- Questions on Breast Health
- Questions on Mammography
- Questions on Lymphoedema
- Information on Support Group
- Questions on Bone Health
- Questions on Health Education
- Information on Donation
- Information on Co-operation & Network
- Information on Volunteers
- Information on The Shop
What are the breast screening guidelines in Palestine?
Following the guidelines given here improves the chances that breast cancer can be found at an early stage and treated with success.
The Palestinian Ministry of Health recommends the following guidelines for finding breast cancer early in women without symptoms:
Mammogram: Women age 35 and older should have a screening mammogram every two years and yearly from age 50. While mammograms can miss some cancers, they are still a very good way to find breast cancer.
Clinical breast exam: Women should have a clinical breast exam (CBE) as part of a regular exam by a health expert.
Breast self-exam (BSE): BSE is advised for women from ago 18. Women should report any changes in how their breasts look or feel to their health professional right away.
Research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply being aware of what is normal for each woman. If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes.
See your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.
Women at high risk: Women with a higher risk of breast cancer should talk with their doctor about the best approach for them. This might mean starting mammograms when they are younger, having extra screening tests, or having more frequent exams.
Signs of breast cancer include the following:
- swelling of all or part of the breast
- skin irritation or dimpling
- breast pain
- nipple pain or the nipple turning inward
- redness, scaliness, or thickening of the nipple or breast skin
- a nipple discharge other than breast milk
- a lump in the underarm area
How often should I do a breast self-exam (BSE)?
You should do the self breast self-exam at least once a month. Look for any changes in breast tissue, such as changes in size, a lump, dimpling or puckering of the breast, or a discharge from the nipple. If you discover a persistent lump in your breast or any changes in breast tissue, it is very important that you see a physician immediately. However, 8 out of 10 lumps are benign, or not cancerous.
What is the clinical breast exam and who performs it?
A clinical breast exam (CBE) is an exam of your breasts by a health expert such as a doctor, nurse practitioner, nurse, or physician assistant. For this exam, you undress from the waist up. The examiner will first look at your breasts for changes in size or shape. Then, using the pads of the fingers, she or he will gently feel your breasts for lumps. The area under both arms will also be checked. This is a good time to learn how to do breast self-exam if you don’t already know how.
What are the risk factors for breast cancer?
Gender: Simply being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.
Age: The chance of getting breast cancer goes up as a woman gets older. About 2 out of 3 women with invasive breast cancer are age 55 or older when the cancer is found.
Genetic risk factors: About 5% to 10% of breast cancers are thought to be linked to inherited changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk as well.
Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother’s or father’s side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman’s risk. (It’s important to note that 70% to 80% of women who get breast cancer do not have a family history of this disease.)
Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer (which is called recurrence).
Race: White women are slightly more likely to get breast cancer than are African-American women.
Dense breast tissue: Dense breast tissue means there is more glandular tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for doctors to spot problems on mammograms.
Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer. They have had more menstrual periods and as a result have been exposed to more of the hormones estrogen and progesterone.
Earlier breast radiation: Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer.
Do lifestyle choices influence breast cancer risk?
Not having children or having them later in life: Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant more than once and at an early age reduces breast cancer risk. Pregnancy reduces a woman’s total number of lifetime menstrual cycles, which may be the reason for this effect.
Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly higher risk of breast cancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. It’s a good idea to talk to your doctor about the risks and benefits of birth control pills.
How is breast cancer detected?
The term screening refers to tests and exams used to find a disease like cancer in people who do not have any symptoms. The earlier breast cancer is found, the better the chances that treatment will work. The goal is to find cancers before they start to cause symptoms. The size of a breast cancer and how far it has spread are the most important factors in predicting the prognosis for the patient. Most doctors feel that early detection tests for breast cancer save many thousands of lives each year.
What is cancer?
Cancer occurs when cells in a part of the body begin to grow out of control. Normal cells divide and grow in an orderly fashion, but cancer cells do not. They continue to grow and crowd out normal cells. Although there are many kinds of cancer, they all have in common this out-of-control growth of cells.
Different kinds of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That’s why people with cancer need treatment that is aimed at their kind of cancer.
What is metastasis?
Sometimes cancer cells break away from a tumor and spread to other parts of the body through the blood or lymph system. They can settle in new places and form new tumors. When this happens, it is called metastasis (meh-tas-tuh-sis). Cancer that has spread in this way is called metastatic cancer.
Even when cancer has spread to a new place in the body, it is still named after the part of the body where it started. For example, if prostate cancer spreads to the bones, it is still called prostate cancer. If breast cancer spreads to the lungs, it is still breast cancer. When cancer comes back in a person who appeared to be free of the disease after treatment, it is called a recurrence.
