Asiri Blog

The Importance of Staying Breast Aware

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Did you know that nearly 4500 women in Sri Lanka are diagnosed with breast cancer each year, and a 1500 of them do not survive? Combining cancers related to both men and women, breast cancer is the most common. So, how do you even begin to safeguard yourself from breast cancer? Well, you can’t completely do so. But, early detection can lead to swift action. Let’s break it down.

We all have loved ones or know a friend, or a friend of a friend who has had or is dealing with breast cancer. Some have survived, while others sadly, have not. But, according to Dr. Himaru Wirithamilla MBBS (Col), MD (Surgery), MRCS (Edin), patients should not die from breast cancer. “Early detection can lead to an almost 80% survival rate,” he said. “So, if you take a 100 women, 80 of them would survive and live on for 20 years or more.”

Unfortunately, due to financial constraints, the local public health sector does not have a formal breast cancer screening programme, like that of more developed countries. The facility however exists in bigger government hospitals and leading private hospitals for Sri Lankan ladies to have comparable quality of care.

Generally, doctors would rather attempt less radical treatment than complete removal of breast/s for women diagnosed with breast cancer. “Breasts are a significant part of a woman’s identity and removal often affects self-confidence and opens up a whole gamut of psycho-social and family issues,” explained Dr. Himaru.

In the UK, all women at the age of 50 years are invited to walk in for a screening mammogram. If a change is detected, the patient will be directed to a breast clinic for further evaluation and care. This process is repeated every 3 years. The breast cancer screening programme in the UK has reduced breast cancer related deaths by 30%.

Breast conservation surgery is an option for women who have been diagnosed with breast cancer. “We remove only the lesion and pick the lymph node which drains the lesion, usually in the armpit, during the same operation. We then test both,” said Dr. Himaru. “If detected early and if the lymph node is negative, then the armpit does not need any treatment. If, however, it is involved, we can offer treatment only there and then give radiation to the breast followed by medication. The breast remains. If a lady requires removal, then we can offer reconstruction of the breast, too. Most of the time a team of specialists, which may include plastic surgeons manage such patients in a holistic manner.”

Commonly, women seek medical attention if they are in pain, have nipple discharge, discover lumps or see breast disfigurement.


The frequent complaint among women with breast-related problems is pain. “This may (or may not) be related to the menstrual cycle,” said Dr. Himaru. “With cyclical pain, it is common for women to experience discomfort, heaviness and soreness of the breasts during their periods. Typically the pain is not cyclical if women experience discomfort throughout and not specifically during their period.” The truth of the matter is only 5% of women which present with breast pain will be diagnosed with breast cancer. But the goal is to alleviate their anxiety, provide symptom relief and to detect any underlying cancer.

What you must understand is that breasts are dynamic and not static. They keep changing throughout your life, during your cycle, through pregnancy, etc. When your body changes, so do your breasts. “What happens is that when a woman reaches adulthood, she usually fixes on a bra size, not realizing that this won’t stay the same,” revealed Dr. Himaru. Through pregnancy, delivery, and breast feeding, the bra size is not changed despite her breasts altering at each rite of passage. “As a result, there is a considerable lack of support for her breasts. Another example is when weight is gained, the breasts change and there is no proper support or the bra may be too tight,” he said.

When there is a lack of support, there is tension leading to pain. If you experience pain, a supportive, well-fitting bra is recommended even at night.

Aside from this, some women are sensitive to certain types of food; often, items that contain caffeine, for example, can aggravate pain (think coffee, tea, chocolate and cheese). Dr. Himaru recommends that you first check if your pain is related to a food type, before stopping it all wholesale. What’s more, simple pain medication like aspirin, paracetamol, etc. will ease any pain, too. “90% of women who come with breast pain settle with a simple remedy like this,” shared Dr. Himaru. “With the remaining 10%, a fraction of this group will require something further to help ease the pain. To these women, we give hormone manipulation with medication. It is an anti-estrogen which gives relief. The medication could also be one which is used for breast cancer patients.” It’s nothing to be alarmed over and your doctor will explain all of this to you, but this drug is given with a purpose, if you happen to fall into this minority.

Nipple Discharge

This is pretty common and can be divided into physiological and pathological. Physiological relates to discharge that happens naturally, like breast feeding and sometimes even attaining puberty. Pathological deals with discharges from the nipple due to an abrasion of the process. It could also be hormonal – for example there are hormones that regulate the breast. Certain types of medication can also cause breast discharge.

In the breast, around the nipple are multiple duct lobular units. “When breast feeding, milk comes from multiple ducts,” revealed Dr. Himaru. “But if the discharge comes from one duct, spontaneously and if it is blood stained, then there could be something going on in that duct lobular unit and it is best to get it checked out.”


“With discovering breast lumps, it is best to be breast aware,” said Dr. Himaru. Examine them regularly on your own and stick to monthly routine. This is vital, as it’s the only way you will notice a change. “Have a look at your breasts facing a mirror, then check them from the side on each side and leaning forward. Then feel yourself in a comfortable position, preferably lying back down on your bed, feeling the breast with the opposite hand against the chest wall. Include all areas of your breast as well as your armpit. Sometimes, there might be lymph nodes that can go undetected if not checked during your routine.” If you feel a lump, consult a doctor and a triple assessment will take place.

How it all works

If you head to the clinic with any of the above complaints, prior to diagnosis, a triple assessment is conducted. Scary? Not so much! It’s just 3 steps.

First, a clinical assessment is conducted. “We take a look at your history, we conduct a risk assessment and we examine you,” explained Dr. Himaru. Next, imaging of the breast(s) is done in two ways: One is a mammogram and the other is an ultrasound. “Mammography involves squeezing the breasts between 2 plates and taking an x-ray in 2 directions. Sometimes women with breast pain cannot undergo this, so we take an ultrasound scan instead,” said Dr. Himaru. The mammogram and ultrasound complement each other and showcase two different sets of information. After this comes histology, where a sample of tissue is obtained, analysed under the microscope and read by a pathologist to determine a diagnosis.

Luckily most of the problems of the breast are of a non-cancerous nature. Yet, if it can be detected at early stage, your doctor can achieve a very good outcome both in terms of survival and cosmetic procedure. Ladies, you are strongly encouraged to conduct your routine self-examination and to use available facilities for breast cancer screening.

Risk factors

  • Being female
  • Age over 40
  • Early menarche
  • Having your first child at a later age
  • Nulliparity (not having children at all)
  • Not breastfeeding
  • Family history of breast cancer
  • Smoking and alcohol
  • Hormones (oral contraceptive pills or hormone replacements)