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What is a breast self-exam?

A breast self-exam is an important way for women to monitor their breast health and detect any changes that may be a sign of breast cancer.

Breast Cancer in Ireland Statistics

• According to the National Cancer Registry Ireland (NCRI), breast cancer is the most common cancer among women.
• Doctors diagnose approximately 3,700 women with breast cancer each year.
• Doctors diagnose approximately 30 men with breast cancer in Ireland each year.
• Breast Cancer accounts for 29% of all cancers diagnosed in women.
• The incidence rate of breast cancer in Ireland is 185 per 100,000 women.
• Breast cancer is diagnosed on average at 62 years old.
• The five-year survival rate for breast cancer in Ireland is approximately 85%.

It is important to regularly perform breast self-exams.

 

Breast self-exam steps:

1. Begin by standing in front of a mirror with your arms at your sides. Look for any changes in the size, shape or contour of your breasts, as well as any changes in the skin texture or colour, such as dimpling , puckering or redness.
2. Next, raise your arms overhead and look for the same changes as above.
3. With one arm raised, use the opposite hand to examine the breast and armpit area. Use the tips of your fingers to feel for any lumps or thickening in the breast tissue, starting at the outer edge and working inwards in circular motions.
4. Repeat step 3 with the other breast and armpit.
5. Finally, lie down and repeat the exam with one arm raised, using the opposite hand to examine the breast and armpit area. Repeat with the other breast.

 

However, it is also important to remember that breast self-exams are not substitute for regular mammograms and clinical breast exams. It is important to note that women should contact their healthcare provider if they notice any changes or abnormalities in their breasts.

What are the most common types of Breast Cancer?

There are various typesof breast cancer. Each type is unique, and treatment options vary. Be sure to consult with your physician regarding diagnosis and treatment.

Ductal Carcinoma In Situ (DCIS)

DCIS is non-invasive that starts in the milk ducts of the breast, it is regarded as the initial stage of breast cancer, since it hasn’t extended beyond the milk ducts. It has a low risk of becoming invasive. 

Invasive Ductal Carcinoma (IDC)  

IDC is the most common type of breast cancer, accounting for about 80% of all cases. IDC starts in the milk ducts and invades and grows in the surrounding breast tissue. IDC can form a lump or thickened area in the breast. As the cancer grows, it may cause changes in the shape or size of the breast. IDC may also spread to the lymph nodes or other parts of the body through the blood stream or lymphatic system. Treatment for IDC usually involves surgery to remove the tumour, followed by radiation therapy, chemotherapy, hormone therapy or targeted therapy, depending on the stage and characteristics of the cancer.  

Invasive Lobular Carcinoma (ILC)

ILC originates in the lobules, the glandular tissue that produces milk, and then spreads to the surrounding breast tissues. ILC is less common than invasive ductal carcinoma, accounting for about 10-15% of all invasive breast cancer cases. ILC often does not form a distinct lump, and can be difficult to detect by mammography or physical examination. Instead, it may appear as subtle thickening or fullness in the breast, or as changes in breast texture. ILC is also more likely to be multifocal, meaning it may occur in multiple locations within the same breast or in both breasts. Like other types of invasive breast cancer, ILC can spread to other parts of the body through the lymphatic system or bloodstream, a process called metastasis. Treatment for ILC usually involves surgery to remove the tumour, followed by radiation therapy, chemotherapy, or hormone therapy, depending on the stage and characteristics of the cancer. 

Inflammatory Breast Cancer (IBC)

IBC is rare and aggressive form, accounting for about 1% to 5% of all cases. It occurs when cancer cells block the lymph vessels in the skin of the breast, causing the breast to become red, swollen and warm. 

Triple Negative Breast Cancer (TNBC)

TNBC does not contain oestrogen receptors (OR), progesterone receptors (PR) and human epidermal growth factor receptor 2 (HER2).  These receptors are proteins that are present on the surface of breast cancer cells and can help fuel the growth and spread of the cancer. TNBC accounts for approximately 10% to 20% of all breast cancer cases and is more common in younger women and those with BRCA1 mutation. TNBC is often more aggressive and has a higher risk of recurrence than other types of breast cancer. Because TNBC lacks these three receptors, it does not respond to hormonal therapies or drugs that target HER2 receptors. Instead, treatment for TNBC usually involves a combination of surgery, chemotherapy and radiation therapy. 

