Breast Cancer

Breast cancer occurs when there is an abnormality of tissue growth that leads to a lump. Cell located in the breast rapidly multiples and produces additional tissues. There are two types of tumours which are benign that is non-cancerous or malignant where it's cancerous. It is possible for cancerous cells to spread around within the breast area, to the lymph nodes (glands) in your armpit, and to other areas in the body.

Causes
The cause of breast cancer is still not clearly known. Women who have a strong family history of breast cancer are more susceptible to the disease or those who started menstruation early in their life. Regular female hormones manage the division of cells within the breast and might trigger the development of breast cancer. Women who are over 40 years and abover are also prone to having breast cancer as compared to those who are younger.

Symptoms

The signs and symptoms of breast cancer might include the following:

  • A painless lump in the breast.

  • Bleeding or unusual discharge from the nipple.

  • Dimpled or puckered skin over the breast

  • Persistent itch and rash around the nipple.

  • Pulled in or retracted nipples.

  • Swollen and thickened skin over the breast.


Types of breast cancer
  • Non-invasive Breast Cancer

    A precancerous condition that is limited to the ducts is known as Ductal Carcinoma-In-Situ (DCIS) whereas invasive cancer with a risk factor is called Lobular Carcinoma-In-Situ (LCIS) (lobules).

  • Invasive Cancer

    This is a condition whereby When the cancer has grown past the ducts or lobules and affected the surrounding tissues, it is classified as an invasive cancer. If the tumor is relatively small and has not spread to the lymph nodes in the early stages, it is usually treatable.

  • Metastatic Breast Cancer

    When the cancer has spread to other parts of the body, especially when cancer cells are detected in the lymph nodes under the arm, it is called metastatic breast cancer. At this point, there is a risk of it spreading to other lymph nodes and organs such as the bones, liver or lungs.

Breast Cancer Screening

The purpose of screening is to identify signs breast cancer before the symptoms are very noticeable and it is usually done to detect the cancer earlier so it can be treated and cured. Kindly note that should your doctor recommend a screening test, this does not in any way indicate that you already have cancer. Screening can be performed even though you do not display any cancer symptoms.

Women 39 years and below should undergo a Monthly Breast Self-Examination; whilst women 40 years and above should undergo a Monthly Breast Self-Examination and Annual Mammography Screening. 

Screening can be divided into 5 types:

Breast Self-Examination (BSE)

Begin by examining your body:

  • Stand opposite a mirror and scrutinise your breasts, taking note of their unique shapes and dimensions 
  • Then, raise your arms above your head and look at your breasts once more
  • Next, put your hands on your hips and press inwards to harden the muscle under your breasts
  • Observe closely to note any noticeable differences in your breasts

  • Then, palpate:

    • Start from your underarm and check your breast in concentric circles, beginning from the outer region to the nipple
    • Your breasts should also be palpated in vertical movements
    • Gently squeeze your nipples to check for any abnormal discharge
    • Now, place your arm at the side, then check for lumps under your armpit again using your free hand
  • Clinical Breast Examination (CBE)

  • Clinical Breast Examinations are performed by certified doctors. While checking your own breasts is a good practice, do remember to get your breasts examined by a doctor at least once a year, because he/she may be able to spot differences that you might have missed.

    Your doctor will scrutinise the size, shape and texture of any lump (if there is one) and also if it moves easily. For your information, benign lumps differ from cancerous ones as they are often soft, smooth, round and movable. A malignant lump often feels hard, is oddly shaped and feels firmly attached within the breast.

  • Screening Mammogram

  • Essentially an X-ray of the breast, the mammogram is the current Gold Standard for detecting around 90% of breast cancers at a very early stage. A mammogram may involve a small amount of pain, when the breast is squeezed, but this is important to obtain good pictures and most importantly, the pain is just for a few seconds only.

    Please note that there can be situations where the breast symptom that you display is NOT detected via a mammogram. In this instance, your doctor may recommend an ultrasound and if necessary, a biopsy, as a necessary precaution.

  • Ultrasound

  • An ultrasound device works by sending out sound waves which bounce off tissues and a computer then uses the echoes to create a picture which can be inspected via a monitor by your doctor. The pictures could indicate whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac and while cysts are not cancer, a solid mass could be cancer. This exam can be used in conjunction with a mammogram.

  • Biopsy

  • A biopsy involves removing fluid or tissue from your breast to check for cancer and there are times when it is necessary for your doctor to refer you to a surgeon or breast disease specialist for one. A mammogram may reveal some suspicious areas, which cannot be felt during a clinical breast exam. Other methods include imaging procedures to help see the area and remove the tissue and may involve ultrasound-guided, needle-localized, or stereotactic biopsy.

    Tissue from your breast can be removed in different ways:

    • Fine-needle aspiration: A thin needle is used to remove fluid from a breast lump. Fluid with cells are then vetted for cancer with a microscope by a pathologist at a lab. If the fluid is clear, it may not need to be checked by a lab.

    • Core biopsy: Also known as a needle biopsy, the procedure involves using a thick needle to remove breast tissue, which is then checked for cancer cells by your pathologist.

    • Surgical biopsy: Your surgeon removes a sample of tissue with an incisional biopsy from a lump or abnormal area, which is then checked for cancer cells by your pathologist. An excisional biopsy involves taking the entire lump or area.

