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More women are being diagnosed with breast cancer. But treatment is getting better and less invasive, notes Dr Tan Yah Yuen from BreastCare Surgery.

In 2007, Time magazine reported that 1 million women in the world will be diagnosed with breast cancer that year. The incidence is typically higher in developed nations and cities.

Over the years, this number continues to increase at an alarming rate. Women are advised to be aware of the symptoms of breast cancer and seek medical advice early.

Symptoms

• A lump in the breast that is usually not painful
• Sudden onset of nipple discharge that may be bloody or clear
• Dimpling or puckering of the skin
• Recent retraction of the nipple
• Scaly sore or rash on the nipple
• Sudden swelling, warmth, redness or darkening of the breast that does not go away
• Change in size or shape of the breast
   

Advances in surgery
When breast cancer is diagnosed, treatment is often multi-disciplinary in nature. Treatment usually includes one or more of the following:

• Surgery
• Chemotherapy
• Targeted therapy
• Radiotherapy
• Endocrine therapy

Surgery for breast cancer is no longer as debilitating or disfiguring as once thought. A diagnosis of breast cancer does not equate to loss of the breast.

In a large majority of early breast cancer cases, the breast can be conserved by removing the tumour with a rim of normal tissue instead of removing the entire breast. Various oncoplastic surgery techniques are then employed to obliterate the tissue defect so that the final cosmetic appearance of the breast approaches as near normal as possible.  

In suitable cases, chemotherapy can be given first to shrink the cancer in order to allow a smaller volume of breast tissue to be removed.

This enables the surgery to achieve adequate margin clearance and yet minimise the extent of surgery.

For women who require removal of the whole breast, they may choose to have immediate breast reconstruction using their own fatty/muscle tissue, a silicone implant or a combination of both. The most commonly used tissue is harvested from the latissimus dorsi muscle from the back, or fat and muscle tissue from the tummy area. Very often the nipple and areola, if removed, can also be reconstructed at the same time.

Breast reconstruction plays an important role in boosting a woman’s body image after breast cancer treatment.
Part of breast cancer surgery involves removal of the lymph nodes under the armpit for accurate staging. As recent as 10 years ago, the standard practice was to routinely remove all the lymph nodes. This may result in shoulder stiffness, weakness and arm-swelling or lymphoedema for some women.

Nowadays, a technique termed sentinel lymph node biopsy reduces the need for such radical surgery. By making use of a radioactive tracer, a blue dye, or both modalities, the first draining lymph node(s) in the armpit can be identified accurately and removed. These sentinel lymph nodes are then tested for cancer. If the cancer is early and the sentinel lymph nodes are negative for cancer, then the remaining lymph nodes do not need to be removed. This greatly reduces the risk of the woman developing complications associated with extensive lymph node surgery.

Protecting yourself
The American Cancer Society encourages women to have a healthy diet of fresh fruits and vegetables, reduction in consumption of red meat and fats, prevention of obesity/weight gain, and regular exercise at least five times a week to reduce cancer risk. However, many other factors such as hormonal and genetic effects cannot be changed.

The best strategy to protect ourselves is to go for early detection and treatment of breast cancer.

Recommendations for screening

Age > 25 years:

• Monthly breast self-examination
   

Age 40-49 years and above:

• Monthly breast self-examination
• Yearly mammogram +/- ultrasound
   

Age 50 and above:

• Monthly breast self-examination
• 1-2 yearly Mammogram +/- ultrasound
   

Breast cancer should not be feared. Almost every woman will know a friend, colleague or relative who has been treated for breast cancer.

The good news is that the cure rates for breast cancer are very high if it is diagnosed and treated appropriately in the early stages.

Treatment has also become more sophisticated with many options and fewer long-term undesirable sequelae if the cancer is detected early.

Lead a healthy lifestyle with a good diet and exercise, attend regular health screening and seek medical advice when there is an abnormality.

Early detection is the best strategy to combat breast cancer!

Screening: Detect it early

Mammograms
Mammography screening is the most effective way to detect breast cancer. It takes just a few minutes to get a good image of the breast.

As it involves having their breasts compressed to spread the tissue apart, some women may find it uncomfortable or painful. But these two minutes of discomfort could save your life.

Self-examination
Examining your own breasts regularly can help early detection:

• Facing a mirror with your shoulders straight and arms on your hips, look at breasts and nipples for any rash, redness, swelling or changes such as a nipple that has become inverted (pushed inward instead of sticking out).
• Raise your arms and look for the same changes as above.
• Squeeze each nipple gently to see if there is any discharge such as a watery, milky, or yellow fluid or blood.
• Lie down and feel each breast. Keeping your fingers flat and close together, use your right hand to feel the left breast and vice versa. Do it from top to bottom, side to side – from collarbone to abdomen, from armpit to cleavage. Begin with a soft touch, and increase pressure to feel the deeper tissue. Cover the entire breast.
• Do the same as above while standing or sitting. The best time to examine your breasts is after a shower when the skin is still damp.