Keeping abreast of cancer of the breast

AN APPLE A DAY - Tyrone M. Reyes M.D. () - October 15, 2002 - 12:00am
Breast cancer is every woman’s fear. It is the most common form of cancer affecting Filipino women, and it ranks as the second leading type of cancer among all Filipinos of both sexes.

But despite the fear that comes with the discovery of a lump in your breast, progress is being made.

The number of deaths due to breast cancer is actually declining.

Early detection and prompt care are big steps toward successful treatment of the disease.

That’s why regular exams by your physician, mammograms, and breast self-examination are keys to taking good care of yourself.
Risk Factors
Although the cause or causes of breast cancer aren’t known, certain factors are believed to increase your chance of developing this disease. Factors that may affect your risk include your age, personal or family medical history, age at childbearing and age at first menstruation.

Other factors that may increase your risk of developing breast cancer includes obesity and a diet high in fat. If you’re 40 percent or more above your ideal body weight, you may have an increased risk of developing cancer.

In addition, some studies have indicated that women who take estrogen replacement therapy and drink alcohol may be increasing their risk of breast cancer because alcohol may further increase estrogen levels.

However, having no known risk factors for breast cancer won’t necessarily protect you from developing the disease. All women are at risk of developing breast cancer. It is estimated that 75 percent of breast cancers occur in women with no known high risk factors.
Breast Self-Examination
The earlier breast cancer is caught and treated, the better the chances for a cure. By doing breast self-examination (see illustration), you increase your chances of finding any breast changes which may include:

• Lumps or thickening in the breast or under the arm

• Changes in breast skin, such as dimpling or red discoloration

• Changes in or around the nipple, such as discharge, inversion or any scalding, thickening or discoloration of the skin.

• Any changes in the size or shape of the breast.
Because women vary in their concerns, preferences and risk of cancer, talk with your doctor about how best to minimize your own risk. Here are some guidelines:

If you’re between 20 and 39 years old:

• Examine your breast monthly

• Have breast exams by your doctor at least every three years.

If you’re between 40 and 49 years old:

• Examine your breasts monthly

• Have a breast exam by your doctor every year

• Ask you doctor how often you should have a mammogram.

If you’re 50 or older and at normal or high risk:

• Examine your breasts monthly

• Have a breast exam by your doctor every year

• Have a mammogram every year.

If a lump is found in your breast, your doctor may want to do additional tests. These may include the removal of a sample of the lump (biopsy) to examine it under the microscope. Sometimes, a biopsy is done by inserting a needle into the breast and drawing out some of the tissue, Other times a surgical biopsy, with removal of the entire abnormality, will be recommended.
Treatment Options
If you have breast cancer, your doctor may consider several treatment options. These may include surgery and follow-up (adjuvant) therapies, such as radiation, chemotherapy or hormone therapy.

• Surgery.
Most women with breast cancer have surgery to remove the cancer from the breast. Usually, some of the lymph nodes under the arm are also removed and looked at under the microscope to see if there are any cancer cells, which may indicate whether the cancer has spread. Different types of operations include:

• Lumpectomy
(sometimes called excisional biopsy or wide excision). In this surgery, your surgeon removes the lump in the breast and some of the tissues around it. This is routinely followed by radiation therapy. Some of the lymph nodes under the arm are also removed.

• Total (simple) mastectomy.
This is the removal of the whole breast. Sometimes, lymph nodes under the arm are also sampled.

• Modified radical mastectomy.
This is the removal of the breast, the lymph nodes under the arm, the lining over the chest muscles and, rarely, part of the chest wall muscles. This is a common operation for breast cancer.

• Radical mastectomy (also called Halsted radical mastectomy).
This is the removal of the breast, chest muscles, and all of the lymph nodes, under the arm. For many years, this was the most used operation but is now reserved for very few women whose cancer has spread to the chest muscles.

Even if your surgeon removes all the cancer that can be found at the time of the operation, you may receive radiation therapy, chemotherapy or hormone therapy after surgery to try to kill any cancer cells that remain.

• Radiation Therapy.
With radiation therapy high-dose x-rays are used to kill cancer cells and shrink tumors. Radiation may be delivered two ways:

• External.
When it comes from a machine outside the body, it’s called external radiation therapy (teletherapy).

• Internal.
Radiation may also come from materials that produce radiation (radioisotopes) that are delivered into the area where cancer cells are found (brachytherapy).

In this treatment, drugs are used to kill cancer cells. Chemotherapy is also called systemic treatment because the drug enters your bloodstream and can kill cancer cells throughout the body.

Researchers continue to develop new drugs to aid in the treatment of breast cancer. Two drugs, anastrozole (Arimidex) and letrozole (Femara), gained the approval last year of the US Food and Drug Administration (FDA) for use as a first-line treatment for postmenopausal women with advanced breast cancer.

Both anastozole and letrozole significantly inhibit the production of estrogen. In some cases, they may be preferable to tamoxifen (Nolvadex), which blocks estrogen receptors in some cells and stimulates them in others.

Another drug, trastuzumab (Herceptin), has been used in clinical trials involving certain women with advanced breast cancer. The drug increased the response to chemotherapy by 50 percent and extended the time the cancer was controlled from six months to nine months.
The Bottom Line
Early detection of breast cancer is crucial to beating the disease. If you notice any changes in your breasts, see your doctor as soon as possible.

Taking the time each month to examine your breasts, having regular breast exam with your doctor, and following up with mammography if your doctor recommends it, may save your life.
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