THE DOCTOR SAYS: By DR MILTON LUM
BREAST cancer is the commonest cancer in women in most parts of the world. There is a geographical variation with the highest incidence in North America and North Europe, an intermediate incidence in South America and South Europe. The incidence is lower in Asia and Africa.
According to the Second Report of the National Cancer Registry, there were 3,738 cases in 2003. It is the commonest cancer in all ethnic and age groups of Malaysian women, comprising 31% of all cases. The peak incidence is in the 50 to 59 age group, with a decline in older groups; 64.1% of all cases were diagnosed in women aged between 40 and 60 years.
Experience worldwide has shown that its early detection and treatment help in making possible a high cure rate.
What is breast cancer?
Most breast lumps are not cancerous (benign). They can be removed and in most instances, do not come back to threaten life.
Breast cancers nearly always develop in lobular or ductal tissue and not the fat. Ductal cancer is most common. The abnormal cells can spread (metastasise) outside the breast to surrounding structures. If this happens, it means that the cancer may have spread to other parts and organs, for example, bones, liver or lungs.
The term stage is used by doctors to describe the extent of the cancer. There are four stages viz:
Stage 0 – non-invasive carcinoma or carcinoma in situ. Lobular carcinoma in situ refers to abnormal cells in the lining of a lobule. It seldom becomes invasive but its presence indicates that the person has an increased risk of developing breast cancer.
Ductal carcinoma in situ refers to abnormal cells lining a duct. The cells have not spread beyond the duct to invade surrounding breast tissue.
Stage 1 – the cancer is not more than 2cm across and it has not spread beyond the breast.
Stage 2 – the cancer may not be obvious but it has spread to the axillary lymph nodes; or the cancer is between 2-5cm, with or without spread to the axillary lymph nodes.
Stage 3 – the cancer may not be obvious but it has spread to the axillary lymph nodes and lymph nodes near the breastbone or other tissues near the breast, or it is more than 5cm across.
Stage 4 – the cancer has spread beyond the breast and axillary lymph nodes to other parts of the body. Risk factors
The exact causes of breast cancer are not known. Studies have shown that breast cancer increases with increasing age. Most patients do not have any of the risk factors listed below, apart from the risk of increasing age.
A woman’s chances of getting breast cancer are increased in the following conditions:
Women who have had breast cancer have an increased risk of getting breast cancer in the other breast.
Women whose mother, sister or daughter had breast cancer.
Changes in genes like BRCA1, BRCA2 and others increase the risk. Gene testing in families in which there is breast cancer may sometimes show the presence of genetic changes that increase the risk. In women who have these genetic changes, doctors may suggest ways to try and delay or prevent the development of breast cancer, to improve detection.
There is evidence to suggest that the longer a woman is exposed to estrogen, the more likely she may develop breast cancer, that is, the risk is somewhat increased in those whose periods began early (before 12 years), had a late menopause (after 55 years) or who took hormone replacement therapy for the long-term (more than 3-5 years).
Certain breast changes like atypical hyperplasia or lobular carcinoma in situ increases the risk.
Breast cancer is more likely to occur in breasts that have more lobular and ductal tissue. Such breasts appear dense on mammograms.
Women who have their first child late (after 30 years) have an increased risk than women who have a child at a younger age.
Women whose breasts were exposed to radiotherapy before 30 years, especially those who had radiotherapy for Hodgkin’s disease, have an increased risk. The younger a woman had radiotherapy, the higher will be her risk of breast cancer in later life.
Some studies suggest a slightly increased risk in women who consume alcohol; have a diet rich in animal fats; are obese after menopause and who are in the higher socio-economic group. Symptoms
There maybe no symptoms at the initial stages of the development of breast cancer. As it grows, it can cause changes, which every woman should be aware of:
thickening or lump in or near the breast or armpit (axilla)
change in the size, shape or outline of the breast
dimpling, ridges or pitting (skin appears like that of an orange)
change in the appearance or feel of the skin of the breast, nipple or areola e.g. warm, swollen, red or scaly
nipple discharge or tenderness
nipple pulled back (retracted) into the breast If there is one or more of the above symptoms, a doctor should be consulted without delay. In most instances, it may not be cancer but it is important that any problems are diagnosed and treated as soon as possible.
Dr Milton Lum is Chairperson of the Commonwealth Medical Trust. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
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