Breast Cancer

Breast cancer is detected when cells grow abnormally in the breast. They often manifest as a tumour that can be seen on an x-ray or felt as a lump.

What is Breast Cancer?

Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

The risk of cancer increases with age, especially above 40 years of age for the pre-menstrual group and above 50 for the post-menstrual group. Having said this, there have been cases of breast cancer afflicting younger women (men).

Breast cancer is the most well-researched form of cancer and if detected early, is highly treatable.

Risks of Breast Cancer:

  • Gender - females are at a higher risk of developing breast cancer
  • Age – more cases are recorded in women above 40 years of age
  • Family history – the risk is higher in women with breast cancer among young first-degree female relatives (sister, mother, daughter). Carriers of the BRCA1 and BRCA2 genetic mutation are at high risk to develop future breast cancer
  • Radiation exposure – multiple exposures to radiation in the chest area at a young age increases the risk for breast cancer
  • Menstrual history - girls who start menstruating (having periods) younger than age 12 have a higher risk of breast cancer later in life. The same risks applies to women who go through menopause when they're older than 55
  • Reproductive factors – late pregnancies (after 30 years of age), using oral contraception (high dose) or combination hormone replacement therapy
  • Breast density - the risk of breast cancer increases as the amount of dense tissue in a breast increases
  • Lifestyle – frequent consumption of alcohol poses a risk for breast cancer
  • Obesity - a body mass index of more than 25 has an increased risk to develop breast cancer with a higher death rate. A small waist and waist-hip ratio (WHR) give a significant protection against breast cancer in pre-menopausal women

In Malaysia, approximately 1 in 19 women are diagnosed with breast cancer.

Symptoms of Breast Cancer

Just like other parts of the body, it is important to pay attention to any changes in the breast, appearance-wise or internally.

Some key symptoms to look out for:

  • Nipple tenderness
  • A change in the skin texture or an enlargement of pores in the skin of the breast (some describe this akin to an orange peel's texture)
  • A lump in the breast (it's important to remember that all lumps should be investigated by a healthcare professional, but not all lumps are cancerous.)
  • Any unexplained change in the size or shape of the breast
  • Dimpling anywhere on the breast
  • Unexplained swelling of the breast (especially if on one side only)
  • Unexplained shrinkage of the breast (especially if on one side only)
  • Recent asymmetry of the breasts (Although it is common for women to have one breast that is slightly larger than the other, if the onset of asymmetry is recent, it should be checked.)
  • Nipple that is turned slightly inward or inverted
  • Any nipple discharge—particularly clear discharge or bloody discharge

Regular screening is always important for early detection and better chances of treating breast cancer and for survival.

What types of screenings are available:

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Breast self-examination (BSE)

All women (and men) should practice a monthly BSE as early as 18 years of age. This practice helps detect any abnormalities with the breast and is used to detect breast cancer.

How do I perform a BSE? (suggest including images)

  • Do your BSE at the end of your monthly period.
  • If you are pregnant, no longer have periods or your period is irregular, choose a specific day each month.
  • This should not be performed in the shower or with lotion on your skin or fingers.
  • Should you find a lump or notice any other abnormalities, don't panic. About 80% of lumps found are not cancerous. See your doctor promptly for further evaluation.

Mammogram

A mammogram is a low-dose x-ray that detects changes in breast tissues. They are usually performed in women who do not display any breast problems or in women have some symptoms. The Ministry of Health (MoH) Malaysia recommends an annual mammography for all women above the age of 50.

Ultrasound

For women below the age of 50, an ultrasound is recommended to detect any abnormalities of changes in the breast tissue.

Biopsy

If there are any changes detected in the breast tissue, a further examination of the tissue is done to rule out breast cancer. A biopsy is the only sure way to diagnose breast cancer. A cell from the area is removed and studied to determine this.

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Treatment options

Lumpectomy
Mastectomy
Radiation Therapy
IORT
Chemotherapy
Hormone Therapy
HER2-Targeted Therapy

Lumpectomy

A lumpectomy is a surgery to remove a portion of the breast that displays cancer cells. Your doctor may recommend a lumpectomy if the portion infected is small and has not spread to other parts of the breast.

After a lumpectomy is done, your doctor may still recommend some form of radiation or chemotherapy. These will all depend on the characteristics of the tumour.

Mastectomy

A mastectomy is the removal of the entire breast. Your doctor will recommend a mastectomy on occasion if the size of the tumour is large or the patient has displayed high risk of recurrence.

Radiation Therapy

Radiation Therapy uses high-energy radiation from x-rays to kill cancer cells and shrink tumours.

IORT

The Intraoperative Radiation Therapy (IORT) delivers concentrated dose of radiation therapy during surgery (intra-operative) directly to the site of the tumour when the tumour has just been removed. This reduces side effects and most patients will not need to undergo any additional radiation therapy later.

Under IORT treatment, a patient only undergoes a single dose of radiotherapy, lasting 30 to 40 minutes during the surgery, and thus eliminating the need for additional visits. Since the radiation is delivered precisely to the tumour site in the breast, the surrounding healthy tissue and organs, receive much less radiation exposure than a conventional whole-breast radiation treatment.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. Chemotherapy drugs kill fast-growing cells throughout the body, including cancer cells and normal cells.

Hormone Therapy

Hormonal therapy is an effective treatment for most tumours that test positive for either oestrogen or progesterone receptors (called ER positive or PR positive). Hormones can cause breast cancers to grow and so hormone therapy can be used to slow tumour growth.

HER2-Targeted Therapy

About 20% to 25% of breast cancers have an excess of a protein called human epidermal growth factor receptor 2 (HER2). This protein makes tumour cells grow. There might be higher amounts of HER2 in your breast (HER2+). If this is the case, it is called HER2- positive breast cancer. HER2-targeted therapy is drug therapy that treats HER2+ breast cancer.

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