The sea of information on breast cancer available online today can get overwhelming at times. To help you, we consulted the experts on this issue that is close to the hearts of many women.
In our previous interview with Consultant Breast Surgeon, Professor Dr Nur Aishah Taib, Head of Breast Unit, University Malaya Medical Center (UMMC), Prof Aishah debunked 6 common myths associated with breast cancer. In this article, we seek her expert opinion on 6 condensed must-knows about breast cancer and the rising phenomenon of breast cancer among young women. Read on and be enlightened.
We’ve also included a very informative video at the end with comprehensive information courtesy of Professor Aishah and the Breast Cancer Resource Centre UMMC. Be sure to make time to watch the video because you are worth it.
Professor Aishah, let’s delve into key matters that woman should know about breast cancer:
1. What are the main risk factors of breast cancer?
As you get older (age 50 or older), your risk of breast cancer goes up.
A significant family history plays a role especially if there are more than one first or second degree relative with breast cancer. Having a mother, sister or daughter (first-degree relative) with breast cancer puts someone at moderate risk. That said, it is also important to note that most women (8 out of 10) who get breast cancer do not have a family history of breast cancer.
Certain inherited genes
About 5% to 10% of breast cancer cases are thought to be hereditary. The most common cause of hereditary breast cancer is an inherited mutation in the BRCA 1 and BRCA2 genes. In normal cells, these genes help prevent breast cancer by making proteins that help keep the cells from growing abnormally. Mutated versions of these genes cannot stop abnormal growth and that can lead to breast cancer.
A personal history of breast cancer
Previous breast cancer, breast cancer survivors must adhere to a screening protocol for the opposite breast as they have a higher risk of developing a new cancer in the opposite breast.
Do not lose hope, early detection can improve survival and can even bring about lumpectomy and not mastectomy and even prevent having chemotherapy again.
Benign breast disease
Women diagnosed with certain benign (non-cancer) breast conditions may have a higher risk of breast cancer such as ductal carcinoma in situ (DCIS) (Stage 0 cancer), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or changes in the breast.
Having dense breast tissue
One is said to have dense breasts when they have more glandular and fibrous tissue and less fatty tissue. Unfortunately, dense breast tissue can also make mammograms less accurate. This has been shown to be an independent risk factor to breast cancer. Worldwide studies are underway to find ways to screen and modify the density.
Other risk factors include the onset of menstruation before age 12, going through menopause after age 55 and having radiation therapy to the chest. Lifestyle-related breast cancer risk factors include drinking alcohol, being overweight or obese, not being physically active, use of oral contraceptives or undergoing hormone therapy after menopause.
2. What are recommended methods to detect breast cancer early?
Breast awareness - adopt a personal way of detecting lumps in the breast by examining them every month. The best way is to examine after the last day of your period. The breast is less engorged and lumpy during this time.
Screening is to detect cancer before they become obvious by the patient or clinical examination.
Clinical breast examination has been found to reduce mortality in a large study in India. Hence a visit to the doctors for an annual breast examination can begin as early as 25 years old.
Screening using mammogram is a proven method for detecting early breast cancer in women between 40 to 75 years old. However, do note that mammograms alone are not the perfect test as a cancer diagnosis may be missed 20% of the time.
Ultrasound is used as an adjunct or assists interpretation of mammograms.
Other methods like electrical impendence tomography, thermography are experimental and should not be used for screening.
Future methods using automated breast ultrasound are currently underway to find alternative imaging for dense breasts.
3. What shouldn’t you do on the morning of your mammogram?
Make sure you do not use powder, deodorant or any perfume as these may have particles that can be seen on mammogram.
You don’t need to fast for mammogram. Sometimes, the procedure may cause discomfort so one dose of paracetamol can be taken prior to going for a mammogram.
4. What should you know before going for a mastectomy?
Make sure the indications for the surgery is correct and you have consulted trained general surgeons and breast surgeons. Breast conserving surgery is an excellent alternative to mastectomy in the right patient that produces similar results in recurrence and survival. That means the patient has a solitary tumour confined to a small part of the breast. And to be able to have a successful breast conserving surgery, radiotherapy must be given, nowadays we also have the intraoperative radiotherapy option in UMMC. Please discuss this with your surgeons.
