Breast cancer

What are the symptoms of breast cancer?

• Feeling a lump in the breast or under the armpit can be a regular self-examination at home. The lump may be tender or painless. All women should perform a breast self-examination every month, approximately one week after the end of their period.
• Changes in breast size or shape: Although both breasts may vary in size and shape, observing any changes in one or both breasts will help patients detect any signs of cancer early on.
• Dimpled or thickened breast skin, resembling an orange peel, or a change in the color or texture of the skin around the areola should be addressed immediately by a doctor for a thorough diagnosis, as these could be signs of cancer spreading to the underlying tissue.
• Drainage or fluid from the nipple, especially if the discharge is bloody and only comes from one nipple, should be addressed immediately by a doctor for a thorough breast examination.
• Abnormal breast pain or mastitis: If you experience breast pain outside of your period, or if the skin around your breast is swollen, red, or inflamed, especially if you feel a lump, do not dismiss it as normal. Itchy breast rashes that don’t go away completely even after treatment. Rashes can occur on the nipples or breasts, most commonly.
• They begin as a red, itchy rash, but even after treatment by a dermatologist, they don’t completely heal and develop into hard, scabbed sores. See a doctor for a breast cancer diagnosis, as this may be due to cancer cells spreading to the skin above the nipple or breast.

Information from the Breast Cancer Society of Thailand

https://www.thaibreast.org/TH/home.html

Factors that Cause Breast Cancer
Controllable Risk Factors

• Excess body weight is associated with breast cancer, especially in postmenopausal women. This is because body fat primarily produces estrogen instead of the ovaries, increasing the risk.
• Exercise: Studies have shown that exercising for 45-60 minutes, five or more days per week, can reduce the risk of breast cancer.
• Alcohol consumption is associated with breast cancer because alcohol impairs the liver’s ability to regulate estrogen levels, a potential cause of cancer.
• Smoking slightly increases the risk of breast cancer.
• Estrogen: Estrogen stimulates breast cells to grow. Long-term exposure to estrogen increases the risk of breast cancer, such as avoiding long-term hormone replacement therapy.
• Birth Control Pills: Using birth control pills for a limited period of time only slightly increases the risk of breast cancer. However, if you stop taking birth control pills for more than 10 years, the risk is no different from that of a normal person.
• Stress and Anxiety: There are no clear studies on breast cancer risk, but reducing stress and calming your mind can increase the body’s immune system.

Uncontrollable Risk Factors

• Gender : Women are more likely to develop breast cancer than men because female breasts are constantly changing and growing. This is due to the hormones estrogen and progesterone.
• Age : The older you get, the greater your chance of developing breast cancer. If you’re between 30 and 39, you have a 1 in 228 (0.44%) chance of developing breast cancer. This increases to a 1 in 29 (3.5%) chance of developing breast cancer by age 60.
• Family genetics : If you have a first-degree relative (e.g., father, mother, brother, sister, or daughter) who developed breast or ovarian cancer before the age of 50, you are at a higher risk.
• Smoking slightly increases your risk of breast cancer.
• Estrogen: Because estrogen stimulates breast cells to grow, prolonged exposure to estrogen increases the risk of breast cancer. Some factors can be controlled, such as avoiding long-term hormone replacement therapy, maintaining a healthy weight, or avoiding alcohol consumption.
• Birth Control Pills: Using birth control pills for a limited period of time only slightly increases your risk of breast cancer. However, if you stop taking birth control pills for more than 10 years, your risk is no different from that of a normal person.
• Stress and Anxiety: There are no clear studies on breast cancer risk. However, reducing stress and calming the mind can boost the body’s immune system.

Information from the Thai Breast Association

https://www.thaibreast.org/TH/home.html

How many stages are there of breast cancer?

The stage of breast cancer depends on tumor characteristics, such as size, hormone receptor activity, and whether it has spread to lymph nodes or other organs. Knowing the stage of the disease allows for treatment planning and predicting treatment outcomes. Stages range from 0-4. Stage 0 indicates cancer cells are confined to the milk ducts, while stage 4 indicates cancer has spread to other organs.

Information from the Breast Association of Thailand

https://www.thaibreast.org/TH/home.html

How to Perform a Breast Self-Examination

Step 1: Look for abnormalities in your breasts by standing in front of a mirror.

• Stand with your arms close to your body and compare both breasts.
• Look for abnormalities by examining the size, shape, dimples, and wrinkles, as well as the color of the skin and areola.
• Raise both arms above your head and examine both breasts, as in Step 1, moving your arms up and down.
• Place both hands on your waist and press and release, while tensing your breast muscles. Observe both breasts for any abnormalities.
• Don’t forget to squeeze your nipples to check for blood or abnormal mucus discharge from the nipples. See a doctor immediately if any abnormalities occur.

