Early detection saves lives from breast cancer

Breast cancer is one of the most frightening diseases among women worldwide. In fact, it is the most frequently found cancer in women. Although deaths from breast cancer have declined over time, it remains the second leading cause of cancer death among women overall besides lung cancer. Due to advancements in diagnosis and treatments, breast cancer can be successfully treated, especially if it is caught at its earliest stage.  According to the American Cancer Society, when breast cancer is detected early in the localized stage without spreading to other organs (metastasis), the survival rate rises drastically. Early detection of breast cancer by using digital mammogram and ultrasound is essentially important as it is strongly associated with an increased treatment options and survival rates with improved quality of life. Although there is no definitive method of preventing breast cancer, early detection provides the best chance of effective treatment, resulting in reduced disease severity and mortality rates.

Cause remains unknown

Breast cancer develops when some breast cells within the mammary glands or milk ducts begin to grow abnormally. These cells proliferate more rapidly than healthy cells do. They continue to accumulate uncontrollably, causing a lump or mass in the breast. Cancerous cells may spread or metastasize through the breast to adjacent lymph nodes or other parts of the body e.g. bones, liver, lungs and brain. Up to now, no one knows the exact causes of breast cancer. However, mounting of scientific evidence has revealed that certain risk factors contribute to breast cancer. These include the consumption of contraception (estrogen), taking hormone medication over a long period of time, the start of menstruation at an early age, women who have never had a child, a history of radiation treatment around the breast, obesity and smoking. Breast cancer can begin in different areas of the breast, such as the milk ducts, the lobules or the tissue in between. Among several types of breast cancer, the most common type is ductal carcinoma –breast cancer that starts in cells that line the milk ducts, which carry breast milk to the nipple. Invasive ductal carcinoma refers to breast cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other parts of the body. Interestingly, breast cancer often exhibits no warning sign or symptom besides palpable breast mass or lump. Breast cancer is usually overlooked since patients might have no pain or discomfort feelings. If left undiagnosed, abnormal symptoms involve thickening or swelling of the breast, irritation or dimpling of breast skin, redness or flaky skin and abnormal nipple discharge including blood.  

Increased risk when turning to 40

A large number of statistic studies indicate that women aged over 40 years are at greater risk of breast cancer. In fact, cancerous cells within the breast might be previously formed, but it is only detected when women turn to be 40 more older. Breast cancer gradually develops. It takes approximately 90 – 180 days to increase the size from 1 cm. to 2 cm. in diameter. Singular cancerous cell consumes years to form a lump sized 1 cm., meaning that before the lamp is felt or detected, there should be cancerous cell formation within the breast. High-risk group refers to women who have at least 2 first-degree relatives (defined as close blood relatives , including mother, older sister and younger sister) diagnosed with breast cancer. The risk of developing breast cancer in high-risk group substantially increases 10 times, compared to normal populations. More importantly, they also tend to have breast cancer at younger age. Therefore, early detection by using digital mammogram and ultrasound helps to screen for and early detect of breast cancer even symptom has not yet arisen.  

Early detection saves lives    

To increase the chance of successful treatment and complete recovery, two contrubuting factors are vital keys. These include early detection and effective treatments.  In some cases, breast mass is palpable. Over 85% of patients come to see the doctor with a lump in their breast that has surpassed the early stages. The mass should be big enough (at least 1 cm. in diameter) to be touched and that might be too late. To promote earlier detection of abnormalities, screening with digital mammogram greatly helps to identify the abnormal cell formation within the breast. The quality images obtained from digital mammogram can detect the abnormalities in mm. scale. If abnormal mass is found, ultrasound in combination with biopsy might be further conducted. The pathological results derived from tissue biopsy are used to confirm whether the suspected lump is cancer. Even though, there is no definitive prevention against breast cancer, screening and early detection should be timely applied without symptoms. In addition to monthly breast self-examination, it is highly recommended to have breast examination performed by breast specialists every 3-5 years. In women aged over 40, annual breast screening with digital mammogram and ultrasound is advised. However, women who have strong family history of breast cancer should consider starting breast screening earlier when they are 35. Early detection of breast cancer increases the chance of successful treatment and complete recovery while preserving the breast and improving quality of life.  