Treatment

Surgery might be required to remove the tumour.

Breast conserving surgery:

  • A lumpectomy which removes the cancer and surrounding tissue.

  • A quadrantectomy which removes one-quarter of the breast that has the lump.

  • Masectomy which removes the whole breast.

Alternative treatments:

  • Chemotherapy

  • Hormone therapy

  • Targeted therapy

  • Radiation therapy (high-energy x-rays) to kills the cancer cells

  • Rehabilitation

  • Nutrition and lifestyle support to help you recover

  • Shoulder exercises and arm care to avoid stiffness and swelling

Frequently Answer Questions (FAQs)

Does the risk of breast cancer reduce with physical activity?

Your immune system gets a boost and your weight can be better controlled with exercise. Did you know that with just three hours of exercise per week, i.e. approximately 30 minutes a day, a woman can begin to lower her risk of breast cancer!


Can I prevent breast cancer by maintaining a healthy diet?

To reduce your risk of developing breast cancer, start eating plenty of fruits, green and orange vegetables and maintaining a nutritious, low-fat diet. Fat triggers estrogen production that can spur tumor growth and increase the risk, hence it's good to have a low-fat diet.


Can breast cancer be caused by smoking?

Smoking has been shown to be a contributing risk factor for developing breast cancer through recent research in the last year (2012). Another risk factor is second hand smoke. More significantly, other heart and lung diseases have also been linked directly to smoking.


How many times should I perform a breast self-exam?

The optimal frequency to perform a breast self-exam is once a month, where you should be looking for any changes in breast tissue, and size. Take note of any distinct lumps, dimpling or puckering of the breast, inversion of the nipple, redness or scaliness of the breast skin, nipple/areola area, or discharge of secretions from your nipples.


Am I at higher risk if I have a family history of breast cancer?

In reality, a mere 5-10% of individuals diagnosed with breast cancer possess a family history of this illness.


Is it painful to undergo a mammogram?

As the mammography procedure requires squeezing he breasts, this may cause slight discomfort for short moment. One way to overcome this is to schedule your mammogram one week after your menstrual cycle because your breasts will be less tender during that time.


Is breast cancer risk affected by my menstrual and reproductive history?

You may be at higher risk if you fit the following criteria: began your menstrual cycles before age 12, have no biological children, or had your first child at age 30 or older, or began experiencing menopause after 55. The number of menstrual cycles a woman has over time also influences risk, according to research.


Can the risk of breast cancer be reduced by breastfeeding?

The risk of developing breast cancer can be reduced by breastfeeding.


Is breast cancer risk affected by breast size?

There is no solid evidence to support the notion that breast cancer risk is affected by breast size. However, radiologists find that mammograms are harder to read when it involves dense breast tissue.


How can I handle the side effects brought on by breast cancer treatments?

For a start, you could request for steroids to help reduce radiation-induced swelling from your radiation therapist. Another approach would be to change your chemotherapy medication or go for a lower-dose prescription to help reduce nausea, vomiting, diarrhea or constipation. To protect yourself against chemotherapy- and radiation-induced heart and lung damage, you can also take preventive medications.


How can I know if my breast cancer has spread?

Metastatic breast cancer is a secondary cancer, i.e. the cancerous cells begin in breast tissue
and then spread to other parts of the body. Among the more common areas of breast cancer metastasis would be the bones, lungs and liver.


Tips (Breast care to-do list)

  1. Perform a Breast Self-Examination (BSE) consistently every month
  2. Schedule a Clinical Breast Examination (CBE)
  3. Get a mammogram once a year
  4. Scrutinise your family history
  5. Maintain a healthy weight / lifestyle
  6. Exercise consistently
  7. Consume less red meat & fat
  8. Avoid / reduce consumption of alcohol 
Myths vs Facts on Breast Cancer
    • MYTH: My family has no history of breast cancer, that means I’ll never get it.
    • FACT: Most people diagnosed with breast cancer have had no prior family history of it.

    • MYTH: We don’t have to worry about breast cancer as long as we maintain a healthy weight, exercise regularly, eat healthy, and limit alcohol.
    • FACT: While practicing these healthy living habits can help lower breast cancer risk, the habits CANNOT eliminate it 100%.

    • MYTH: Breast cancer can be caused by wearing a bra.
    • FACT: There is ZERO evidence that bras actually bring about breast cancer.

    • MYTH: Breast cancer can be caused by using underarm antiperspirant.
    • FACT: There is ZERO evidence of the connection between underarm antiperspirant and breast cancer, however, the safety of antiperspirants is still being studied.

    • MYTH: Breast cancer can be detected early through annual mammograms.
    • FACT: While mammography is currently the best early-detection tool we have, it doesn’t always find breast cancer at an early stage.

    • MYTH: If there’s a lump, it must be Breast Cancer.
    • FACT: Breast cancer that is developing for the first time might not cause a lump.

    • MYTH: Early-stage breast cancer rarely returns.
    • FACT: There is always some risk that cancer will return, even with early-stage breast cancer.

    • MYTH: Only middle-aged and older women will get breast cancer.
    • FACT: Younger women CAN and DO get breast cancer, and the same goes for men.

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