CONSULTANT radiologist Dr Derria Cornwall is urging Jamaicans to get screened for breast cancer before symptoms appear, as more than 40 per cent of the cases are being detected at stage three, when the cancer is already invasive and advanced.

Speaking at a virtual Zoom meeting of the Kiwanis Club Kingston on Tuesday evening, Cornwall said too many women are waiting until they notice a lump, or another change before seeking a mammogram, missing the opportunity to detect the disease early.

“We don’t have enough women going to get their mammograms when their breast still feels normal. It used to be less than five per cent of women going to get mammograms while their breast still feels normal, now it’s about eight to 15 per cent. Most women who go to get their mammograms are symptomatic. They are not screening, they are being diagnosed,” she said.

Cornwall, who is director of the Women’s Imaging Centre at the University Hospital of the West Indies (UHWI), said fewer than 10 per cent of breast cancers were being detected as
ductal carcinoma in situ — when abnormal cells are found while still confined to the ducts where they developed.

In contrast, she highlighted: “Most of our cancers are being found advanced at stage three, and we need to fix that. Stage three is when it’s already started to spread to the lymph nodes. And stage four is when it spreads distally to the brain, to the lungs, to the bone,” stated Cornwall.

Her appeal extended to men, who she urged to remain alert to breast changes and seek medical attention for suspicious signs. Men with certain inherited gene mutations, she explained, may also need mammograms on their doctor’s recommendation.

Citing research involving UHWI, Cornwall said the proportion of women undergoing mammography before developing symptoms remained low, warning that a breast which feels normal is not necessarily free of cancer. She explained that mammography can detect changes too small for a woman, her partner, or a doctor to feel.

The need for earlier detection was particularly pressing given the number of younger women affected, Cornwall told the meeting.

She said 33 per cent of Jamaican women with breast cancer were under 50, while 15 per cent were under 40. She also reported that 30 per cent of women who died from the disease were younger than 55.

“The mortality rate keeps increasing…now it is going up to 66.9 per hundred thousand over the last three years. That’s startling. That’s significant. And what is even more significant is that 30 per cent of these females who die are under the age of 55. That is very young… Breast cancer is now in the top 10 leading causes of death in Jamaica,” said Cornwall.

For women without a family history of cancer, Cornwall urged annual mammograms beginning at age 40, noting that a doctor’s referral is not required to access the examination in Jamaica.

Younger women, she said, should have a doctor assess their risk to determine whether screening needs to begin earlier. Factors warranting attention include a strong family history of breast cancer, certain inherited gene mutations, and previous radiation treatment to the chest.

She pointed out that some women at increased risk of breast cancer may need to begin screening as early as 25 and require magnetic resonance imaging (MRI) alongside mammography.

Cornwall also cautioned against treating the absence of a family history as protection from the disease.

“Eighty per cent of women who get breast cancer don’t have anyone with cancer in their family. It’s only about 15 per cent of women who have the family history, where there’s more than one person in their family with breast cancer, and only about five to 10 per cent of women actually have the hereditary gene where they get the genetic mutation that causes an increase in breast cancer. In other words, most women who get breast cancer don’t have it in their family,” she said.

However, she acknowledged that getting more women screened required confronting barriers involving cost, availability, accessibility, and awareness.

“In Jamaica, we don’t have a national screening programme. In places like the United Kingdom, when you are born, you’re put into a system, and when you’ve reached the age to start screening, you actually get a message, either a mail or something else [saying], ‘Congratulations on approaching the age to start screening,’ ” she said.

Cornwall explained that Jamaica relies on opportunistic screening, where a health-care provider uses a consultation for another complaint to recommend a mammogram, as well as public education encouraging women to arrange their own checks.

She added that access to free mammography remained limited, while some people’s belief that they are healthy discourages them from seeking testing.

The radiologist urged people to have breast lumps and other changes investigated, including nipple discharge, newly inverted nipples, skin changes, and a persistent nipple rash. For men, she encouraged awareness of their chest and reporting anything unusual.

“Cancer does not discriminate. As a matter of fact, cancer has no manners. Early detection is vital. Outcomes are better. Patients return to productivity sooner. The costs are lower,” charged Cornwall.