Everything You Need to Know: Breast Cancer
Breast cancer gets quite a bit of attention and there's a good reason for it. It is the most common cancer in women worldwide with numbers rising fast among Southeast Asian women.
Here’s what you should know.
What is breast cancer?
Breast cancer is a type of cancer that starts in the breast. It happens when mutated breast cells grow out of control. There are many types and the type is determined by which breast cells turn cancerous.
In women, a breast is made up of three main parts:
Lobules: milk glands
Ducts: tubes that transport milk to the nipple
Connective tissue: fibrous and fatty tissue that holds everything together
Most breast cancers begin in the ducts or lobules and can spread beyond the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasised. Metastatic breast cancer, also known as stage IV breast cancer, most commonly spreads to the liver, brain, bones, or lungs.
Is it true only older women or those with a family history of breast cancer are at risk of breast cancer?
While it is true that ageing and genetics contribute to the development of breast cancer, most people diagnosed with breast cancer do not actually have a family history of it. This suggests that other factors contribute to the development of breast cancer, but doctors can’t explain why one person gets breast cancer while another does not.
What is causing an increase in breast cancer amongst Southeast Asian women?
The increase in breast cancer amongst Southeast Asian women has been linked to the adoption of a more Western lifestyle and diet. This includes developments such as having children later in life or having fewer children, breastfeeding for a shorter duration, a more sedentary lifestyle, consuming more fat and less traditional foods like rice, fresh vegetables, and soy (associated with reducing the risk of breast cancer). Singapore for instance has the highest rate of breast cancer in Southeast Asia (65 per 100,000).
Does this mean a healthy lifestyle and a good diet can eliminate the risk of breast cancer?
Eliminate, no, but maintaining a healthy lifestyle and a good diet can lower the risk of breast cancer.
Since risk cannot be eliminated, only reduced, it’s important to get regular screenings/mammograms, perform breast self-exams, and pay attention to any unusual changes in the breasts, as early detection.
Changes to look out for include:
A lump or tissue thickening that feels different
Breast pain and pulling
Red, pitted skin over the breast
Swelling in all or part of the breast
Discharge from the nipple
Peeling, scaling, or flaking of skin
An inverted nipple
Changes to the appearance
Swelling under the arm
Women over the age of 40 are highly encouraged to get mammograms annually, especially if they have a family history of the disease.
Will wearing a bra and using antiperspirant deodorant increase the risk of breast cancer?
There are theories that an underwire bra and antiperspirants can affect the flow of lymph fluid and cause a buildup of toxins in the lymph nodes. There is, however, no evidence to back claims that underwires restrain how toxins are eliminated from the body through the lymphatic system. On the other hand, studies about antiperspirant deodorants do indicate a higher buildup of aluminium in breast tissue but are not directly linked as a definitive cause of breast cancer.
Risk factors that increase the chances of breast cancer include:
Inherited genetic mutations
Mutations to the BRCA1 and BRCA2 genes are inherited. These mutations increase the risk for breast and ovarian cancers.Reproductive history
How long a woman menstruates i.e. early menarche and late menopause extends a woman’s exposure to hormones produced in the ovaries (endogenous estrogen and progesterone) increases the risk of breast cancer. The use of hormonal birth control, having a first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy are also factors that increase the chances of breast cancer.Having dense breasts
Dense breasts have more connective tissue than fatty tissue making it difficult to see tumours on a mammogram.Personal history of breast cancer or other breast diseases
Women who have had breast cancer are more likely to get breast cancer again. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are also associated with a higher risk of getting breast cancer.Family history of breast or ovarian cancer
A woman’s risk for breast cancer is higher if a first-degree relative or multiple family members on either parent’s side of the family have had breast or ovarian cancer.Not being physically active
Women who are not physically active have a higher risk of getting breast cancer.
Being overweight or obese after menopause
Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.Taking hormones
Some forms of hormone replacement therapy that include both estrogen and progesterone taken during menopause can raise the risk for breast cancer.Drinking alcohol
Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.
Why is early detection so important?
Early detection provides the best chance of effective treatment and the types of treatments possible. This in turn increases the chances of survival and improves the quality of life of the patient.
