Breast Cancer: What I Wish Everyone Knew from a Medical Physicist’s Point of View

By Dr. Isaac Kwesi Acquah, Medical Physicist

October is Breast Cancer Awareness Month, so you will probably see a lot of pink ribbons, posters, social media campaigns, and messages encouraging women to check their breasts.

That awareness is important.

But from my perspective as a medical physicist, I think we need to move the conversation beyond simply wearing pink.

We need to understand what breast cancer actually is, what increases our risk, what signs we should never ignore, how it is diagnosed, and, most importantly, why finding it early can make such a huge difference.

There are also a few misconceptions about breast cancer, mammography, and radiation that I think deserve some clarification.

So, no complicated medical language today. Let us talk about breast cancer in a way that everyone can understand.

First, what exactly is breast cancer?

Our bodies contain trillions of cells. Normally, these cells grow, divide, and die in a controlled manner.

Cancer begins when some cells stop obeying those controls.

In breast cancer, abnormal cells develop within breast tissue and begin multiplying uncontrollably. Many breast cancers begin in the ducts that carry milk or in the lobules that produce milk.

If these abnormal cells remain confined to where they started, the disease may be described as in situ. If they invade the surrounding breast tissue, we call the cancer invasive.

The real danger comes when cancer cells acquire the ability to travel beyond the breast, often first to nearby lymph nodes and potentially later to organs such as the bones, lungs, liver, or brain. This is called metastasis.

This is one of the reasons early detection matters so much.

A small tumour confined to the breast is a very different clinical problem from a cancer that has already spread throughout the body.

Breast cancer is common, but it is not automatically a death sentence

This is probably one of the most important things I want people to understand.

Cancer does not automatically mean death.

According to the World Health Organization, an estimated 2.4 million women were diagnosed with breast cancer worldwide in 2024, and approximately 694,000 women died from the disease.

Those are serious numbers.

But breast cancer is also one of the cancers for which early diagnosis and appropriate treatment can make an enormous difference.

Unfortunately, fear itself can become part of the problem.

Someone notices a lump.

She becomes frightened.

She tells herself, “Maybe it will disappear.”

Another month passes.

Someone recommends a herbal preparation.

Another person says, “Don’t let them operate on it. Once they touch cancer, it spreads.”

More time passes.

Eventually, she reaches the hospital, but the disease may now be far more advanced than when she first noticed the problem.

That delay can matter.

My message is simple:

Finding a breast abnormality early does not guarantee that it is cancer. But ignoring it does not make cancer disappear.

“But nobody in my family has breast cancer.”

I hear variations of this argument frequently.

Family history certainly matters, but having no family history does not mean you cannot develop breast cancer.

In fact, the WHO reports that approximately 80% of breast cancers occur in women without specific risk factors other than being female and increasing age.

So, when someone says:

“Nobody in my family has ever had breast cancer, so I am safe.”

That conclusion is simply incorrect.

Inherited mutations in genes such as BRCA1, BRCA2, and PALB2 can significantly increase risk, and women with strong family histories may require individual risk assessment. However, hereditary disease represents only part of the breast cancer picture.

Who can develop breast cancer?

Anyone with breast tissue can potentially develop breast cancer.

Breast cancer overwhelmingly affects women, but men can develop breast cancer too. The WHO estimates that about 0.5–1% of breast cancers occur in men.

So, gentlemen, a persistent breast lump, nipple change, or unusual discharge should not be dismissed simply because you are male.

For women, risk generally increases with age.

Other established risk factors include obesity, alcohol consumption, tobacco use, previous radiation exposure, certain reproductive factors, some forms of postmenopausal hormone therapy, family history, and particular inherited genetic mutations.

But risk factors are not guarantees.

A woman can have several risk factors and never develop breast cancer. Another woman may appear perfectly healthy, exercise regularly, have no family history, and still develop it.

That is why awareness matters for everyone.

What should you actually look for?

Many people have been taught that breast cancer means finding a lump.

A lump is important, but it is not the only possible warning sign.

Pay attention to:

• A new lump or unusual thickening in the breast
• A lump or swelling in the armpit
• A change in breast size or shape
• Skin dimpling or puckering
• Unusual redness or changes in the breast skin
• Changes in the nipple
• A nipple becoming newly inverted
• Abnormal nipple discharge, particularly bloody discharge
• A persistent change that simply feels unusual for you

One particularly important point is that breast cancer does not always hurt. A suspicious lump may be painless.

So, please do not use pain as your test for seriousness.

Equally important, not every breast lump is cancer.