Does a family history of breast cancer put someone at a higher risk?
If you have a grandmother, mother, sister, or daughter who has been diagnosed with breast cancer, this does put you in a higher risk group. Have a baseline mammogram at least five years before the age of breast cancer onset in any close relatives, or starting at age 35. See your physician at any sign of unusual symptoms
Breast cancer detection during pregnancy
When a pregnant woman develops breast cancer, it is often diagnosed at a later stage than it is in women who are not pregnant. This is because during pregnancy, hormone changes cause a woman’s breasts to enlarge and become more tender and lumpy. This can make it harder for you or your doctor to find a lump in your breasts. Mammograms are also harder for doctors to read during pregnancy because the breasts become denser. The early changes caused by cancer could also be mistaken for or hidden by the normal changes that happen with pregnancy.
It is relatively safe to have a mammogram during pregnancy. The amount of radiation needed for a mammogram is small. And the radiation is focused on the breast. For extra protection, a lead shield is placed over the abdomen to stop radiation from reaching the womb. Still, scientists can’t be certain about the effects of even a small dose of radiation on an unborn baby. If your doctor does not believe you need to have your mammogram right away, it may be best to wait. Other imaging tests that do not use radiation, such as breast ultrasound, may be used instead. These are thought to be safe alternatives to mammograms during pregnancy.
Even during pregnancy, early detection is an important part of breast health. Talk to your doctor or nurse about breast exams and the best time for your next mammogram — especially if you are age 40 or older, or if you or your doctor notices a change in how your breasts look or feel. As always, if you find any lump or change in your breasts tell your doctor or nurse right away.
Can men get breast cancer?
Yes, men can develop breast cancer. However it is rare. Less than 0.5% of all breast cancers occur in men and they account for less than 1% of all male cancers. Breast cancer is more common in men over 60 years. Because many are unaware that breast cancer can occur in men, some delay consulting their doctors about breast lumps results in a delay in diagnosis.
For the majority of men who do develop breast cancer no obvious cause can be found. In about one third there is a strong family history of breast cancer, suggesting a possible genetic link in these cases. Other factors known to increase the chances of developing male breast cancer include chronic liver disease and some testicular abnormalities, both of which can alter the balance of hormones in the body, which may lead to the development of breast cancer.
Can you do clinical breast examinations in your Centre?
Please phone us to set an appointment. In addition, if you require community based outreach make sure you have at least 15-20 women registered for the session.
If I have breast fed my babies, does that protect me against breast cancer?
Breast feeding doesn’t guarantee that you won’t develop breast cancer in the future.
I am fourteen. For the last few months I have been getting pain and tenderness in my breasts from time to time. Does this mean I could be getting breast cancer?
Breast cancer is very uncommon in women under thirty and in women under 20 it is very rare. However pain and tenderness in the breast from time to time, especially around the time a period is due, is very common. This discomfort can occur at any time in a woman’s life from puberty onwards.
In teenagers breast pain and tenderness is almost always a sign of the hormonal changes taking place as part of the growing process and settles down with time. If it is very uncomfortable see the gynaecologist for advice about easing the symptoms.
What is Mammography?
A mammogram is a special type of X-ray of the breasts. Mammograms can show tumors long before they are big enough for you or your health care provider to feel. Mammograms are recommended every two years for women, 40-50 years and they are also recommended for younger women who have symptoms of breast cancer or who have a high risk of the disease.
This test is used to look for breast disease in women who do not seem to have breast problems and it can also be used when women have symptoms such as a lump, skin change, or nipple discharge.
During a mammogram, the breast is pressed between 2 plates to flatten and spread the tissue. The pressure lasts only for a few seconds. Although this may cause some pain for a moment, it is needed to get a good picture. Very low levels of radiation are used.
For the mammogram, you undress above the waist. You will have a wrap to cover yourself. A technologist (a woman) will position your breast correctly for the test. The pressure lasts only a few seconds while the picture is taken. The whole procedure takes about 20 minutes.
About 1 in 10 women who get a mammogram will need more pictures taken. But most of these women do not have breast cancer, so don’t be alarmed if this happens to you.
Women with a higher risk of breast cancer should talk with their doctor about the best approach for them. They may benefit from starting mammograms when they are younger, having them more often, or having other tests along with them. If you are at higher risk, your doctor might recommend an ultrasound or MRI (magnetic resonance imaging) be done along with your mammograms.
How should I prepare for a mammogram?