Step 2: Breast Examination

Breast tissue, including the mammary glands and milk ducts, is located in the visible area. Therefore, a breast examination must cover this area. Palpation should be performed both sitting and lying down, using the palms of the index, middle, and ring fingers, towards the tips, as this is a sensitive area.

Palpate the entire breast at three levels of intensity:

• Slightly superficial to the skin;
• Deeper
• Deep to the chest wall.

There are several palpation directions, and you can choose any of the three sensations:

• Spiral sensation
• Wedge sensation
• Up-down sensation

Breast cancer screening methods using diagnostic equipment / technology

Mammography

This is the most widely accepted breast cancer screening method and can reduce the mortality rate from breast cancer. It is a specialized X-ray examination of the breast using a specialized instrument.

The breast is pressed as flat as possible and two images are taken of each breast. An ultrasound may be performed to assist in diagnosis or confirm abnormalities found on the mammogram, which will increase the accuracy of the diagnosis.

Mammography (MRI) is recommended for women aged 40 and older, every 1-2 years. Women at higher risk for breast cancer are more likely to have a mammogram than the general population.

Mammography (MRI)

Due to the cost of MRI, it is currently recommended that MRI be combined with mammography only for those diagnosed with BRCA gene abnormalities at age 30 or older or those with a history of high-dose breast radiation exposure at a young age. Summary of breast cancer screening guidelines for Thai women.

Mammograms are recommended to begin at age 40 and performed annually.
Breast examinations by a doctor or trained healthcare professional.
Breast examinations are recommended to begin at age 40 and performed annually.
Breast self-examinations are recommended to begin at age 20 and onward.
Monthly.
 

Breast cancer screenings are recommended to be performed by a specialist or experienced nurse.

Breast self-exams should begin at age 20 and be performed monthly, approximately one week after menopause. If any abnormalities are found, consult a doctor immediately.

CHULA CANCER Radiation Therapy and Oncology

https://www.chulacancer.net/

Breast Cancer Treatments

Surgery

• Breast-Conserving Surgery
• Total Mastectomy
• Breast Reconstructive Surgery
• Axillary Lymph Node Dissection
• Total Mastectomy to Reduce the Risk of Breast Cancer

Radiation Therapy

Radiation therapy, or “radiotherapy,” uses high-energy rays to destroy cancer cells and shrink the tumor. Radiation therapy is painless, but some irritation may occur to the irradiated skin. Radiation therapy for early-stage breast cancer is often administered after surgery to remove the tumor. Repeated radiation therapy is used to eliminate any cancer cells that may remain after surgery and to reduce the rate of breast cancer recurrence.

Chemotherapy

Chemotherapy works by preventing the division and spread of cancer cells. While chemotherapy can be used in all stages of advanced breast cancer, it can also affect normal cells, particularly rapidly dividing cells such as hair, nails, oral mucosa, gastrointestinal mucosa, and bone marrow (blood cell production). This can lead to side effects during treatment.

Targeted Therapy

Targeted therapy is a type of cancer treatment. Targeted therapy targets cancer cells. This type of treatment only destroys cancer cells, leaving healthy cells unharmed. This type of treatment can work on its own or in conjunction with other treatments, such as chemotherapy (either conventional or standard).

Immunotherapy

The human immune system is a collaborative effort of various organs, tissues, and cells. It functions to defend against foreign invaders that can cause disease. When the body experiences abnormalities, such as disease or infection (including bacteria, fungi, viruses, and other parasites), the immune system is stimulated to fight these invaders, preventing or reducing the severity of the disease.

Immunotherapy involves medications that enhance the body’s immune system. These medications are derived from both naturally occurring immune cells and synthetically produced in the laboratory. These medications enhance the immune system’s effectiveness by:

• stopping or inhibiting cancer cell growth
• preventing cancer cells from spreading to other parts of the body
• helping the body more effectively eliminate cancer cells

Hormonal Therapy

Using anti-hormone medications to reduce the levels of estrogen and progesterone in women, which stimulate breast cancer cell growth.

Radiation Therapy

This is a breast cancer treatment option for patients who have undergone breast-conserving surgery, have large tumors, or have lymphatic metastases. Effective technology can reduce the amount of radiation that can impact the body and reduce patient anxiety.

Palliative Care

Focuses on reducing physical and psychological distress. It is often used to treat patients with advanced breast cancer or in conjunction with primary cancer treatment. The treatment includes patient and family support from diagnosis to the end of life.

Information from CHULA CANCER, Radiation Therapy and Oncology

https://www.chulacancer.net/

Breast Cancer Prevention

While the exact cause of breast cancer remains unclear, good lifestyle practices can help reduce your chances of developing it. These include:

• Choose a nutritious diet, focusing on fruits and vegetables.
• Control your weight to avoid obesity.
• Exercise 30 minutes a day, 5 days a week.
• Abstain from smoking.
• Abstain from alcohol.

Reference: Breast Cancer | Bangkok Cancer Hospital, Wattanosoth