There are many benign breast conditions. However, you cannot reliably determine what a lump is simply by touching it at home.

If you discover something unusual, get it properly assessed.

Know what is normal for your breasts

I think breast awareness is more useful when people understand what it really means.

You do not need to live in fear, examining yourself every morning and worrying about every tiny difference.

Instead, become familiar with what is normal for your body.

Look at your breasts occasionally. Feel them. Know their usual appearance and texture.

That way, when something genuinely changes, you are more likely to notice it.

And if something does change, do not panic, but do not ignore it either.

Get it checked.

Now let me put on my medical physicist hat

One question people sometimes have is:

“Doesn’t mammography itself use radiation?”

Yes.

A mammogram uses low-dose X-rays to produce detailed images of breast tissue.

And yes, X-rays are ionising radiation.

So why would healthcare professionals deliberately expose someone to radiation while trying to detect cancer?

Because medicine is about balancing risk against benefit.

In medical physics and radiation protection, one of our fundamental principles is optimisation. We want enough radiation to produce an image of sufficient diagnostic quality while keeping exposure as low as reasonably achievable.

The radiation dose from a properly performed mammogram is low, while mammography can detect abnormalities before they become large enough to feel.

For women in populations where routine mammographic screening is recommended, the potential benefit of detecting breast cancer earlier generally outweighs the small radiation risk associated with the examination.

The WHO describes mammography screening particularly for women aged 50–69 in settings where organised screening and appropriate follow-up services are available. Individual recommendations may differ depending on national guidelines, age, family history, and personal risk.

So, please do not refuse a clinically appropriate mammogram simply because someone tells you:

“Radiation causes cancer, so mammography causes breast cancer.”

That statement removes radiation risk completely from its medical context.

Mammography is not the same as diagnosis

This distinction is also important.

A suspicious mammogram does not automatically mean that someone has breast cancer.

Further assessment may involve additional mammographic views, ultrasound, MRI in selected cases, and ultimately a biopsy if necessary.

The biopsy allows tissue to be examined by a pathologist.

This is where we begin answering some crucial questions:

• Is it actually cancer?
• What type of cancer is it?
• What biological characteristics does it have?
• Does it express oestrogen receptors (ER)?
• Does it express progesterone receptors (PR)?
• Does it express HER2?

These details matter because breast cancer is not one single disease.

Two women can both be told, “You have breast cancer,” yet require quite different treatments.

What happens if breast cancer is diagnosed?

This is where modern cancer management becomes multidisciplinary.

Depending on the tumour, its stage, biological characteristics, and the patient’s overall condition, treatment may involve:

• Surgery to remove the tumour or breast
• Chemotherapy to destroy cancer cells using anticancer drugs
• Hormonal therapy for cancers whose growth is driven by hormones
• Targeted therapy for tumours with particular molecular characteristics, such as HER2-positive cancers
• Radiotherapy to destroy cancer cells in a precisely defined region and reduce the likelihood of recurrence

Often, patients receive a combination of these treatments.

And this brings me to the part of cancer treatment closest to my profession.

What exactly does radiation do to cancer?

Radiotherapy uses carefully controlled doses of ionising radiation to damage the DNA of cancer cells.

If sufficient damage occurs, those cells lose their ability to continue dividing and eventually die.

Sounds simple?

It isn’t.

The challenge is delivering enough radiation to control the cancer while protecting healthy structures nearby.

For breast cancer, depending on the area being treated, these structures may include the heart, lungs, spinal cord, and the opposite breast.

This is where medical physics becomes critical.

Before treatment begins, the patient may undergo a CT simulation. The radiation oncologist defines the areas requiring treatment and the organs that need protection.

Then, a treatment plan is developed.

Behind that treatment are calculations involving beam energies, radiation dose distributions, treatment geometry, tissue densities, machine characteristics, and numerous safety checks.

As medical physicists, one of our responsibilities is essentially to help answer this question:

Can we deliver the prescribed radiation dose accurately to the intended target while keeping the dose to normal tissues within acceptable limits?

Modern radiotherapy can shape radiation remarkably precisely around a target.

But precision means very little without accuracy.

That is why radiotherapy machines undergo extensive quality assurance, calibration, and verification.

When we say someone is receiving, for example, a particular dose in Gray (Gy), there is a considerable amount of physics behind making sure that the machine actually delivers what was prescribed.

Will radiotherapy make me radioactive?

For the standard external-beam radiotherapy commonly used for breast cancer:

No.

The radiation is delivered while you are on the treatment machine. When the beam switches off and you leave the treatment room, you are not carrying that radiation around with you.