Before scheduling a mammogram, it is recommended that you discuss any new findings or problems in your breasts with your doctor. In addition, inform your doctor of any prior surgeries, hormone use, and family or personal history of breast cancer.
The best time for a mammogram is one week following your period. Always inform your doctor or x-ray technologist if there is any possibility that you are pregnant.
We recommend you:
- Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots.
- Describe any breast symptoms or problems to the technologist performing the exam.
- If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam.
- Ask when your results will be available; do not assume the results are normal if you do not hear from your doctor or the mammography facility
What will I experience during and after the procedure?
You will feel pressure on your breast as it is squeezed by the compressor. Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.
Are Mammograms Painful?
Mammography does compress the breasts and can sometimes cause slight discomfort for a very brief period of time. Patients who are sensitive should schedule their mammograms a week after their menstrual cycle so that the breasts are less tender.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology will examine the films and write a report.
What are the limitations of mammography?
Initial mammographic images themselves are not always enough to determine the existence of a benign or malignant disease with certainty. If a finding or spot seems suspicious, your radiologist may recommend further diagnostic tests.
Can a pregnant woman have mammography?
We recommend the woman discusses with her doctor the pros and cons before undergoing the examination. It is possible to take precautions to protect the fetus and mother.
I am 23 years old. Can I do a mammogram?
Young women tend to have dense breasts and therefore it is more difficult to detect abnormalities using mammography. Our advice is to see a specialist who will decide if you need a mammogram.
What is lymphedema?
Our bodies have a network of lymph nodes and lymph vessels that carry lymph fluid, much like blood vessels carry blood to all parts of the body. The lymph fluid contains white blood cells which help us fight infections. During surgery for breast cancer, the doctor usually removes at least 1 lymph node from the underarm area to see if the cancer has spread. Some lymph vessels that carry fluid from the arm to the rest of the body are also removed because they are wrapped around the nodes.
Removing lymph nodes and vessels from the underarm changes the way the lymph fluid flows in that side of the upper body. This makes it harder for fluid in the arm to get to other parts of the body. If the remaining lymph vessels cannot drain enough of the fluid from the breast and underarm areas, the excess fluid builds up and causes swelling, or lymphedema. Radiation treatment to the lymph nodes in the underarm can affect the flow of lymph fluid in the arm and breast area in the same way, increasing the risk of lymphedema.
Lymphedema usually develops slowly over time. The swelling can range from mild to severe. It can start soon after surgery or radiation treatment. It can also begin months or even years later.
Doctors still do not fully understand why some patients are more likely to have problems with fluid build-up than others. They expect that in the future fewer women will develop lymphedema because breast surgery and treatment keep getting more conservative (that is, as more women are treated with lumpectomy).
How can I reduce swelling after surgery or radiation?
See our Leaflets: Lymphoedema, Arm Exercise
Right after surgery, the affected arm or breast area may swell. This swelling is usually short-term and slowly goes away over the next 6 to 12 weeks.
These tips may help ease the swelling during this time:
- Use your affected arm like you normally would to do things like comb your hair, bathe, dress, and eat.
- Two or 3 times a day raise your affected arm above the level of your heart and keep it there for 45 minutes. Lay down to do this and fully support your arm. Put your arm up on pillows so that your hand is higher than your wrist and your elbow is a little higher than your shoulder.
- Exercise your affected arm while it is supported above the level of your heart by opening and closing your hand 15 to 25 times.
Repeat this 3 to 4 times a day. This exercise helps to reduce swelling by pumping lymph fluid out of the arm through the undamaged lymph vessels.
- To get back your normal shoulder and arm movement, begin exercising your affected arm about a week after your surgery. But talk to your doctor, nurse, or physical therapist before doing any exercises. For most people normal range of motion returns within 4 to 6 weeks.
- If you have radiation therapy after surgery, it may cause or prolong arm swelling. It may also cause some swelling in the breast toward the end of the treatment. This swelling is short-term and will slowly go away. During treatment and up to 18 months afterward, you should do simple stretching exercises each day to keep full movement in your shoulder
How can I prevent and control lymphedema?
At this time there are no scientific studies to show that women can prevent lymphedema. Still, most experts recommend following the basic guidelines listed here. They may help you lower your risk of developing lymphedema or delay its onset.
Your body responds to infection by making extra fluid to fight the infection. Removal of or damage to lymph nodes and vessels makes it harder to transport this extra fluid, and this can trigger lymphedema. Good hygiene and careful skin care may reduce the risk of lymphedema by helping you avoid infections.
