As part of Breast Cancer Awareness Month, we interviewed Joyce Habib, Consultant Oncologist at HealthBay Polyclinic, who gave us her expert opinion on the symptoms, myths, and lifestyle choices associated with breast cancer.
Why did you decide to go into medicine?
I was initially drawn to medicine because of my love for science and the amazing complexity of the human body. I also wanted to work in an environment where I could help people and make a positive difference in their lives. It is a great privilege to be able to help people who are often at their most vulnerable moments.
What made you decide to specialise in breast care / oncology?
I chose Oncology because it is a very dynamic field. It is thrilling to be part of a forward-looking specialty that has and continues to evolve so quickly. Just a little bit more than a decade ago, chemotherapy was the mainstay treatment for most cancers. A lot has changed since then!
Our understanding of cancer biology has progressed substantially over the course of time and has paved the way for major breakthroughs in the field, most notably the incorporation of immunotherapy and targeted therapies into our therapeutic armamentarium.
In no other specialty has the knowledge of disease biology led to so many therapeutic advances as it has in oncology. This is really exiting!
Oncology is also at the cusp of the precision medicine revolution. We now have the possibility to look at genes of any given cancer and make decisions about which drugs to use for individual patients.
What was it that particularly attracted you to HealthBay Polyclinic? And why the UAE?
I was attracted by Healthbay’s vision and ethos: to become a leading institute for cancer prevention and treatment in the UAE by promoting excellent patient care. While many hospitals can feel intimidating for patients, Healthbay offers a really unique outpatient clinic setting but without compromising on the quality of care. In fact, we pride ourselves on having the highest quality customized cancer care using state-of-the-art medical knowledge and technology.
In your opinion, is there a cultural barrier in the region that prevents women from being screened for breast cancer? Or is this a misperception?
Despite excellent awareness campaigns and availability of screening programs, I have seen numerous women who were reluctant to seek screening or just ignored a lump in their breast. Why is this still happening? Sadly there is still somewhat of a taboo around cancer in the region. Although things are improving, we must continue to focus our energy on educating women and their families on the importance of early breast cancer detection through screening and prompt evaluation as soon as symptoms occur.
Is there a link between lifestyle and the risk of developing breast cancer?
Definitely, we know that some, but not all, risk factors for breast cancer are lifestyle-related. These include:
Being overweight or obese: Being overweight or obese especially after menopause increases your risk of developing breast cancer, particularly the hormonal type. The higher your body mass index (BMI), the higher your risk.
Alcohol consumption: Women who consume alcoholic beverages on a regular basis are also at increased risk of breast cancer. For example, one study showed that consuming 3 to 6 alcoholic drinks per week is associated with an increased risk of about 15%.
No or late pregnancy: Not having children or having your first pregnancy at age 35 and above is also a known risk factor for breast cancer. On the other hand, women who had their first pregnancy between the ages of 20 to 25 have 10-20% lower risk of developing breast cancer.
Taking hormone replacement therapy (HRT) after menopause: Women who have used hormonal therapy containing both estrogen and progestin for more than 3 years to help with hot flashes or other menopausal symptoms increase their risk of breast cancer.. The longer women use HRT, the higher the risk. For example, taking HRT for 5 years can double your risk for breast cancer and your risk goes up to threefold if you have taken HRT for 10-15 years.
On the other hand, there are lifestyle factors that have been shown to decrease your risk of developing breast cancer:
Breastfeeding: Breastfeeding for at a year has a protective effect against breast cancer. It is estimated that every year of breastfeeding can decrease your risk by about 5%.
Regular exercise particularly after menopause can decrease your risk of developing breast cancer by about 10-20%.
Diet: Consuming a diet rich in plant foods, fish, and olive oil (Mediterranean diet) has also been shown to protect you from breast cancer although the evidence is not as strong compared to other risk factors.
What are the signs and symptoms of breast cancer that women (and men) should watch out for?
Nowadays a large percentage of breast cancers are detected during a screening mammogram or ultrasound before symptoms even develop. So we are seeing fewer women presenting with symptoms. This is a good thing because by the time symptoms occur, the disease is usually more advanced.
Signs/Symptoms of breast cancer include:
A lump or mass in the breast
A change in the size or shape of the breast
A lump or mass underneath the armpit. This occurs when breast cancer spreads to lymph nodes underneath the armpit
Swelling, thickening or redness of the skin of the breast
Puckering or dimpling of the skin of the breast resembling the skin of an orange
Nipple abnormalities such as a persistent discharge from the nipple that can be at times bloody. Persistent pain or soreness in the nipple, nipple erosion or inversion.
There are many myths regarding cancer. Can you share one and explain why it is factually inaccurate?
I hear from my breast cancer patients quite a lot that “sugar can make my cancer grow”.
A lot of my patients are concerned about eating any sugar, bread, rice or even starchy vegetables because they fear that these foods are broken down to sugar by their digestive system. There is no evidence whatsoever that eating sugar or starch will make your cancer grow.
Why, in your opinion, is it so important to increase awareness about breast cancer?
Early detection can, and does, save lives! When a woman is diagnosed with early stage breast cancer there is close to 90-95% chance her cancer will be cured. On the other hand, the chance of curing breast cancer decreases when it is detected at a more advanced stage. Because screening allows us to detect breast cancer at its earliest stage when the chance for a cure is high, it is essential that we continue to educate women and encourage screening.
What, in your opinion, could be done to increase awareness?
Many campaigns focus on raising awareness of symptoms. More could be done to raise awareness of lifestyle factors which can cause breast cancer. While it is important to get screened, it is equally important to prevent cancer in any way you can, for example by exercising regularly, eating healthily, maintaining a healthy body weight, breast-feeding. Some of these risk factors are particularly relevant for the Middle East and the UAE specifically.
Finally, what advice would you give someone who was worried about breast cancer?
I would urge anyone who is worried about breast cancer or concerned that they might have breast cancer to speak to their doctor. It is sometimes hard to separate fact from fiction when looking at information on the internet; get checked by a doctor – and remember the earlier you get your symptoms checked by a doctor, the better.