Power of Early Detection

01 October 2023

The World Health Organization (WHO) reported that in 2020, 2.3 million women were diagnosed with breast cancer. In addition, according to Malaysia’s Breast Cancer Foundation, approximately one out of every 19 Malaysian women face the risk of developing breast cancer.

This alarming statistic highlights the pressing concern of breast cancer in Malaysia, where it ranks as the leading health issue among women due to its high mortality and morbidity rates.

Recognising the importance of this issue, consultant clinical oncologist Dr Christina Lai at Sunway Medical Centre, Sunway City emphasises the critical role of raising breast cancer awareness.

Don’t turn a blind eye

Breast cancer is characterised by abnormal cell growth in breast tissue which results in the formation of a tumour. Although men can also be affected, it usually occurs in women.

Common types of breast cancer include:

> Ductal Carcinoma in Situ (DCIS) - Pre-cancer that starts in the milk ducts and has not spread into the rest of the breast tissue

> Infiltrative ductal carcinoma - Originates from the cells lining the milk ducts and has spread into surrounding breast tissue

> Infiltrative lobular carcinoma - Arises from cells within the milk-producing glands known as lobules and has spread into surrounding breast tissue

Some commonly recognised symptoms of breast cancer include the presence of a lump or mass in the breast or underarm area, changes in breast size or shape and nipple abnormalities such as inversion, discharge or scaling.

Dr Lai points out that there are signs that might be overlooked as people may not readily associate them with breast cancer.

She explains, “A lot of people would not notice right away if there are changes on the skin, such as the appearance of rough patches similar to an orange peel. They may think it’s an allergic reaction. If the breasts suddenly become very hot, inflamed and red, you might dismiss it as an infection and not think too much of it. But it could be a condition called inflammatory breast cancer.”

Recognising these less obvious symptoms is crucial for early detection and prompt medical intervention.

Assess your risks

Breast cancer risk factors can be divided into modifiable and non-modifiable categories. Modifiable factors include a high-fat diet, not being physically active, smoking, drinking alcohol and long-term usage of hormone replacement therapy (HRT) or oral contraceptive pills.

Dr Lai stresses, “Especially for young women seeking contraception, instead of purchasing it over the counter, it's advisable to consult a healthcare professional who can thoroughly review your medical history, assess risk factors and recommend the appropriate type and dosage of contraceptive pills."

Additionally, certain modifiable factors are tied to reproductive history. Factors such as having a first pregnancy after age 30, not breastfeeding and never having a full-term pregnancy can all raise the risk of getting breast cancer.

Meanwhile, non-modifiable factors include factors such as age, genetic mutations, family history, having dense breast tissue, as well as the ages at which menarche (the first menstrual period) and menopause occur.

Dr Lai also addresses common misconceptions about breast cancer, including the myth that it only affects older women. In reality, breast cancer can affect women of all ages, with the risk increasing with age. She also dispels myths related to factors like soy consumption, wired bras and deodorants, emphasising the importance of evidence-based information.

She further explains, "Most of the time, people think, 'Oh, I have small breasts. My risk of cancer is very low.' No, you are at risk as long as you have breasts. However, the opposite belief is correct. If you have bigger breasts, your risk of breast cancer is a bit higher because there's more breast tissue there."

Safeguarding your well-being

The early detection and prevention of breast cancer are critical components of women's healthcare. Aside from addressing the modifiable factors, women can employ a range of strategies to empower themselves in taking charge of their breast health.

Performing monthly breast self-exams starting in your 20s is a simple yet effective way to become familiar with your breast tissue. Here's a step-by-step guide:

> Stand in front of a mirror and visually inspect your breasts for any changes in size, shape or skin texture. Check for any visible lumps or dimplings.

> Raise your arms and repeat the visual inspection.

> Check for any nipple discharge, changes in nipple appearance or discomfort.

> Finally, while lying down, use your fingertips to gently palpate your breast tissue. Move your fingers in a circular motion, covering the entire breast and armpit area. Pay attention to any lumps or unusual changes in texture.

Mammography & ultrasound

Mammograms are specialised X-ray screenings aimed at detecting breast abnormalities, serving as a vital tool in breast cancer detection, especially for women aged 40 and older. These screenings can uncover potential tumours or calcifications represented as white spots, which can indicate precancerous conditions like DCIS even before they are detectable through manual breast self-examination.

For women under 40, especially those with dense breast tissue, combining breast ultrasound with mammography can significantly improve the accuracy of detection. Ultrasound provides an additional imaging technique that effectively identifies abnormalities that might not be visible on a mammogram alone.

While some women may prefer ultrasound over mammograms due to the perceived discomfort of the latter, Dr Lai recommends a combination of both methods for a more comprehensive evaluation and this should be done once a year.

She elaborates, “When white spots are identified on your mammogram, a biopsy is often recommended. This proactive approach is crucial because if left untreated, there is a 70% to 80% likelihood that these precancerous findings will progress to cancer within a decade.”

This underscores the importance of screening as it enables early detection at stage zero, allowing for timely intervention before the condition escalates to cancer.

“If you are nervous about the process, my advice is to bring a friend along. Doing it together with someone you trust can make it a lot less intimidating. You don't have to face it alone. It's also important to keep in mind that not all breast lumps turn out to be cancer. Actually, only about 10% to 20% do. Even if it does turn out to be cancer, early detection makes a huge difference. It often means less invasive treatments and a better outcome. Waiting too long to get checked can make things more complicated, potentially involving more extensive surgery and treatments. It’s always better to catch it early.”

Customised care

When it comes to breast cancer, timely and appropriate treatment plays a pivotal role in improving outcomes and increasing survival rates. Treatment strategies for breast cancer can vary significantly based on factors such as the type and stage of cancer, as well as individual patient considerations.

Surgery is often the initial step, which could be lumpectomy (breast-conserving), oncoplastic (breast-conserving with reconstruction) or mastectomy (complete breast removal). Additionally, lymph nodes in the armpit may be examined for cancer spread.

When cancer has advanced or presents a high recurrence risk, chemotherapy may be prescribed. This is to either kill cancer cells or prevent their growth and can be administered intravenously or as oral medication.

Targeted therapy is a precise treatment method that specifically targets the proteins or genes responsible for promoting cancer growth. This approach minimises damage to healthy cells and proves especially effective for HER2-positive breast cancers.

Dr Lai emphasises, “It's important to note that treatment plans are highly individualised and a multidisciplinary team of healthcare professionals collaborate to determine the most suitable approach for each patient.”

In addition, regular follow-ups and monitoring are done to ensure progress is tracked and to promptly address any potential side effects or complications, which is of utmost importance.

With advancements in treatment options and early detection efforts, more women are surviving breast cancer and leading healthy, fulfilling lives after diagnosis. Make your health a priority and be sure to get regular check-ups and screenings without delay.

For more information, contact 03-7491 9191.

Source: The Star

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