When a lump turns cancerous, early detection and a range of treatment options can make a difference.
1. MAMMOGRAM BY NUMBERS
Go for a yearly mammogram if you are between 40 and 49, and once every two years if you are between 50 and 69. While self-examinations may detect bigger lumps that are about 2.1cm in diameter, mammograms can find smaller lumps about 1.1cm in diameter. What this means: The earlier you find a cancerous lump, the greater the chance of a cure.
2. SURGERY IS USUALLY THE FIRST STEP
However, with aggressive or late-stage cancers (Stage 3 onwards), chemotherapy may be done first. Such neoadjuvant (therapy administered before surgery) chemotherapy aims to shrink the tumour so that a smaller area of the breast needs to be removed.
3. THE TWO PRIMARY SURGICAL PROCEDURES
Patients may have a lumpectomy (breast-conserving surgery) or mastectomy (removal of the entire breast). The choice depends on the patient’s preference, and the size and position of the tumour.
4. BREAST RECONSTRUCTION IS NOW COMMON
It is done at the same time as the mastectomy.
5. GETTING RID OF THE REMAINING CANCER CELLS IS CRUCIAL
A lumpectomy is usually followed by radiation therapy (RT), which attempts to destroy any possible remaining breast cancer cells after the tumour is removed. Side eff ects of RT include darkened and dry skin on the breast – this is usually temporary and harmless.
6. A BETTER WAY TO CHECK LYMPH NODES FOR CANCER
Instead of removing all surrounding lymph nodes during surgery, which raises the risk of lymphoedema (longterm swelling in the arms and legs), a sentinel lymph node biopsy is now done for tumours smaller than 2cm. This procedure only removes key lymph nodes to test for the spread of cancer. If the results are negative, no further lymph node removal is required.
7. ADD-ONS CAN INCREASE THE CHANCES OF SURVIVAL
To reduce the risk of recurrence, adjuvant therapies – treatments given after surgery – are recommended. These include chemotherapy, hormonal therapy or the use of targeted drugs, depending on the size and grade of the tumour and the presence of biomarkers like oestrogen and progesterone.
8. THE CANCER MAY BE FUELLED BY HORMONES OR GENES
Invasive breast cancers are often categorised according to the presence of hormone receptors (oestrogen and progesterone) or whether they have too much of the protein HER2.
If the cancer is found to be hormone receptor-positive, it means that the disease may be responsive to hormone medicines like tamoxifen. Side effects of taking such medication include mood swings, blood clots and endometrial cancer, although the risk of such eff ects occurring is very low.
On the other hand, HER2-positive cancers make up 15-20 per cent of breast cancer cases and tend to be more aggressive. Treatment options involve the use of targeted drugs like Herceptin, which can help reduce the risk of relapse by 52 per cent, and the risk of death by 33 per cent; these drugs come with a risk of allergic reactions and a small risk of heart failure.
EXPERT SOURCE: Dr See Hui Ti, senior consultant, medical oncology, Parkway Cancer Centre
Lee Xin Hui, Her World, October 2015