Stages of breast cancer

The stage of breast cancer ranges from 0-4. Stage 0 is the earliest detection of breast cancer development. There is no invasion to the breast tissue. Discovered at this stage, breast cancer can be cured. Stage 1 is defined as cancer measuring less than 2 cm. confined in a limited area which has not spread to the lymph nodes. Stage 2 is cancer sized between 2-5 cm. and it begins to spread into the lymph nodes in the armpit. At this stage, there is no lymph node invasion to other areas. Stage 3 refers to breast cancer sized over 5 cm. which invades the lymph nodes in the armpit but not to other organs. Stage 4 is breast cancer that spreads to other parts of the body, regardless of its size. If breast cancer is early detected at stage 0, patients have almost 100% chance of survival. If the size of breast cancer is up to 1 cm. in diameter, the chance of survival slightly decreases to 98%. If the size increases to 1-2 cm., the survival rate drops drastically to 80%. Larger tumors tend to indicate later-stage breast cancer, leading to metastasis to other organs. Thus, early detection increases chance of survival.  

Whole breast removal surgery VS. breast-conserving surgery 

Due to genetic advancements, genetic testing can be deployed to detect women who carry inherited genes that significantly increase the chance of developing breast cancer. Most inherited cases of breast cancer are associated with mutations in two genes which are BRCA1 and BRCA2. Genetic testing is practically indicated in women who have had strong family history of breast cancer. If these genes are mutated and the mutations are detected, chance of developing breast cancer rises up to 80%. In this case, prophylactic mastectomy – a surgery to remove one or both breasts to reduce the risk of developing breast cancer (up to 90%) is suggested. In stage 0, surgery as the main treatment option preserves almost 100% chance of  being cured. In patients who have stage 1 with a tumor mass sized smaller than 1 cm., surgery as a single therapy results in 90% chance of being cured. In the past, breast cancer surgery at any stage entailed removal of the whole breast, so-called mastectomy. But, the latest breast conserving surgery at early stages of breast cancer allows surgeons to remove only the cancerous lump and rebuild the shape of the breast after surgery, thereby reducing the psychological impact on patients. Some women who are not candidates for breast conserving surgery require a mastectomy. If breast-conserving surgery is selected, radiation treatment is concurrently required. Studies have demonstrated that adjuvant radiotherapy after surgery confers a protective effect with respect to reduce disease recurrence. However, if the whole breast is surgically removed, radiation is not required. These two treatment options yield the similar survivorship which is up to 100% without the administration of chemotherapy. In late stage 1 or more advanced stages, mastectomy to remove the whole breast (s) is advised. In addition, chemotherapy, hormonal therapy and targeted therapy might be given to reduce chance of recurrent breast cancer. If the whole breast is removed, breast reconstructive surgery is needed to rebuild a total breast using the silicone or patient’s skin, fat or muscle. Not only to enhance physical confidence, but breast reconstruction also substantially helps to improve patient’s quality of life without cosmetic concerns.  

Get to know digital mammogram

Digital mammogram is an advanced diagnostic radiology technique similar to the X-ray. It is extremely efficient to detect even small lump or mass in the breast. Due to its high resolution, high quality images help to identify the abnormalities even developed in the early stages while greatly reducing examination time. The whole process of examination usually takes 5-10 minutes. During digital mammogram examination, the breast is quickly compressed for 5 seconds. Compression reduces the amount of radiation needed to penetrate the tissue and also spreads out the breast tissue to help produce clearer images, leading to accurate diagnosis which guides the treatment plans. Nonetheless, during breast compression it might cause pain the breast with different degree of pain, depending on the size of the breasts among individuals.  Digital mammogram is considerably safe since it uses less radiation. Generally, it is only required 1-2 times a year, thus it does not produce harmful effects to the body.   Reference: Professor Dr. Supakorn Rojananin Director of the Breast Center, Bangkok Cancer Hospital Wattanosoth.
For more information, please contact Bangkok Cancer Hospital Wattanosoth Tel. 1719.