Breast cancer is most common cancer in women.
It affects women of all races, and usually affects women in their 50s and 60s.
However, in women who have a genetic predisposition or family history, symptoms can present much earlier in life.
Although rare, men can develop breast cancer too. According to American statistics (SEER database), approximately 12.3 percent of women (1 in 8) will be diagnosed with breast cancer at some point during their lifetime, based on 2009 to 2011 data.
It is relatively easy to diagnose breast cancer.
It almost always presents with a mass in the breast, discovered by the patients usually.
Occasionally nipple and skin changes can occur, such as dimpling, tethering, redness or swelling. Sometimes it can present with a mass or a gland in the armpit too, so don’t forget to check the armpit. Screening mammography can also pick up suspicious breast masses. Confirmatory tests include a mammogram and ultrasound of the breasts, followed by a biopsy of the breast mass.
Upon a diagnosis of breast cancer, your gynaecologist or general practitioner will refer you for further specialist care.
A multi-disciplinary team approach nowadays is the norm and the team usually involves breast surgeons, plastic surgeons for breast reconstructions, radiologists, medical and radiation oncologists, and supportive staff such as counsellors and physiotherapists for lymphoedema management (swelling of the arm after surgery).
Following a diagnosis of breast cancer, which is always distressing for any woman, the next step, which is the most important, is to determine the stage of the breast cancer.
Staging tests are usually blood tests and X-rays. The treatment of breast cancer largely depends on the stage of the breast cancer.
There are four stages of breast cancer. Stage 1 and 2 are called early breast cancer. They are usually managed by surgery first, followed by an assessment with your medical oncologist to discuss the need for risk reduction to decrease future recurrences with systemic treatment, and the need for further local control with radiotherapy.
These treatments after surgery are called adjuvant treatments.
Stage 3 breast cancer is sometimes called locally advanced disease. Your breast surgeon and medical oncologist usually work together to control the breast cancer first and stop it from spreading further, followed by surgery and radiotherapy. When the breast cancer has spread beyond the breast and local lymph glands, it is called stage 4 disease.
Spreading of the breast cancer is called metastasis and the usual sites of spreading are the bones, lungs, liver and brain.
Stage 1 and 2 breast cancers carry the best prognosis. Stage 3 is intermediate and stage 4 is poor.
Therefore, early detection and early treatment is the key to surviving breast cancer.
Women aged 50 and older should have a screening mammogram every two years. Women should also perform breast self-examinations, starting in their 20’s. If you find a suspicious lump or notice other breast changes, get it checked out.
The treatment of breast cancer can be divided into local treatment and systemic treatment. Local treatment consists of surgery and radiotherapy. Systemic treatment usually means chemotherapy, hormonal therapy and other novel therapies such as Herceptin. Systemic treatment is usually discussed with you by a medical oncologist, either to decrease the risk of recurrence, or to treat metastatic disease.
In terms of surgery, there are two types of surgery. If all the breast tissue is removed, it is called a mastectomy. If the cancer is removed with part of a breast, it is called a lumpectomy or a breast conserving surgery.
Choosing either a mastectomy or a breast conserving surgery will depend on the stage of the breast cancer and the location of the breast cancer in the breast. The decision of which surgery will be guided by your surgeon. Plastic surgeons are becoming increasingly important in breast cancer after-care. Reconstruction of the breast can be achieved with either a prosthesis or with your own tissue. Each method has its pros and cons and every patient is different.
For more information on breast cancer, visit the American Cancer Society’s website at https://www.cancer.org/cancer/breastcancer/ or the Centers for Disease Control and Prevention’s website on https://www.cdc.gov/cancer/breast/index.htm
By: Dr Sze Wai Chan, Medical Oncologist, Life Bedford Gardens Hospital and Sandton Oncology
