A total of 21,634 Malaysian women were diagnosed with breast cancer between 2012 and 2016 (according to Malaysia National Cancer Registry Report 2012-2016), making it the most common form of cancer, accounting for 34.1% of all cancers among females in the country.

In conjunction with Breast Cancer Awareness Month, observed throughout October annually, join Dr Ahmad Muhsin Mohammad Nor, Consultant General Surgeon – Sri Kota Specialist Medical Centre as he delves into the prevalent disease’s risk factors, symptoms and treatment, reminding us the irrefutable importance of early detection and screening.

When it comes to breast cancer, early detection and screening are words that often dominate conversations, primarily among women. After all the disease afflicts an estimated figure of over ONE MILLION women around the world each year, and is the second leading cause of cancer deaths among women worldwide, second to lung cancer.

In Malaysia, breast cancer is the most common form of cancer affecting women; according to the Breast Cancer Foundation (www.breastcancerfoundation.org.my), 1 in 19 women are at risk of developing breast cancer at some stage in their lives.

Contrary to popular belief, however, a breast cancer diagnosis does not automatically equate to an existence of doom and gloom. The key lies in early detection and screening, followed by sound diagnosis and the most suitable treatments. Furthermore continuous cancer research globally and ever-evolving technological advances in detection and treatment harbour much promise of a long, happy, quality life for patients, at-risk individuals, as well as champion survivors.

What is breast cancer?
Breast cancer is a type of cancer that originates from the breast. The cancer cells, when left untreated, continue to grow and can spread to other parts of the body such as the liver, lungs, bones and brain. It is one of the most common causes of cancer deaths in Malaysia.

What are the symptoms of breast cancer?
Patients with breast cancer may exhibit symptoms such as a breast lump with or without breast pain. Some patients may notice some blood-stained discharge coming out of the nipple. The nipple may also turn inwards. Others have symptoms such as skin dimpling, or skin changes on the breast, and lumps felt at the underarm. Patients with advanced breast cancer may have bone pain such as at the spine, a distended abdomen due to accumulation of abdominal fluid, and yellowish discolouration of the eyes and skin.

What are the risk factors?
A risk factor is anything that raises your chance of getting a disease. There are many risk factors for breast cancer. Some risk factors cannot be controlled while others can be changed. A person who has a family member with breast cancer such as her sibling or mother is at risk of developing breast cancer as well. Age is a risk factor. An older woman is more at risk than a younger person.

Other risk factors include women who reached puberty early as well as menopause at a much later age than normal, women who have never birthed a child and women who do not breastfeed their children. Oral contraceptive pills or hormone replacement therapy for a prolonged period may also increase one’s risk of breast cancer. Other factors are related to lifestyles such as regular alcohol intake and being overweight after menopause.

How is breast cancer diagnosed?
There are three things that doctors need to do in general to diagnose breast cancer. This is called the triple assessment. The first is to do a thorough physical examination of both breasts and the armpits to look for breast lumps and lumps in the armpit. Then, the patient will need to undergo an imaging either a mammogram or an ultrasound (or both) to further visualise the breast lumps and look at the characters of the lumps via the imaging. Finally, a sample of the lump will be taken (biopsy) and sent to the laboratory for definitive diagnosis. This is achieved by pricking the breast lump with a small needle to take the sample. A local anaesthesia may be given to alleviate the pain before sampling is done.

Can early detection and screening really prevent breast cancer?
Yes. Screening means performing tests or examinations in people who show no symptoms. Early detection means detecting the disease much earlier, before symptoms are even felt. It is recommended that women do regular breast self-examination at least once a month in front of the mirror to check for breast lumps. Do seek an appointment with the doctor whenever there is a breast lump or changes to the breast noted during the examination. Once you reach 40 years of age, a screening mammogram is highly recommended, which is a form of x-ray done at the breasts to detect any abnormalities. Early detection and removal of the lump can prevent breast cancer.

How can I lower my chances of getting breast cancer?
Some risk factors for breast cancer are not modifiable such as age, a family history of breast cancer, age of puberty and menopause, and the number of children you have.

However, certain factors like prolonged use of oral contraceptive pills or hormone replacement therapy needs to be discussed with your doctor especially if you already have other unmodifiable risk factors. It’s important to maintain a healthy lifestyle – exercise regularly to maintain a healthy body weight and keep away from alcohol as it can increase levels of estrogen and other hormones associated with breast cancer.

Can menstruation cause breast cancer?
Menstruation itself does not cause breast cancer. However, studies have shown that the higher number of menstrual cycles a woman has over time will increase the risk of breast cancer. Hence, the earlier the puberty, the higher the risk. Women who have never birthed would also experience more menstrual cycles and will be at a higher risk. Women who have not reached menopause at a late age or those taking hormone replacement therapy are at a higher risk due to a prolonged exposure to the hormones oestrogen and progesterone.

Will breast cancer affect fertility?
Breast cancer itself does not affect fertility. However, during the treatment of breast cancer, a patient may need further therapy such as radiotherapy, chemotherapy and hormonal therapy. These therapies are not to be given while a woman is pregnant, thus those with breast cancer may need to postpone their plans to bear a child during the duration of treatment. Certain types of chemotherapy are known to cause infertility as well. Hence, it is crucial for those who plan to get pregnant after breast surgery to consult with their doctors first.

How is breast cancer treated?
The mainstay of treatment for breast cancer is surgery to remove the cancer. This can either be by removing part of the breast that is affected or removal of one side of the breast altogether. This depends on several factors such as the location and size of the breast lump, as well as the willingness to undergo radiotherapy if only part of the breast is removed. An imaging such as a computed tomography (CT) scan will further show if the breast cancer has metastasised elsewhere such as the liver, lung, bone or brain. Based on the stage and types of the cancer, some patients may need chemotherapy, radiotherapy with or without hormonal therapy after the surgery.

How often should I do a breast self-exam?
It is recommended that all women do a breast self-examination at least once a month to check for any breast lumps. This should preferably be done in front of the mirror so you can easily spot any asymmetry of the breast or skin changes that weren’t previously present or seen. If you feel or notice any changes, stay calm, and consult your health provider soonest possible so they can recommend appropriate tests and procedures to investigate those changes.

Sources

Dr Ahmad Muhsin Mohammad Nor
Consultant General Surgeon,
Sri Kota Specialist Medical Centre