HER2 Positive Breast Cancer

HER2 Positive Breast Cancer is contains HER2 receptors. This means that the cancer cells have an excess of HER2 protein, which can promote the growth of cancer cells. HER2 positive breast cancer accounts for approximately 15-20% of all breast cancer cases. It is more common in younger women and tends to be more aggressive than other types of breast cancer. HER2 positive breast cancer can also be associated with a higher risk of recurrence. Treatment for HER2 positive breast cancer often involves targeted therapy with drugs that specifically block the HER2 protein.  

On the 12^th March, I first became aware of this new term, social distancing. Little did I think when I left the office that day, that I would not return for an unknown number of weeks. It was not difficult to adapt to a changed work schedule. Rather than a twice-weekly 5.15 am rise to catch an early morning train to Dublin, I now spread my working hours over weekdays, starting each morning at 9.00 am.  I had to familiarise myself with Zoom and the potential of technology for communication with colleagues.  Zoom, emails, text, messages help us all to keep in touch, but emails and text messages in particular lack the non-verbal clues such as facial expressions, so essential in communication.

While it is not possible to complete practical aspects of Biobanking remotely, such as sample processing, data entry to the Biobank Information Management System or benchwork, it provides an opportunity to tackle tasks such as updating the quality manual, revising or reviewing SOPs, looking critically at what we can do better and how.

Meanwhile, back in the Histopathology Department, samples for Biobanking have ground to a halt. Cancer patients are having their surgeries done in private hospitals and it has not been possible to procure consent for biobanking.

The British politician Jacob Rees Mogg, sometimes referred to as the honourable member for the 19^th century, recently commented:  “During the plague, Parliament closed, but even I have moved on from 1349 and with the help of technology, Parliament will remain open during the COVID-19 pandemic”.  So we too have to carry on and make the best of current circumstances with the help of technology.

Una Gibbons

* Minister Varadkar was asked by Finian McGrath TD if he will support Biobank Trust Ireland (sic) in 2015-2016 (details supplied); and if he will make a statement on the matter.The new Health Research Regulations (HRR), August 2018 (part of the Irish Data Protection Act, May 2018), in response to the EU General Data Protection Regulations (GDPR) require that patients give explicit consent for the use of their non-personal data in new medical research projects. However, a unique feature of the HRR is that if a research project is considered to be of significant public benefit and consent is not possible to obtain, a (highly detailed) application to a Committee may result in an exceptional declaration that consent is unnecessary.

Millions of potentially very valuable research tissue samples from patients’ operations have been stored in Irish pathology departments as part of clinical records over the last 40 years. These archival (i.e. pre-2018) samples are used if required during a patient’s next admission to hospital, for consultation or for medico-legal purposes. But archival tissue samples are also very widely used ethically and legally, in research worldwide, including in Ireland north and south. Research examination of the archival tissue together with linked patient data from hospital databases can be correlated with treatment response and disease outcome. Modern precision medicine and the development of new treatments for cancer and other diseases depend on being able to use archival tissue. Contacting all these patients for their consent is not feasible. Anonymous contact by post or by phone – years after an operation – is completely different to face-to-face explicit consent: it is distressing for patients and their families. Moreover, surveys show this is not what patients want. GDPR interpretation in other EU countries does not render highly valuable archival tissue burdensome to access for research. Furthermore, the European Data Protection Board has recently disagreed with the rigid approach to data protection in Ireland’s HRR.

Irish research projects are carried out safeguarding patient privacy and confidentiality, following scientific and ethical approval. Legal use of non-personal data associated with archival pathology samples should be based on their inestimable research value and the potential public benefit derived therefrom. The HRR make special provision for research of significant public benefit, but the enormous scale, diversity and uniqueness of non-personal data associated with archival samples makes multiple separate detailed applications to a Consent Declaration Committee inappropriate. Instead, this must be specifically addressed and clarified in an amendment to the HRR, in the public interest and for the sake of future patients.

Eoin Gaffney MD, March 11, 2019

REPLY

I acknowledge the benefits that would accrue from a national biobanking infrastructure. In 2012 the Health Research Group adopted a National Plan for Biobanking. An action “to take steps to establish a national biobanking system and support infrastructure by 2016” was subsequently included in the Action Plan for Jobs.

The Health Research Board, which is funded by my Department, has led work on the biobanking initiative with the relevant agencies and is progressing the initiative. It would, therefore, be appropriate for Biobank Trust Ireland to engage with the HRB on the matter.

See link to RTE news coverage of the “Biobank Ireland – Now We Are 10” meeting in September 2014.

www.rte.ie/news/2014/0911/642907-biobank/