The earliest detection method taught to every woman from puberty is breast self-examination. Although there is no actual evidence that performing this examination every month reduces mortality, it does help women become more aware of the normal appearance and feel of their breasts so that any changes are easier to detect and in turn, diagnose.
Are mammograms safe?
Having one may hurt, especially as the breast tissue is compressed during a mammogram. However, a mammogram, or x-ray of the breast, cannot increase the risk of breast cancer or cause it to spread. Although there are small doses of radiation associated with mammography, the risk of harm from this radiation exposure is very low. It remains the gold standard in detecting breast cancer early.
Other methods of detection include:
Breast ultrasound
Breast ultrasound uses sound waves to make a computer picture of the inside of the breast. It can show certain breast changes, like fluid-filled cysts, that are harder to identify on mammograms.
Breast MRI
Breast MRI (magnetic resonance imaging) uses radio waves and strong magnets to make detailed pictures of the inside of the breast.
Biopsy
A biopsy is the only definitive way to diagnose breast cancer. A tissue sample is taken and sent to a laboratory for analysis. The lab then determines if the cells are cancerous, the type of cells involved, the aggressiveness of cancer, and whether the cancer cells have hormone receptors that may influence treatment options.
What are the types of breast cancers and what treatments are involved?
There are many types of breast cancers and each type is determined by the specific breast cells that are affected. The type of treatment a patient receives also depends on the type of cancerous cells and how far it has spread.
There are two main categories:
Invasive - Has spread from the breast ducts or glands to other parts of the breast
In situ (noninvasive) - Has not spread from the original tissue
These two categories describe the most common types of breast cancers:
Ductal carcinoma in situ (DCIS) - Non-invasive cancer confined to the ducts of the breast.
Lobular carcinoma in situ (LCIS) - Cancer that begins in the milk-producing glands of the breast that has not yet spread to nearby tissue.
Invasive ductal carcinoma (IDC) - The most common type of breast cancer that begins in the milk ducts and spreads to nearby breast tissue which increases its chances of spreading to nearby organs as well.
Invasive lobular carcinoma (ILC) - This cancer first developed in breast lobules but has invaded nearby tissue.
Triple-negative breast cancer (TNBC) - An aggressive and invasive breast cancer that is very difficult to treat. The cancer cells do not have estrogen or progesterone receptors, nor does it make too much protein called HER2 (a growth-promoting protein on the outside of all breast cells). The cancerous cells test “negative” for all three tests.
Inflammatory breast cancer (IBC) - A rare breast cancer that does not look like typical breast cancer. Instead of a lump, symptoms show up as an inflamed rash. It causes breast swelling and dimpling or thickening of the skin of the breast so that it may look and feel like an orange peel. It is also more aggressive—it grows and spreads much more quickly—than more common types of breast cancers.
Paget disease of the nipple - A breast cancer that begins in the ducts of the nipple and affects the skin and areola.
Phyllodes tumour - A rare breast cancer that grows in the connective tissue. Most are benign, but some are not.
Angiosarcoma - Cancer that grows on the blood vessels or lymph vessels in the breast.
Each patient’s treatment plan is tailored to their needs and may include one or more types of treatments. The most common are:
Surgery - An operation where doctors cut out cancer-affected tissue.
Chemotherapy - Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
Hormonal therapy - Blocks cancer cells from getting the hormones they need to grow.
Biological therapy - Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.
Radiation therapy - Using high-energy rays (similar to X-rays) to kill the cancer cells.
Women of all ages need to pay attention to their breasts, perform self-exams, report any unusual changes to their doctors and insist that breast cancer be ruled out if there’s a concerning symptom. Although breast cancer is often associated solely with women, men, too, can be affected. In fact, approximately 1% of all breast cancer diagnoses are in men.
It is important to realise that breast cancer can recur and there can be side effects even after treatment is successfully completed. Pain and tightness, fatigue, skin changes, tingling and numbness in the hands and feet, menopausal symptoms, as well as mental and emotional side effects such as anxiety, fear of recurrence, and relationship changes can affect a patient’s quality of life.
