Awareness, early detection can save your life

Breast Cancer:

OCTOBER marks the world breast cancer awareness month. On average there are one million new breast cancer cases diagnosed per year in the world. It is the leading cause of cancer affecting women and the incidence is increasing.

Every year, thousands of women are told that they have breast cancer and we know of friends or relatives that are diagnosed with this treatable disease. It affects women of all ages, races and social classes.

In Brunei, there are on average 50 to 60 new patients diagnosed with breast cancer annually. It is unfortunate that most patients are presenting with advanced disease for which cure would be less likely.

Breast cancer can occur in man but this is rare. It represents only one per cent of all breast cancer cases diagnosed. The management is similar to that of female cases.

1. What is breast cancer?

The breasts are made up of many glands which are lined by tiny building blocks called cells, which can produce milk. For a poorly understood reason, sometimes one of these cells starts multiplying out of control and it can then produce a lump or tumour.

In some women it can take a very long time for the tumour to appear, usually three or four years, sometimes even longer than that.

Tumours can be either benign or malignant. Benign or innocent tumours remain growing in one area and do not spread.

Malignant tumours are made up of cancer cells which can spread to other parts of the body through the blood stream or the lymphatic system. There they can form new tumour called a recurrence, secondaries or metastases.

2. What causes breast cancer?

It is still unknown and the cause is not completely understood. Increasing age is the main factor influencing the risk of having breast cancer, although it does occur in younger patient.

Established risk factors for developing breast cancer are:

Previous history of breast cancer

Family history of breast cancer

History of benign breast disease

Early onset of menstrual period and late menopause

Exposure to ionising radiation at young age

There are other factors being suggested,

Diet rich in animal fats

Use of contraceptive pills and hormone replacement therapy

3. What are the symptoms of breast cancer?

Breast cancer is first noticed as a painless lump in the breast in majority of cases. However there are other signs to be aware of

Breast change in size or shape, dimpling of the skin, lump or thickening.

Nipple blood stained discharge, rash on nipple or surrounding area,

inverted ( turned in ), lump or thickening.

Arm swelling in the arm pit.

If a woman develops any one of this sign or symptom, she should go and see a doctor as soon as possible to get it checked out.

4. What are the tests available to diagnose breast cancer?

Mammography This is a process of x-raying the breast, and can detect cancer before it can be felt. This is currently the most sensitive method of detecting breast cancer at an early stage.

The disadvantage of this test is that it is limited by the density of the breast tissue, and in young women, where the breast tissue is dense, this is not useful. In older women, especially after the age of 50 years, the dense breast tissue becomes replaced by fat.

Hence mammography can easily detect any abnormalities at this age. It is not advised routinely for younger women. In Brunei, majority of breast cancer cases arise in women of age less than 50 years who are still menstruating. Routine mammography is therefore not useful.

Fine needle aspiration cytology This involves taking cells from the lump with a syringe and studied under a microscope. This procedure can be done in the outpatient clinic, and is rapid and painless. It is widely practiced in breast clinic all over the world.

When used in combination with clinical examination and mammography, the accuracy for diagnosing cancer is very good.

Other methods ultrasound examination, core needle biopsy and excision biopsy are different ways of getting tissues for examination.

5. What are the treatments available for breast cancer?

Once the diagnosis is confirmed, you will be seen by the surgeon and the oncologist (cancer specialist) who will discuss with you the options available.

There are many factors to consider which include your age, the type of breast cancer, the actual size and position of the lump as well as whether there has been any spread to the lymph glands under your arm.

This means that the most effective treatment is decided upon for each women individually.

Decisions about the choices of treatment are often made by both the hospital doctors and patient together.

Surgery there are two main types of surgery, mastectomy (removal of breast) and lumpectomy (removal of tumour lesion). In addition, lymph nodes of the armpit of the involved side are removed with both methods.

Radiotherapy This is a local treatment for breast cancer. It has been shown in studies that this is necessary to prevent local relapse after surgery. Patients are sent to Overseas centre for this treatment which is not currently available in Brunei.

Chemotherapy This is treatment with anti-cancer drugs. They can kill cancerous cells as well as affecting normal cells.

It is used most often after surgery for women who have not yet had their menopause and who are thought to be at an increased risk of developing a recurrence of the disease. It is given as an injection into a vein or as tablets.

Hormone treatment This will blocks the effect of oestrogen on cancer cells and causes them to die. At present, a drug called Tamoxifen is given as tablet once a day for up to five years.

6. What are the side effects of these treatments?

Radiotherapy there are few or no side effects. You may feel more tired than usual. Sometimes the skin becomes red and sore like sunburn. This will settle with simple treatment.

Some will notice an alteration in their skin texture and/ or sensation. These can occur much later on after completing radiotherapy.

Chemotherapy There are many different types of drugs available and each has different side effects. As every woman is an individual, it means that people react differently to the treatment.

Common side effects that can be encountered are nausea, vomiting, disturbance of menstrual periods, tiredness, reversible hair loss, mood swings etc. some of these side effects can be controlled with medications.

Surgery Skin of the breast may feel tight, muscles of the arm and shoulder may be stiff. There may be numbness and tingling in the underarm, arm and shoulder. Also the arm may be swollen after surgery to the armpit.

7. What should I do to look out for breast cancer and where can I

get help?

A woman should perform regular breast self examination (BSE). This can be done once a month and at the same time every month. It is best done seven to 10 days after the onset of menstruation.

If you find any abnormality as stated previously, you should go and see a doctor at the nearest clinic for further tests.

Ministry of Health has published a leaflet on BSE which is available in government clinics and hospitals.

You need not panic as nine out of 10 breast lumps are benign. However awareness and early detection can save your breast and life.

The author is a Specialist Oncologist at the National Cancer Centre Courtesy of National Cancer Centre