Follow these tips to help you care for the hand and arm on the side of your body that had surgery:
- Whenever possible, have your blood drawn, IVs, and injections given in your unaffected arm. Also have flu shots and vaccinations in your unaffected arm or somewhere else. Inform your doctor or nurse that you are at risk for lymphedema.
- Keep your hands and cuticles soft and moist by regularly using moisturizing lotion or cream. Push cuticles back with a cuticle stick rather than cutting them with scissors.
- Keep your arm clean. Clean and protect any skin openings caused by cuts, scratches, insect bites, hangnails, or torn cuticles. First, clean it with soap and water. Then use an antibiotic cream or ointment and cover with a bandage.
- Wear protective gloves when using chemical cleansers or steel wool, when doing any gardening or yard work, and when washing dishes.
- Wear a thimble when sewing to avoid needle and pin pricks to your finger.
- Use an electric shaver to remove underarm hair; it may be less likely to cut or irritate the skin than a straight razor or hair removal cream.
- Use an insect repellent to avoid bug bites when outdoors. If you are stung by a bee in the affected arm, clean and put ice on the area, raise the arm, and call your doctor or nurse if it shows any signs of getting infected.
Try to avoid burns
Like infections, burns can cause the body to make extra fluid that may build up and cause swelling when lymph nodes have been removed or damaged.
Tips to avoid burns include:
- Protect your chest, shoulder, and arm from sunburn. Use sunscreen labeled SPF 15 or higher and try to stay out of the sun during the hottest part of the day.
- Use oven mitts that cover your arms when removing food from the oven.
- Avoid oil splash burns from frying and steam burns from microwaved foods or boiling liquids.
- Avoid high heat, such as from hot tubs and saunas. Dot use heating pads on the affected areas. Heat can increase fluid build-up.
Try to avoid constriction
Constriction or squeezing of the arm may increase the pressure in the blood vessels. This may lead to increased fluid and swelling. Lymphedema has also been linked with air travel, possibly because of the low cabin pressure.
- Wear loose jewelry, clothing, and gloves. Avoid anything that forms a snug band around your arm or wrist.
- Do not use shoulder straps when carrying briefcases and purses.
- Do not have your blood pressure taken on the affected arm. If both arms are affected, blood pressure can be taken on your thigh.
- On long or frequent flights, wear a compression sleeve. A well-fitted compression sleeve may help prevent swelling. Ask your doctor or physical therapist if you should be fitted for a sleeve to wear during air travel. You may also want to discuss ways to safely raise your arm above the level of your heart and exercise it during long flights.
Try to avoid muscle strain
It’s important to use your affected arm for normal everyday activities to help you to heal properly and regain strength. This includes doing things like brushing your hair and bathing. Using your muscles also helps drain lymph fluid from the limbs. If you’ve had surgery or radiation treatment, ask your doctor or nurse when you can begin to exercise and what type of exercises you can do. But keep in mind that overuse, which can result in injury, has been linked with the start of lymphedema in some women.
It’s a good idea to follow these tips:
- Use your affected arm as normally as you can. Once you are fully healed, about 4 to 6 weeks after surgery or radiation treatment, you can begin to go back to the activities you did before your surgery.
- Exercise regularly but try not to over-tire your shoulder and arm.
- Avoid vigorous, repeated activities, heavy lifting, or pulling.
- Use your unaffected arm or both arms as much as possible to carry heavy packages, groceries, handbags, or children.
Try to avoid gaining weight
Extra fat requires more blood vessels. This creates more fluid in the arms and chest, and places a greater burden on the lymph vessels that are left. Women who are more overweight (obese) are more likely to have lymphedema.
I know a lady who has cancer. Can she join the Sunrise group? Is there a fee to join the group?
We welcome new members all the time. Please have her pass by the clinic or phone (02) 6264674 /6277990 for more information and times /dates of meetings. The members of Sunrise are not charged a fee but from time to time they pay a small sum for outings and special events (which are subsidized by donations).
How can members of the Sunrise group help others?
There are several ways:
- Become a trained Reach to Recovery volunteer [link]
- Help in fund raising events
- Participate in community based lectures
Do you have mastectomy bras and wigs? Where can I buy prosthesis?
What is bone density screening?
There are two ways to find out you have osteoporosis: breaking a bone and getting a bone density test.
Osteoporosis is often called the “silent disease” because it develops without symptoms. People often don’t realize they have it until they break a bone. It’s important to find out about the strength of your bones before they break so you can plan ways to decrease bone loss.
The only way to find out if you have osteoporosis is to have your bone density tested. Normal x-rays don’t measure the density of bone. Bone density testing measures the amount of mineral in the bone. The bone density test compares your bone density to what is expected in someone of your age, sex and size. It also compares your bone density to the optimal peak bone density of a health young adult of the same sex.