You can hug your children.

You can sit beside your family.

You are not going to irradiate the people around you.

I think misconceptions like this deserve much more public discussion because fear of treatment should never be created by misunderstanding the science.

What about removing the whole breast?

Another misconception is that every woman diagnosed with breast cancer must lose her entire breast.

Not necessarily.

Some patients may undergo breast-conserving surgery, often called a lumpectomy, followed by radiotherapy. Others may require a mastectomy, in which the breast is removed.

The appropriate option depends on several clinical factors.

The important thing is that treatment should be individualised.

Cancer treatment is not:

“My neighbour had this treatment; therefore, I should have the same treatment.”

Your neighbour’s cancer is not necessarily biologically or clinically identical to yours.

And please, let us talk about herbal remedies

This is particularly important in our part of the world.

I understand why people explore alternative treatments. Cancer is frightening. Treatment can be expensive. People worry about chemotherapy, surgery, and radiation. Families want hope.

But hope should not cost you valuable time.

If someone claims that a herbal preparation can completely cure breast cancer, ask for the evidence.

Not testimonials.

Not, “My auntie used it and she is fine.”

I mean properly conducted clinical evidence.

The biggest danger may not even be the herbal product itself. The biggest danger is sometimes the delay in receiving treatment that we already know can work.

If you want to use complementary approaches, discuss them with your cancer care team because some products can also interfere with conventional treatments.

Please do not disappear from oncology care because someone promised you a secret cure.

Can breast cancer be prevented?

Not completely.

That distinction matters.

You can reduce your risk, but there is currently no lifestyle that guarantees you will never develop breast cancer.

Maintaining a healthy body weight, exercising regularly, avoiding tobacco, and reducing alcohol consumption can contribute to reducing cancer risk.

But remember what I mentioned earlier: many women who develop breast cancer do not have an obvious modifiable risk factor.

So, prevention and healthy living are important, but they do not replace awareness and appropriate screening.

Something else we do not talk about enough: life after breast cancer

Cancer treatment does not end emotionally the day someone finishes chemotherapy or rings the bell after radiotherapy.

Survivors may deal with fatigue, body-image changes, fear of recurrence, sexual health concerns, lymphoedema, treatment-related effects, anxiety, and the challenge of returning to ordinary life.

Good cancer care therefore extends beyond destroying tumour cells.

It includes rehabilitation, psychological support, family support, follow-up, and survivorship care.

We should celebrate survival, but we should also support survivors.

My biggest concern is not simply breast cancer. It is delay.

Technology in cancer care continues to improve.

We have increasingly sophisticated imaging.

We have better radiotherapy planning.

We have more targeted drugs.

We understand tumour biology better than we did decades ago.

But none of these advances can fully compensate for a patient arriving extremely late because a suspicious lump was ignored for months.

This is particularly important for countries such as Ghana and many other African nations, where access to screening, diagnostic services, oncology specialists, and radiotherapy facilities can be more limited.

We therefore need to become very good at something surprisingly low-tech:

recognising warning signs and seeking appropriate care early.

If you remember only five things from this article...

Remember these:

1. A breast lump does not automatically mean cancer, but it deserves proper assessment.
2. Breast cancer can be painless. Do not wait for pain before seeking help.
3. Having no family history does not mean you cannot develop breast cancer.
4. Mammography uses radiation, but the dose is controlled, and the benefit of appropriate screening can greatly outweigh the radiation risk.
5. Early detection and timely, complete treatment can save lives.

And perhaps I would add a sixth:

Do not allow fear to make medical decisions for you.

My personal take

As a medical physicist, I spend a great deal of my professional life thinking about radiation, imaging, treatment accuracy, dose, and technology.

But breast cancer continually reminds me that sophisticated technology is only part of the solution.

The most advanced radiotherapy machine in the world cannot help a patient who never reaches the hospital.

The best mammography system cannot detect cancer in someone who never gets examined.

The most sophisticated treatment-planning software cannot recover months lost because someone was afraid to investigate a lump.

So, this Breast Cancer Awareness Month, my message is not simply:

Wear pink.

It is:

Know your body. Know the warning signs. Ask questions. Get suspicious changes checked. Encourage the women and men you love to do the same. And when medical care is needed, seek it early.

Sometimes the most powerful weapon against cancer is not a machine, a drug, or even radiation.

Sometimes it is simply not waiting too long.

Dr. Isaac Kwesi Acquah is a medical physicist and lecturer with interests in medical imaging, radiation therapy, artificial intelligence, and the application of physics to improving healthcare.