Did you know that breast cancer afflicts more than two million women in the world each year and is the second leading cause of cancer deaths among women worldwide?
In Malaysia, it is the most common form of cancer affecting women with about one in 19 women in this country. Of the new cases of female breast cancer reported in Malaysia, more than 60% were women between the ages of 40 and 60. (National Cancer Registry 2007-2011).
Breast cancer happens when the cells in the lobules (milk producing glands) or the ducts become abnormal and divide overwhelmingly. These abnormal cells begin to attack the surrounding breast tissue and may eventually spread via blood vessels and lymphatic channels to the lymph nodes, lungs, bones, brain and liver.
Most women in Malaysia present with a lump in the breast. The lump is usually painless, grows slowly and may alter the contour or size of the breast. It may also cause skin changes, an inverted nipple or bloodstained nipple discharge. The lymph gland in the armpit will be swollen if affected by the cancer cells. In late stages, the growth may ulcerate through the skin and become infected. Bone pain, tenderness over the liver, severe headaches, shortness of breath and a chronic persistent cough may be an indication of the cancer spreading to the other organs in the body.
How is diagnosis made?
A diagnostic mammogram can help determine if these symptoms are indicative of the presence of cancer. Such signs may include:
- A lump
- Breast pain
- Nipple discharge
- Thickening of skin on the breast
- Changes in the size or shape of the breast
A breast ultrasound is a scan that uses penetrating sound waves that do not affect or harm the tissue and cannot be heard by humans. The breast tissue deflects these waves causing echoes, which a computer uses to paint a picture of what’s going on inside the breast tissue.
During a breast MRI, a magnet connected to a computer transmits magnetic energy and radio waves (not radiation) through the breast tissue. It scans the tissue, making detailed pictures of areas within the breast. These images help the medical team distinguish between normal and diseased tissue.
What is a biopsy?
A breast biopsy is a test that eliminates tissue or sometimes fluid from the suspicious area. The removed cells are examined under a microscope and tested further to check for the presence of breast cancer. A biopsy is the only diagnostic procedure that can certainly conclude if the suspicious area is cancerous. The good news is that 80% of women who have a breast biopsy do not have breast cancer.
There are three types of biopsies:
- Surgical biopsy
- Core-needle biopsy
- Fine-needle aspiration
The latter two are the most commonly used on the breast.
Abnormal cells in an area of body and may develop into cancer in future, also known as Carcinoma In Situ.
Cancer is relatively small and contained within the organ it started.
Cancer has not spread into surrounding tissues but cancer cells may have spread into lymph nodes close to the tumour.
Cancer may have spread to surrounding tissues and lymph nodes in the area.
Cancer has spread from where it started to another organ. This is also known as secondary or metastatic cancer.
Survival rates tell you what portion of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed.
The 5-year relative survival rate for women with stage 0 or stage I breast cancer is close to 100%.
For women with stage II breast cancer, the 5-year relative survival rate is about 93%.
The 5-year relative survival rate for stage III breast cancers is about 72%. But often, women with these breast cancers can be successfully treated.
Breast cancers that have spread to other parts of the body are more difficult to treat and tend to have a poorer outlook. Metastatic, or stage IV breast cancers, have a 5-year relative survival rate of about 22%. Still, there are often many treatment options available for women with this stage of breast cancer.
Treatment options for breast cancer are usually discussed with oncologists or cancer specialists. While the treatment of breast cancer is standard, the oncologist will assess each patient and recommend the appropriate therapy. The oncologists will also be able to advice on some of the new development in the management of breast cancer.
Surgery for breast cancer can be conservative (removing the lump or a segment of the breast only) or may be in the form of a mastectomy (removing the whole breast). In both instances, the glands in the armpit need to be removed and checked for the presence of cancer cells.
Radiotherapy is often combined with surgery with high doses of radiation used to kill cancer cells. This is a localised form of treatment and is mandatory after conservative surgical treatment. It is only given after a mastectomy if the breast tumour is locally extensive. Radiotherapy reduces the risk of local recurrence rate. Radiotherapy is sometimes used as a palliative treatment to control bone pain, bleeding or pressure symptoms.
Radiosurgery (Cyberknife) System enables precise dose distributions to be confidently delivered to the patient with extreme accuracy over a minimum number of treatments, reducing side effects and preserving patient’s quality of life. Unlike any other radiation delivery system, the Cyberknife technology continually tracks and automatically adjusts the beam for movement in real-time, as the patients breaths normally, throughout the entire treatment session. The system’s sub- millimetre accuracy enhances clinicians abilities to treat effectively while preserving health tissue. This could become an important option in the treatment of women with early-stage breast cancer.
External beam radiation therapy (EBRT), the radiation is usually delivered by a machine called a linear accelerator, or linac, which focuses a high-energy x-ray beam to the tumor site from outside the body. Whether you have had a lumpectomy or a mastectomy as part of your treatment, external beam radiation is the most common treatment post-surgery.
Chemotherapy is a treatment option that involves the use of drugs given by injection or, occasionally, orally. It treats the cancer by penetrating the tissues and organ via the bloodstream. These drugs are toxic to the cancer cells but they may also cause some side effects to the normal tissues.
In the early stages, chemotherapy is used as an added treatment to improve the outcome and cure rates. At Beacon Hospital, we understand that chemotherapy treatment can be a major financial burden for the underprivileged patients. Hence, we introduced the Beacon Chemotherapy Welfare Fund for early stage breast cancer patients.
In later stages of breast cancer, chemotherapy is used to control the rate of growth of the tumour and to downsize the bulk of the disease. The use of chemotherapy may also help to control symptoms, prolong survival and improve the quality of life.
The exact cause of breast cancer is unknown. Women with a family history of the disease have an increased risk of getting breast cancer. Carriers of the BRCA I and BRCA II genes, especially, have at least a 40% to 85% risk of getting cancer. Other risk factors include exposure to radiation, a history of benign breast lumps, obesity, high fat diet, early menarche and late menopause. (National Cancer Institute)
As with most cancers, the earlier breast cancer is detected and diagnosed, the better the chances of successful treatment. Research has shown that screening mammography with or without clinical breast examination may decrease the mortality of breast cancer.
A mammogram can detect small cancerous lumps which may be missed in a clinical examination. A mammogram is recommended for women above the age of 50. For high-risk women (with family history), screening is advisable at an earlier age (40-49 years old).
Mammography is advisable every one to two years but for younger women (below 35), the ultra sound scan of the breast may be helpful for patients with symptoms. (National Cancer Institute)
Breast cancer is potentially curable if detected early. Clinical or self-examination combine with screening mammography can detect the disease early. With appropriate treatment, cure rates are encouraging.