The ABCs of breast cancer

MANILA, Philippines - The Philippines is at the center of the battle against breast cancer. Several reports show that the country has the  highest incidence rate in Asia and is among the top 10 countries with the most cases of breast cancer.  The disease is so common that one  of every 13 Filipino women are expected to develop breast cancer in her lifetime.

The  Department of Health and the Philippine Cancer Society, Inc. confirmed  the high prevalence of breast cancer in the country, stating in a report that breast cancer is  the most common cancer in the Philippines, taking at least 16 percent of the 50,000 cases diagnosed with cancer. (2010 Philippine Cancer Facts and Estimates)

To date, breast cancer is still the leading cause of cancer among women, accounting for 28 percent of the total cases. One out of four who are diagnosed with breast cancer die within the first five years, and no less than 40 percent die within 10 years.

Preventable and curable

But despite these alarming statistics, medical authorities stress that breast cancer is a preventable and curable disease. “Despite the high incidence rate, the number of breast cancer survivors is also steadily increasing worldwide because of better disease awareness and the practice of regular screening that helps detect the disease at an earlier, thereby, more curable stage.

Also, understanding the disease can make a difference in helping every Filipino woman be proactive in the battle against breast cancer,” advises Dr. Felycette Gay Lapuz, president of the Philippine Society of Medical Oncology (PSMO).

The Philippine Society of Medical Oncology, Inc. is a scientific and professional organization of competent and caring oncologists committed to the advancement of the science, the ethical and holistic practice of medical oncology, and the active participation in the national, regional and global cancer program.

Breast cancer is a malignant tumor (a collection of cancer cells) arising from the cells of the breast. Although breast cancer predominantly occurs in women, it can also affect men.

“Breast cancer is not just one disease but several types of diseases.  Some are more common than others, and there are also combinations of cancer,” explains Dr. Lapuz.

 Among the  common types of breast cancer are:

• Ductal carcinoma in situ: The most common type of noninvasive breast cancer, this type of cancer has not spread and therefore usually has a very high cure rate.

• Invasive ductal carcinoma: This cancer starts in a duct of the breast and grows into the surrounding tissue. It is the most common form of breast cancer. About 80 percent of invasive breast cancers are invasive ductal carcinoma.

• Invasive lobular carcinoma: This starts in the glands of the breast that produce milk. Approximately 10 percent of invasive breast cancers are invasive lobular carcinoma.

The remainder of breast cancers are much less common and include the following:

• Mucinous carcinoma are formed from mucus-producing cancer cells.

• Mixed tumors contain a variety of cell types.

• Medullary carcinoma is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue.

• Inflammatory breast cancer: This cancer makes the skin of the breast appear red and feel warm (giving it the appearance of an infection).

AT RISK

The following are among the known risk factors for breast cancer:

• Age: The chances of breast cancer increase as you get older.

• Family history: The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, daughter) doubles a woman’s risk.

• Personal history: Having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original breast.

• Women diagnosed with certain benign breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed.

• Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.

• Breast tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of breast cancer.

• Having no children or the first child after age 30 increases the risk of brweast cancer.

• Breastfeeding for one-and-a-half to two years might slightly lower the risk of breast cancer.

• Being overweight increases the risk of breast cancer.

• Use of oral contraceptives in the last 10 years increases the risk of breast cancer.

• Using combined hormone therapy after menopause increases the risk of breast cancer.

• Alcohol use increases the risk of breast cancer, and this seems to be proportional to the amount of alcohol used.

• Exercise seems to lower the risk of breast cancer.

SYMPTOMS

The most common sign of breast cancer is a new lump or mass in the breast. In addition, the following are possible signs of breast cancer:

• Nipple discharge or redness

• Breast or nipple pain

• Swelling of part of the breast or dimpling.

Although breast cancer can be diagnosed by the above signs and symptoms, the use of screening mammography has made it possible to detect many of the cancers early before they cause any symptoms.

Women age 40 and older should have a screening mammogram every year and sh ould continue to

do so as long as they are in good health. Mammograms are a very good screening tool for breast cancer. As in any test, mammograms have limitations and will miss some cancers. The results of your mammogram, breast exam, and family history should be discussed with your doctor.

Women in their 20s and 30s should have a clinical breast exam (CBE) as part of regular health exams by a health-care professional about every three years for women in their 20s and 30s,dss and every year for women 40 years of age and over. CBE are an important tool to detect changes in your breast and also trigger a discussion with your health-care provider about early cancer detection and risk factors.

Breast self-exam (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health-care professional.

If a woman wishes to do BSE, the technique should be reviewed with her doctor or a health-care provider. The goal is to feel comfortable with the way the woman’s breast feels and looks and therefore detect changes.

Women at high risk (greater then 20-percent lifetime risk) should get an MRI and a mammogram every year. Women at moderate risk (15-20 percent) should talk to their doctor about the benefits and limitations of adding MRI screening to their yearly mammogram.

Since breast cancer covers several kinds of diseases, treatment is also individualized. Patients with breast cancer have many treatment options. Most treatments are adjusted specifically to the type of cancer and the staging group. Treatment options should be discussed with your health-care team. The basic treatments for breast cancer include surgery, radiation therapy, chemotherapy, hormone therapy and targeted therapies. Some patients also explore alternative treatments.

“Survival rates for patients with Stage 0 to 2 can go up as high as 93 percent, while those diagnosed in later stages have decreasing rates. With the advancement in therapies, there can be a marked difference in the five-year survival statistic, which was based on patients who were diagnosed at least five years ago and may have received different therapies than are available today,” says Dr. Lapuz.

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