Breast cancer: signs, risks and when to get checked in Kenya

Breast cancer starts when cells in the breast grow out of control. It is the most common cancer in Kenya, and found early it is far more treatable.

A lump or thickening in the breast or armpit, which often does not hurt. A change in the size or shape of the breast. Dimpling, redness or pitting of the skin, like orange peel. A change in the nipple or the skin around it, including a nipple that turns inward. Fluid or blood from the nipple that is not breast milk. A sore or rash on the nipple or areola that does not heal.

Being a woman and getting older. A mother, sister or daughter who had breast or ovarian cancer, especially young. Inherited gene changes such as BRCA1, BRCA2 or PALB2. Radiotherapy to the chest at a young age. First period at a young age, late menopause, or a first child late or not at all. Overweight after menopause, alcohol, tobacco and little physical activity. Hormone replacement therapy after menopause.

Any new lump, a nipple that suddenly turns inward, bloody discharge or skin changes need a clinical breast exam soon, even if a recent screen was normal. Most lumps are not cancer, but only an examination can tell.

With clinical breast exam, mammogram or breast ultrasound. Women aged 25 to 34: a clinical breast exam every 3 years.

A clinical breast exam by a trained clinician. A mammogram, and an ultrasound for younger or denser breasts. A biopsy only if imaging shows something that needs a closer look. A referral to a breast clinic or surgeon when results need it. A risk result is not a diagnosis.

Given my family history, when should I start mammograms? Do I need an ultrasound as well as a mammogram? Are my breasts dense, and does that change my screening? Should I be tested for BRCA gene changes? What should I check between screens, and what should make me come back sooner?

Under the Social Health Authority, breast cancer screening is listed in the Primary Healthcare Fund at facilities that offer it. Mammogram prices at private facilities vary, so ask the facility before you go.

The breast cancer risk assessment asks about 40 questions: family history (including male relatives and the age they were diagnosed), BRCA results, breast density, reproductive history, hormone use and lifestyle. Any warning sign brings up a red Symptom Alert, and it works out when your next clinical breast exam or mammogram is due under Kenya's guidelines. It costs KES 300. A care navigator calls you back within 2 hours (Monday to Saturday, 8am to 8pm) to book what you need at a facility that suits your budget and location.