Ultrasound testing estimates bone strength using sound waves transmitted through the patient’s heel for about 10 seconds. Results compare well with bone density measurements by DEXA (The best and most common bone density test is a dual energy x-ray absorptiometry, or DEXA, scan of the spine and hip, where fractures are most common and most debilitating.) If you have no known risks of osteoporosis such as a family history, past fractures or use of steroids for a long time, you might consider a scan of your wrist, heel or other peripheral body part. There is an 85% “correlation” rate between test results of your hip, spine and other sites. In other words, the bone density in one part of your skeleton will look very much like the density in your other bones if you are like most people.
Who should have the bone density test?
Just as it is important to know your blood pressure or height, it is important to know your T-Score, which is your bone density test result. For most women, the time to watch your T-Score is shortly after menopause when declining estrogen levels no longer protect your bone density. While not universally agreed upon, there are also other cases when a bone density test may be appropriate. Older men, people who have taken medications that affect bone density for prolonged periods (such as some asthma and steroid medications), and people with a history of osteoporosis or fractures in their family could also be tested. Knowing your T-Score and risk factors help you and your physician decide how aggressively you should address osteoporosis prevention and treatment.
What are the risk factors for developing osteoporosis?
The more risk factors you have, the more likely you are to get osteoporosis and broken bones. Some examples are being small and thin, older age, being female, a diet low in calcium, lack of enough vitamin D, smoking and drinking too much alcohol.
Your healthcare provider may recommend a BMD test if you are:
- A postmenopausal woman under age 65 with one or more risk factors for osteoporosis
- A man age 50-70 with one or more risk factors for osteoporosis
- A woman age 65 or older, even without any risk factors
- A man age 70 or older, even without any risk factors
- A woman or man after age 50 who has broken a bone
- A woman going through menopause with certain risk factors
- A postmenopausal woman who has stopped taking estrogen therapy (ET) or hormone therapy (HT)
Some other reasons your healthcare provider may recommend a BMD test:
- Long-term use of certain medications including steroids (for example, prednisone and cortisone), some anti-seizure medications, Depo-Provera ®
and aromatase inhibitors (for example, anastrozole, brand name Arimidex ®)
- A man receiving certain treatments for prostate cancer
- A woman receiving certain treatments for breast cancer
- Overactive thyroid gland (hyperthyroidism) or taking high doses of thyroid hormone medication
- Overactive parathyroid gland (hyperparathyroidism)
- X-ray of the spine showing a fracture or bone loss
- Back pain with a possible fracture
- Significant loss of height
- Loss of sex hormones at an early age, including early menopause
- Having a disease or condition that can cause bone loss (such as rheumatoid arthritis or anorexia nervosa)
Ref. http://www.nof.org/osteoporosis/bmdtest.htm#Who_Should_Have_a_BMD_Test (accessed 24 Mar 2009)
Can you provide bone density screening in other locations than your clinic?
Yes, if we can reach your premises and you have enough people collected to do the tests, just contact us at (02) 6264674 / 6277990
How can we get some of your educational materials or schedule a lecture?
- Just phone, fax or email us (see contact page) with your request. Please note that all the materials are in Arabic.
- Lectures and workshops are usually offered in Arabic although we can also offer them in English, too!
I would like to make a donation. What is the best way to send the money?
Our work is heavily dependant on donations and generally a bank transfer or check works fine.
Check our Donations page for our bank details.
How do I know how my donation will be used?
You may specify how you would like your donation used or we can use it where it is most needed. We publish regular reports and we have yearly audited accounts required of all registered non governmental organizations.
Who are your donors?
Our list of donors includes individuals, international organizations, governments, etc. The current list of donors can be seen on our Donors page.
Do you partner with other organizations?
It depends on the projects we are involved with at any given time but our work mandates a close cooperation with the governmental, non governmental and private sectors to advance our goals of improving public health.
Do you have branches?
We are an independent organization but we do outreach education, screening exams and training projects. In addition, the support group for women living with cancer meets in different locations to facilitate easier access for women around the country.
I would like to volunteer. Can you send me information?
We welcome volunteers in all spheres of our work! Please email us with your interests and contact info.
How can I order a quantity of embroidery?
Please contact us by phone, fax or email specifying your needs. A bank transfer [link] or local check is the easiest way to pay. Please send us the shipping details and how soon you need the items.
Where can I purchase the cookbook?
From time to time we sell them at bazaars and shops. You can always contact us directly and we will get them to you.