mistakenly thought “I will have this test and surgery and then I’ll be completely protected from breast cancer and I’ll also have great breasts like Angelina Jolie”.’ In fact that’s not how it works at all. Obviously breast surgery is not going to make women look like the superstar but it is also not a complete protection from the disease and, if you are BRCA positive, you very definitely need to maintain screening throughout your life.
Basically our bodies are producing new cells, including cancer cells, every day. The cancer cells are broken down by a combination of proteins encoded by our genes and the problem with the BRCA1 and 2 mutations is that they affect the production of these proteins and thus the body’s own ability to fight certain types of cancer cells.
This, in turn, goes along with an increased risk of breast and ovarian cancer.
‘In a “normal” person, the risk of developing breast cancer is around 12 percent, for those with the BRCA1 gene mutation this rises to 65-80 percent! The figures are not quite so alarming for BRCA2, but there is still a significantly increased risk,’ said Dr Iris.
Who should be tested? According to the USA’s National Comprehensive Cancer Network, which formulates international guidelines, generally those who have a first degree relationship to a breast cancer sufferer – that is mother, sister, daughter – are the ones who should be tested.
In Bahrain you will need to request the test yourself through a GP and your sample will be sent away for analysis with results usually taking around six weeks. Charges vary but, due to the technology involved, testing can cost several hundred to thousands of dollars.
Testing can take one of two forms. If the cancer sufferer is still living and able to provide a blood sample, this will be tested for the specific gene mutation and, once this is confirmed, the patient will be tested for this mutation.
However if a person is in a high-risk category and their cancer-suffering relative is unavailable or unable to provide a sample, then the test can be run for the whole spectrum of mutations.
Once a person has tested positive they may then make the decision to opt for surgery, a mastectomy to remove the breasts and reconstruction, or they may look at a management programme.
Dr Iris said: ‘If a patient chooses surgery, they need to be very aware that it is not possible to remove every single piece of breast tissue. Protection is between 50 and 80 percent, so they still need to undergo regular screening with imaging, not just mammogram but also ultrasound or MRI and, for women in Bahrain, they need to be proactive about pushing for this follow-up as, though work is ongoing, it is not yet there as a national call-in programme.’
She added that for those who test BRCA positive there is also an impact if they choose not to have surgery as screening needs to be undertaken earlier and more frequently with very early use of MRI imaging. ‘For those who are BRCA positive and not having surgery, they should be self examining monthly with a six-monthly check by a physician with imaging - this would usually be done yearly with imaging dependent on age.’
Early detection This brings us to the subject of routine screening. In the UK women have access to routine screening with regular mammograms from the age of 50 but Dr Iris says women should be screening yearly once they hit 40 and, again in Bahrain, this is something for which women must take responsibility alongside regular self examination (visit www.thinkpinkbahrain.com for a detailed description of how to go about this).
She explained: “For T1N0 masses (which means type/stage 1 with no lymph node involvement), the survival rate is 95 per cent following a small surgery to remove the mass and five weeks of radiotherapy.
“In the Gulf this is only 20 per cent of patients but in Germany and most Scandinavian countries it is 70 per cent due to a very successful national screening programme!”
In Bahrain, thanks to a joint initiative by Bahrain Cancer Society and the Ministry of Health, there are various places to access free screening.
Dr Iris is particularly confident of the facilities at Salmaniya Medical Complex, the King Hamad Hospital and the Bahrain Defence Force Hospital.
She added: “Also be aware that screening is about early detection, the idea is to look for masses before they would become evident on self examination.
If a woman has already found a lump then it’s a case for diagnostics which should be done through a biopsy before any further action is considered.”
And as Think Pink Bahrain founder Jules has previously emphasised, not every lump is cancer but every lump should be checked.
Well Woman Well Woman health screening is a part of a preventative medicine programme and is designed to detect the early signs of health problems. It will usually include: pap smear, laboratory tests and a Mammogram. American Mission Hospital Well Woman Clinic (17 248 142).
Breast Clinic The Breast clinic is open to facilitate the diagnostic phase of women with possible breast disease. We offer screening, consultation, treatment and referrals as necessary. Dr Sanjay Gupta – Surgeon and Breast Clinic. Call (17 253 447 ext 351).
AMH Radiology Department for mammography Please call (17 248 117).
Breast Cancer Support Group- English Each month a Breast Cancer Support Group coffee morning takes place on the first Wednesday of the month. This is open to all ladies who have had a breast cancer diagnosis, whether they are newly diagnosed or years out of treatment. Call Joanne Lund (39 567 322).
National Mammogram Drive The Ministry of Health has allocated five centres where screening is six days a week with GP referral: Hamad Kanoo Medical Centre (Isa Town); National Bank of Bahrain Medical Centre (Aarad); Naim Medical Centre (Manama); Al Aali Medical Centre (Al A’ali) and Mohamad Jassim Kanoo Medical Centre (Hamad Town).
Eligibility Criteria - Must be a Bahrain citizen or resident aged 40 or older and must not have had any breast surgery or treatment for breast cancer in the past or a mammogram within the previous 12 months. Should not be pregnant.