5. What causes metastases or a relapse? Can these be prevented?
Cancer cells are smart cells that have mechanisms to mutate to survive the human body’s defence. When a tumour is present in the breast, micrometastases may be present in other organs like the lung, liver, bones and brain. These may not be detected by scanners that is available today. Also, these cells have different properties, and the cells that do not respond to the therapies may lay dormant and reactivate later on.
Hence, breast cancer is not just cancer within the breast, it is a systemic disease, hence a whole body treatment is needed. This is provided through chemotherapy, targeted therapy and hormonal therapy.
Decades have gone by with better whole body treatments. The reason why these treatments are needed and not just surgery is because we need to treat the whole body and the remaining breast tissue. These treatments will prevent future relapses especially for those with higher stage disease.
Even if a relapse occurs, there are so many active treatment agents against breast cancer today hence there is hope to prolong life. Some treatments may produce side effects but some actually have minimal effects, thus, do discuss this with your oncologists.
6. What can you do to lower your risk of developing breast cancer?
Adopting healthier lifestyle like reducing animal protein and consuming a plant-based diet as well as regular exercise is recommended to prevent cancer and also for cancer survivors to prevent recurrence and death. Maintaining ideal body weight and having moderate physical activity can improve outcomes even with those with a genetic predisposition.
The World Cancer Research Fund (WCRF), a leading authority on cancer research globally recommends the 7 cancer preventive measures as summarised below:
Breast Cancer Among Young Women
1. What are the main differences about breast cancer in younger women compared to post-menopausal women?
Younger women tend to have a more aggressive type of cancer, usually estrogen receptor (ER) negative and HER-2 overexpressed. At times, the diagnosis can be a triple negative breast cancer when all the biomarkers ER, PR and HER-2 are negative. The elderly postmenopausal woman is like to have a ER positive cancer that has a better prognosis in the short term.
Younger women also may have other specific issues like having cancer whilst pregnant which complicates matters further. They may have a lot of social responsibility as carers to young children and aged parents. They may also have a career to nurture. The psychosocial impact is greater in younger women because of the potential loss in length of life, future fertility and so on.
However, being young, they are in a healthy state and can withstand treatments better, many women have successfully undergone treatments, then returned to work and may also start a family after breast cancer.
Each patient is individualised in their treatments and ability to plan pregnancies and so on, hence, an open discussion with their surgeon and oncologists is important.
Gynaecologists have now embarked upon fertility prevention in young women, where eggs or ovarian tissue are stored for future assisted reproduction techniques that can be done like IVF and so on.
2. Should women under age 40 get mammograms?
No, as younger women tend to have denser breasts which makes the mammogram results less accurate. However, if anyone 35 years and above has a breast complaint, then a diagnostic mammogram will be done. If a woman has been diagnosed with breast cancer, a mammogram will be done despite whichever age group the patient belongs to.
3. What’s the best way for younger women to screen for breast cancer?
Breast awareness and know your family history, a woman should start a screening programme 10 years earlier than a close family member’s age of onset of cancer. For example, if Mom had cancer at 38, her daughter should begin seeing a breast surgeon for screening recommendations by age 28.
These recommendations are individualised to each person. MRI screening may be offered to women with history genetic mutation in the family or if they are characterised as high risk based on their family history.
4. How is breast cancer treated in younger women?
The treatments are the same. In the West, where personalised treatments are available through insurance disbursements, risk is profiled by gene markers that are commercially available like MammaPrint and Oncotype DX. These tests are expensive and not readily available for patients, and at times a younger age is in itself considered as a major risk for relapse. Hence, oncologists tend to recommend chemotherapy in the younger age groups.
Our sincere thanks and appreciation, Professor Aishah for your valuable advice and helping us understand breast cancer better. Thank you once again for availing your time and for all that you and your team are doing to raise awareness and help countless women in their fight against breast cancer. Our warmest wishes from PurelyB!
For a very informative and thorough explanation by a team of medical experts from UMMC* on preparation for breast surgery, chemotherapy and its side effects, physical activities for breast cancer patients and follow-up treatment, watch the video below:
*Credits to Professor Dr Nur Aishah Taib (Consultant Breast Surgeon), Dr Mastura Md Yusof (Consultant Clinical Oncologist) and Dr Mohd Nahar Azmi Mohamed (Consultant Sports Physician) and Breast Cancer Resource Centre UMMC