Early Detection and Prompt Treatment

BREAST cancer is one of the scariest and most frequently diagnosed cancers among women worldwide. Therefore, there is a need to spread awareness of how risk factors, regular screenings, early detection and prompt treatment come into play in the survival rates of breast cancer patients. Risk factors are factors that increase your chance of developing breast cancer.

Dr Kiran Kaur Amer Singh, consultant general surgeon with special interest in breast surgery at Columbia Asia Hospital – Klang, divides risk factors into two types: nonmodifiable and modifiable risk factors.

Non-modifiable risk factors are factors that cannot be changed, which include gender, family history of breast cancer and being a carrier of the BRCA1 and BRCA2 gene mutation. Hitting puberty early (below 12 years old) and menopause later in life (after 55 years old) increase one’s risk of developing breast cancer as well. “Early menarche and late menopause cause prolonged lifetime exposure to endogenous ovarian hormones, that is, oestrogens.

The longer the exposure, the higher the breast cancer risk,” says Dr Kiran.

Modifiable risks come down to lifestyle choices such as sedentary habits, alcohol consumption, smoking and even long-term intake of exogenous hormones in the form of oral contraceptive pills or hormone replacement therapy after hitting menopause. Not bearing children, full-term pregnancy after the age of 30 as well as not breastfeeding increase the risk further. According to Dr Kiran, “Non-modifiable risks cannot be changed. However, risks may be lowered for some patients. For example, prophylactic mastectomy can be performed to lower breast cancer risks in BRCA gene mutation carriers. “In terms of modifiable risk factors, leading a healthy lifestyle, regular exercise and maintaining a healthy weight will not only reduce risks of breast cancer but also its recurrence in survivors. “Limiting the amount of alcohol consumed and cessation of smoking are also important.”

She shares that although family history of breast cancer is a significant risk factor, only 5% to 10% of breast cancer cases are inherited. The remaining 90% to 95% of cases are sporadic. This means that individuals who do not have a family member with breast cancer are not spared from the disease. Therefore, it is essential for women to participate in breast cancer screening programmes and undergo mammogram or ultrasound if recommended so that immediate action may be taken should they be diagnosed.

Dr Kiran adds, “Thanks to breast cancer research over the years, treatment has come a long way, significantly improving the survival rate and prognosis especially for patients with early-stage breast cancer. “There has been advancement in surgical techniques as well as adjuvant treatments, which are now widely available. “We have moved towards breast conserving surgery (lumpectomy) and sentinel lymph node biopsies for suitable patients with early-stage breast cancer. “This means that it may no longer be necessary to remove the entire breast as lumpectomy can be offered with equally good outcome. The idea of surgery is to completely resect the tumour with negative margins, followed by appropriate adjuvant therapy.” Adjuvant therapy helps to reduce risk of recurrence after surgery. Types of adjuvant therapy available include chemotherapy, radiotherapy, hormonal therapy and targeted therapy. However, not all patients will benefit from these treatment modalities. Treatment offered is based on stage of disease, type and grade of tumour, patient’s general health condition, hormone receptor status and other factors.

Addressing the issue of patients seeking treatment only during the later stages of cancer, Dr Kiran believes that education and awareness are the best course to take to alleviate patients’ fears. “Fear of losing one’s breast is common. Therefore, patients should be made aware that if they undergo mastectomy for breast cancer, there are options for creating a new breast. “Breast reconstruction generally falls into two categories: implant-based reconstruction and flap (autologous) reconstruction using the patient’s own tissues. “In this region, the challenge that we face is beliefs. Many patients strongly believe in alternative medicine as the mainstay for cure of breast cancer, and that causes the delay in coming forward for treatment. “The problem of stigma is also common, which creates a significant barrier to medical care. Some don’t even tell their family members about the disease,” she explains.

She adds that other factors that may contribute to the reluctance in coming forward for screening programmes and treatment are the potential cost and misconceptions surrounding breast cancer. “One common misconception is that the radiation of mammogram causes more harm than benefit. This is not true. Mammogram exposes patients to low-dose radiation and the benefit definitely outweighs the harm,” says Dr Kiran. It is only with the eradication of such beliefs that we can see an increase in early detection and survival rate of breast cancer. Early detection saves lives.