What is Breast Cancer?

Breast cancer is detected when cells grow abnormally in the breast. They often form a tumour that can be seen on an x-ray or felt as a lump. Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

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

Breast cancer is the most well researched forms of cancers and if detected early, it is highly treatable.

Risks of breast cancer:

  • Age – more cases are with women above 40 years of age.
  • Family history – slight risk if family members have been diagnosed with breast cancer
  • Radiation exposure – multiple exposures to the chest area at a young age, increases the risk for breast cancer
  • Reproductive factors – late pregnancies (after 30 years of age), using oral contraception (high dose) or combination hormone replacement therapy
  • Breast density
  • Lifestyle – consuming alcohol (beer more so), more than 10g/day poses a risk for breast cancer, obesity

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 or a lump or thickening in or near the breast or underarm area
  • 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
  • Skin of the breast, areola, or nipple that becomes scaly, red, or swollen or may have ridges or pitting resembling the skin of an orange
  • 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 screening are available and recommended:



Breast-self examination

All women (and men) should practice a monthly breast self-examination 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 breast self-examination? (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.
  • If 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. Usually they are 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. Not all biopsies result in cancer.


Treatment options

IORT

Radiation

Lumpectomy

Mastectomy

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. The benefits and risks of choosing a lumpectomy vs mastectomy is almost similar.

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 tumor.

Mastectomy

A mastectomy is the removal of the entire breast including breast tissue and other nearby tissues. Sometimes your doctor will recommend a mastectomy if the size of the tumor is large or the patient has displayed high risk of recurrence.

If you are not in favour of undergoing a mastectomy, speak to your doctor to understand available options. These include undergoing radiation therapy to reduce the tumor size and undergoing a lumpectomy, choosing IORT (if patient fits the criteria), or undergoing a mastectomy and reconstructive surgery to keep the women’s appearance intact.

IORT

The Intraoperative Radiation Therapy (IORT) delivers concentrated dose of radiation therapy during surgery (intra-operative), directly to the site of the tumor when the tumor has just been removed. This reduces side effects and most patients won’t 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, thus eliminating the need for additional visits. Since the radiation is delivered precisely to the tumor site in the breast, the surrounding healthy tissue and organs, receive much less radiation exposure than a conventional whole-breast radiation treatment.