Comprehensive Breast Cancer Care

Invasive breast cancer develops in the cells of a duct or lobule, but it does not remain where it originated. Instead, it spreads and invades surrounding tissue.

• Invasive ductal carcinoma (IDC): Abnormal cancer cells that began forming in the milk ducts have spread beyond the ducts into other parts of the breast tissue.
• Invasive lobular carcinoma (ILC): Starts in the lobules (milk glands) of the breast and spreads to surrounding normal tissue. It can also spread to other regions of the body through blood and lymphatic system.

Triple-negative breast cancer (TNBC) is a type of cancer that lacks the expression of three breast cancer cell receptors (Oestrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor Type II or HER-2).

TNBC accounts for about 10% of all breast cancer types in the world. The other 70% are hormone receptor-positive breast cancers and 20% are HER-2 positive breast cancers.

TNBC is regarded as the most difficult type of breast cancer to treat because the cancer cells metastasize more easily to other organs.

Chemotherapy first polishes off the surface of the tumour, removes its immune-protective layer and exposes it, thereby assisting the body’s immune cells to recognise cancer cells and launch targeted attacks.

However, TNBC patients must meet one condition for immunotherapy: their tumour cells need to contain more than 1% PD-L1 ligand for immunotherapy to be effective.

• PD-L1 is a protein present on the surface of cells that allows the human immune system to recognise the cell as normal instead of foreign.
• When the T cells of the human immune system discover a 'foreign' object, they launch an attack.
• However, the tumour cells also produce PD-L1 on their surface and can bind to the PD-1 receptor of the T cell, causing the T cell to mistake it for a normal cell.
• In this way, the T cell does not send out an attack signal, and the tumour cell escapes the attack.

Immunotherapy drug Atezolizumab specifically binds to PD-L1 to inhibit its interaction with the PD-1 receptor. The drug activates the patient’s own immune system to recognise and attack tumour cells.

Immunotherapy has less side effects than targeted therapy and chemotherapy. However, immunotherapy has to be combined with chemotherapy, so patients may still experience common side effects of chemotherapy, such as hair loss, nausea, loss of appetite, and fatigue.

The side effects of immunotherapy are usually weaker than those of targeted therapy and chemotherapy. However, immunology is rather complicated because every patient’s immune response is different. Immunotherapy may still cause some side effects or immune-related inflammation such as fever, asthma, and cough, or pneumonia, etc. This is because in the process of stimulating the immune system to recognise tumour cells, the immune response will become more active, and will sometimes attack healthy cells if it is not controlled.

Currently, immunotherapy is administered by intravenous injection. Patients do not need to be hospitalised, but the number of visits to the hospital will be more frequent. Although immunotherapy still does not cure cancer, it can prolong the survival rate. Therefore, patients with triple-negative breast cancer should not be disappointed. As long as there is a glimmer of hope, they should actively cooperate with treatment, and at the same time look forward to more effective therapies or drugs in the future.

Women should do a breast self-examination regularly from the age of 20 years old. Learn from your nurse or doctor the right way of doing breast self-examination. If you notice any lump at your breast, please consult your doctor.

1. Look for changes in size, shape, colour and texture of your skin and nipple
2. Feel your breasts while lying down and / or while in the shower
3. To check the left breast, raise your left arm and use your right hand fingertips to make small circular motions
4. Use gentle, firm pressure. Make sure to cover the entire breast and underarm in a systematic way. Feel for changes and unusual lumps. Gently squeeze the nipple and watch for any discharge. Repeat the examination for your right breast.

If you notice any lump at your breast or if you are unsure about it, please consult your doctor for a clinical breast examination.

A mammogram is an x-ray of the breast. It can detect breast cancer up to two years before the tumour can be felt by you or your doctor. It is recommended to have a mammogram done every year after age 40.

How does mammography screen for breast cancer?

• Mammograms can detect early breast lesions that are less than 1 cm in size.
• Higher possibility of being able to have breast-conserving surgery.
• Survival rate is generally better.

A breast ultrasound creates computer images of the insides of the breast using sound waves and their echoes. It can reveal some breast changes that may be more difficult to be observed on mammograms, such as fluid-filled cysts.

How does an ultrasound screen for breast cancer?

• An ultrasound is useful in distinguishing solid tumours from fluid-filled masses like cysts, which are very unlikely to be cancer.
• It may also be used to guide a biopsy needle into a breast ares so that cells can be extracted and examined for cancer.

A breast biopsy may be required if symptoms or the findings of an imaging test (such a mammogram) indicate the possibility of breast cancer. Small samples of breast tissue are taken from the suspicious region during a biopsy so they may be tested in a lab.

How does a biopsy screen for breast cancer?

• A biopsy allows for tissue samples from the breast to be examined for the presence of cancer cells.
• It is the only way to definitely diagnose cancer.