What women should know?

Introduction
 

Cancer is a worldwide scourge and breast cancer is one of its most serious manifestations. It is the most common form of cancer in women and the most common cause of cancer death among women worldwide. The incidence of breast cancer among Thai women is relatively low when compared with the Western world. However, it is increasing, and in 2005 the World Health Organization projected that 12 out of 100,000 women in Thailand would die from breast cancer.

The causes of breast cancer are unknown, but possible risk factors include lifestyle, environmental factors, factors associated with sex hormones and a genetic predisposition for the disease.

Early detection is important for successful management and treatment of breast cancer, Periodic and regular breast self-examination and screenings through mammography and ultrasound play important roles in early detection,

Questions and Answers Concerning Breast Cancer

What are the most significant factors determining whether a person will develop breast cancer?

Sex is the most important. Women are several times more likely to develop breast cancer than men. Age is also significant; we seldom see breast cancer in women younger than 25, but the incidence increases markedly in women aged 40 and older. A person with a family history of breast cancer is also significantly more likely to develop the disease.

Does lifestyle play a role in the development of breast cancer?

Lifestyle factors like smoking, excessive drinking, gaining weight after menopause, and certain diets appear to be linked, but the evidence, particularly in the case diets high in saturated fat, is often statistically insignificant.

Do hormones play a role in the development of breast cancer?

Persistently increased blood levels of estrogen are associated with an increased risk of breast cancer, as are increased levels of the androgens androstenedione and testosterone. A number of circumstances which increase exposure to estrogens made by the body, including not having children, delaying first childbirth, not breastfeeding, early menstrual period and late menopause are suspected of increasing lifetime risk for developing breast cancer.

Do environmental factors create a greater risk of developing breast cancer?

Exposure to ionizing radiation significantly increases the chances of developing breast cancer. A growing body of research also indicates that exposures to certain toxic chemicals and hormone-mimicking compounds including chemicals used in pesticides, cosmetics and cleaning products contribute to the development of breast cancer.

Should breast self-examination be done monthly?

Yes. You do not need to examine your breasts every day; doing so at monthly intervals is enough. If a breast cell turns cancerous, it will take at least two years to grow to about one centimeter. If the cancerous cell is ignored at this stage, it will grow faster, and the chances for a cure become much less. If you examine your breast carefully, you will get to know the consistency of you breast, making it easy to recognize new lumps. Your family doctor or a qualified nurse can teach you how to examine your breast.

Should all women over 25 have an X-ray mammogram every year?

No. Younger women usually have denser breasts and the results of a mammogram are difficult to interpret. In a low-risk asymptomatic woman, the first mammogram should be done at the age of 40. The mammogram and/or ultrasound can detect a small non-palpable cancer of less than 1cm. If any suspicious abnormality is discovered, a tissue biopsy must be done.

Are the first symptoms of breast cancer painful?

No. The early stages of breast cancer do not cause pain. Since early breast cancer is symptom-free, it is often missed in the absence of self-examination of one's breasts. Breast pain without any associated lump is not a serious condition and is common in fibrocystic disease (breast cysts) in the same age group. Breasts can often become tender due to periodic, normal changes in hormone levels.

Is bleeding from the nipple mainly due to cancer?

No. Only 10 percent of such cases are caused by cancer; the other causes are benign diseases such as fibrocystic disease, ductal dilatation or benign ductal papilloma. Bleeding nipples associated with a lump in older women should be considered as a probable case of breast cancer until proven otherwise.

Do all cysts in one's breasts need to be removed surgically?

No. Only large, palpable cysts need aspiration with a fine needle. Cysts generally do not turn cancerous, except for complex ones, which are uncommon except in older patients.
One symptom of a complex cyst is the presence of bloody fluid when the cyst is aspirated with a needle. This content can be analyzed by a pathologist for cancer cells.

Is hormone replacement therapy (HRT) in postmenopausal women safe?

Yes. HRT in postmenopausal women does more good than harm. However, prolonged treatment (over five years) can increase the risk of breast cancer. Hence, prior to undergoing HRT, women should have their breasts examined by a doctor and discuss with them the risk factors involved and the need for follow-ups.

Is mastectomy (surgical removal of the whole breast) the best treatment for breast cancer?

No. Most cancers that are detected early can be treated by local removal of the tumor and X-ray therapy.

Dr.Supakorn Rojnanin is an associate professor and the chief of the Department of Head, Neck and Breast Surgery at Siriraj Hospital's Faculty of Medicine.

For more information, please contactt
Bangkok Breast Center
Tel. (662) 310 3016
Email : info@bangkokhospital.com