Malignant breast diseases
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Benign and Malignant Breast Disease at Rwanda’s First Public Cancer Referral Center
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Ask your doctor about breast cancer screening. Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms. Talk to your doctor about the benefits and risks of screening. Together, you can decide what breast cancer screening strategies are right for you. Become familiar with your breasts through breast self-exam for breast awareness. Women may choose to become familiar with their breasts by occasionally inspecting their breasts during a breast self-exam for breast awareness.
If there is a new change, lumps or other unusual signs in your breasts, talk to your doctor promptly.
Breast awareness can't prevent breast cancer, but it may help you to better understand the normal breat that your breasts undergo and identify any unusual signs and symptoms. Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day, if you choose to drink. Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week.
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If you haven't been active lately, ask your doctor whether it's OK and start slowly. Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy. Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms. To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time. Maintain a healthy weight. If your weight is healthy, work to maintain that weight.
Further, if her insurance company knows that she has these genetic markers of increased risk, she may loose her insurance coverage. If a woman decides to proceed with genetic testing, we recommend that this test be paid for by the individual to keep the results confidential.
Late or no pregnancies: Pregnancies prior to the age of twenty-six are Malignant breast diseases protective. Nuns have a higher incidence of breast cancer. Greater than two alcoholic beverages per day. Most studies indicate that taking estrogen longer than ten years may lead to a slight increase in risk for developing Malignant breast diseases cancer. However, these studies indicate that the positive benefits of taking estrogen as far as reducing the risk for osteoporosis, heart disease and now more recently Alzheimer's and colon cancer, far outweigh the slight increase in risk that may be associated with estrogen replacement therapy. Caution should be exercised in those women with a significantly positive family history of breast cancer or atypical intraductal hyperplasia.
Women with breast cancer are not currently give estrogen replacement. There are no scientific studies currently justifying this practice. However, until those studies are available, by convention, women are taken off estrogen. History of prior breast cancer: Patients with a prior history of breast cancer are at increased risk for developing breast cancer in the other breast. The reason for close clinical follow-up after the diagnosis of breast cancer is not only to detect recurrence of the disease, but also to detect breast cancer in the opposite breast. The mere fact that being female increases the risk of developing breast cancer. However, for every women with breast cancer, 1 male will develop the disease.
Of these 6 Malignant breast diseases, 4 had clinical or radiologic evidence of metastatic disease, 1 patient was treated for stage II breast cancer but the medical record notes that the pathology specimen was lostand 1 was treated for stage III breast cancer but pathological diagnosis from a biopsy was not documented and results on surgical pathology were indeterminate. Among the 18 patients with unknown diagnoses, 5 had been recommended to have a biopsy but did not have one; 1 had a biopsy but the result was never found; 4 had an inconclusive biopsy but a repeat was never done; and 8 were recommended to have further clinical follow-up or were referred for mammography but never returned.
Sixty-six percent of pathologically confirmed breast cancers were hormone receptor-positive. Human epidermal growth factor receptor 2 HER2 status was not routinely provided in pathology reports during the study period given the unavailability of HER2-targeted therapies. About two thirds of these cancers were hormone receptor-positive, which is similar to rates of hormone receptor-positive cancers in the United States [ 10 ]. Although more detailed analysis of these findings is underway, these results are consistent with emerging reports suggesting that when testing conditions are optimized, most breast tumors in Africa are estrogen receptor-positive [ 11 ].
The proportion of patients diagnosed with breast cancer was higher than published reports from other breast clinics in sub-Saharan Africa [ 12 — 15 ], Europe [ 16 ], and North America [ 1718 ]. Among patients with benign masses who had biopsies, the distribution of disease was not markedly different from that of benign conditions seen in breast clinics in developed and developing countries [ 1618 ]. Several case series have described the outcomes of breast biopsies in sub-Saharan African health facilities. A small number of these cases series are from community facilities [ 19 ], but most are from referral centers [ 1220 ].
Our study is unique in capturing the patient population referred to a national breast clinic at a pivotal moment: Our findings may be of use to other inaugural national breast cancer programs and will be vital for monitoring in Rwanda. The most striking of our findings is the high prevalence of cancer among all patients and especially among those presenting with a breast mass. Although rates were highest among women 50 years of age or older of whom It is important to note that our rates do not reflect the cancer rate in a screened general population but rather the rate among a group of women referred to a specialty clinic for a breast concern.
Our rates are also higher than those in a pilot breast cancer screening study in Sudan, where 17 First, referring providers may have sent to BCCOE only patients whom they perceived to be at highest risk for cancer. Particularly during the period of the study, however, the availability of pathology services in other Rwandan facilities was minimal. Particularly when health care resources are highly constrained, the ideal of population-based screening must be balanced with the need to focus resources where they will make the most important difference, for example, through targeting early cancer detection among symptomatic women [ 4 ].
Breast diseases Malignant
Understanding the current spectrum of breast diseases seen in primary care and referral facilities in LMIC can help countries and their health care facilities prepare for early detection programs, including developing clinical algorithms for initial evaluation and referral of patients with a breast problem. Such initial data can also facilitate monitoring shifts in distribution of disease diagnosed before, during, and after implementation of early detection programs. Rwanda, a small, population-dense country of 11 million in East Africa, has recently embarked on an ambitious national plan to address noncommunicable diseases, including cancer [ 56 ].
Chemotherapy was provided free of charge to a small number of patients at Rwinkwavu Hospital, a rural district hospital in the eastern province. The Butaro Cancer Center of Excellence BCCOE was the first public facility in the country to provide cancer diagnosis and care especially chemotherapy on a significant scale using standardized protocols [ 67 ]. BCCOE was also the first facility providing large-scale cancer services that were affordable to the general population; because of charitable support, chemotherapy, pathology, and other cancer diagnostic and care services are provided free of charge [ 6 ].