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All About Breast Cancer

By: Yvonne Marie Ferrer, MDAll About Breast Cancer

When I was asked to write about breast cancer, I immediately accepted because this was a subject matter close to my heart, having two sisters diagnosed with this dreaded condition. Fortunately, early detection saved my elder sister while the aggression of the cancer cells caused my younger sibling to continue her fight. As a member of the same generation, I have a higher risk of getting the same Big C. Thus, as a doctor, I need to always bear in mind the science of screening, monitoring, and preventing it from happening. As a potential patient, I need to follow what the experts say about prevention and early detection. Read on to have a better understanding of one of the leading causes of death in women.

How common is breast cancer?

Breast cancer starts when cells in the breast begin to grow out of control and form a mass which is usually felt as a lump and may be seen radiologically via mammography or ultrasound. The tumor is considered malignant if the cells are able to invade surrounding tissues or spread (metastasize) to other areas of the body. Women are most prone to it but men are not exempted.

This malignancy is very common worldwide. 2018 WHO cancer statistics reveal that there are 2.1 million people diagnosed with the disease globally. It is the second leading cause of cancer, next to the lungs. The overall incidence rate was 52.4%, with 17.5% mortality. In our country, 24,798 new cases of breast cancer were reported in 2018, and it remains to be the leading cause of cancer in women. An estimated 8,057 patients have died of this malignancy in the same year. It cannot be denied that this condition has greatly burdened patients and their families, and it is predicted that the numbers will increase in the coming years.

How do I know if I have breast cancer?

The most common symptom of this type of malignancy is a breast mass or lump. But do note that not all lumps are cancer. There are benign lumps which may or may not develop into the Big C. Below are telltale signs of breast cancer:

  • Hard breast mass that may or may not be painful
  • Swelling of a breast part
  • Dimpling of the skin, resembling that of an orange peel
  • Redness, thickening or scaliness of the nipple or breast skin
  • Nipple discharge or bleeding

It is important that you know what your breasts normally look and feel like. Any change in appearance and feel would warrant a visit to your physician who may then do a breast exam by looking for any palpable mass your breasts. It is highly recommended that all women do a regular self-breast exam so that new masses can be detected and investigated on early. Watch how your doctor does it or ask her to teach you so you can do it at home and immediately report any changes that you notice. Do not wait for the mass to grow bigger or to look for additional signs and symptoms before you consult your OB-Gyne or your surgeon.

After the clinical breast exam, diagnostic tests like mammogram and/or ultrasound may be requested to check if the mass is benign or malignant. Most of the times, a biopsy is done to clinch the diagnosis. A biopsy is done by taking either some tissue from the mass through a needle or the whole mass through excision. The mass or part of it is then sent to the pathological laboratory for examination.

Just a warning: not feeling a lump does not rule out breast cancer. My older sister did not feel a mass at all. Good for her, she listened to her doctor and had regular mammograms which caught the tumor at a very early stage. 

What happens when I am diagnosed with breast cancer?

When the unfortunate happens and you are diagnosed with the condition, it is but human to feel sad and scared. But don’t fret. There is still hope as there has been a lot of research on this condition which paved the way for more treatment options.

Management depends on staging:

Stage 0: Also called in situ or noninvasive, the cancer is only in the ducts or the lobules of the breast and has not affected the surrounding breast tissue.

Stage IA: The tumor is small but has already invaded the surrounding breast tissue.

Stage IB: The tumor in the breast is 20mm in size or smaller; the cancer cells have invaded the lymph nodes of the armpit (axillary) and formed clusters sized 0.2 mm to 2 mm.

Stage IIA: There may be no tumor in the breast or if there is, it is less than 20mm and there is evidence of cancer in the axillary lymph nodes; or the tumor may be between 20 and 50mm and has not spread to the axillar.

Stage IIB: The tumor size is 20-50mm and has spread to 1-3 axillary lymph nodes or the mass is greater than 50mm but has not spread to the axilla.

Stage IIIA: Any size of the tumor and has spread to 4 to 9 axillary or internal mammary lymph nodes. No metastasis to other parts of the body.

Stage IIIB: Cancer cells have spread to the chest wall or if the diagnosis is Inflammatory Breast Cancer. No metastasis to other parts of the body.

Stage IIIC: Tumor is of any size and has spread to 10 or more lymph nodes of the axilla or the internal mammary or the collarbone. No spread to other parts of the body.

Stage IV: Tumor of any size and the cancer cells have spread to other parts of the body like the liver and lungs.

Surgery is the mainstay of treatment. Stage 0 is usually managed by lumpectomy, wherein only the tumor and a margin of cancer-free tissue is taken out. All other stages are managed by mastectomy, wherein the whole breast is removed. A sentinel lymph node biopsy, wherein 1 to 3 axillary lymph nodes are taken out, or an axillary lymph node dissection, wherein many lymph nodes are harvested, is usually done to check spread to the axillary lymph nodes and confirm staging.

Chemotherapy is done either before or after the surgery. The regimen is based on the staging and the ER (estrogen receptor), PR (progesterone receptor), and HER2/neu (human epidermal growth factor) status. These last 3 are the receptors that may or may not be present in the tumor. Receptor status dictates treatment after chemotherapy. Those who are ER and PR positive may be prescribed with hormonal therapy such as tamoxifen. Since these hormones are used by the tumor for its growth, blocking the receptors may then help prevent cancer recurrence and even death. HER2/neu is a protein that promotes the growth of cancer cells. Those who are positive for this are given targeted therapy such as trastuzumab or lapatinib to prevent growth or re-growth of the cancer cells.

Radiation therapy using high energy x-rays is also done to avoid recurrence.

Immunotherapy is the newest mode of treatment for most cancers, including the breast. It works by boosting your immune system to recognize and fight cancer cells.

What can I do to prevent breast cancer?

Unfortunately, there is no vaccine that can help prevent this disease. Knowing how one can get it and avoiding these may help you stay cancer-free. While the female gender and genetics play important roles and are impossible to avoid, there are other factors that you can control.

  • Weight. Being overweight increases the risk for the development of breast cancer. Proper nutrition and exercise are beneficial. A low-fat diet is recommended and has shown to reduce the risk. 45 minutes of exercise 5 days a week also prove to be helpful.
  • Alcohol consumption decreases the liver’s ability to regulate levels of estrogen in the body. A high estrogen level is associated with a higher risk of developing the disease.
  • Recent oral contraceptiveuse has been shown to increase the risk of breast malignancy. Studies show that women who ceased to take oral contraceptive pills for 10 years or more do not have an increased risk.
  • Stress and anxiety do not directly increase the risk of breast cancer. However, these two may affect the immune system which then increases the chances of getting the condition. Yoga, meditation, and praying are highly recommended to combat these unwanted states of mind.

My older sister has already won the battle against breast cancer. Early detection, proper intervention, and lifestyle modifications were her weapons of war. While my younger sister is still fighting it, hope is not lost. We believe that she will be victorious with the care of her oncologist, the support of her family and friends, and the advances of medicine.

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