Global Health Asia-Pacific July 2022 | Page 98


A lump in the breast is the most common symptom of breast cancer

Dr Goh Tiong Meng advises on how to detect the malignancy early
Early detection of breast cancer is the most important factor to improve the survival of breast cancer patients .

Breast cancer is the most common cancer in women . Its incidence increases with age and is 100 times more common in females than males .

Its most important risk factor is a family history of breast cancer . There is a higher risk when affected relatives are closely related , younger , and more in number . �ther risk factors include early menarche ( first menstruation ), late menopause , nulliparity ( no children ), or a late first child . Certain diseases of the breast also increase the risk of breast cancer e . g ., atypical hyperplasia , which is a precancerous condition that affects cells in the breast , and previous breast cancer . The most common sign is a lump in the breast , which is usually painless . It can also present with nipple discharge , nipple rash , dimpling and swelling of the breast , a retracted nipple , and pain . Once any of these signs occur , one must see a doctor to make an accurate diagnosis . A mammogram ( X-ray of the breasts ) or ultrasound may be required , and a biopsy is usually needed to confirm the diagnosis . Early detection of breast cancer is the most important factor to improve the survival of breast cancer patients . This can be achieved through public education , regular breast self examinations ( BSE ), screening mammographies , and examinations by health professionals . The average size of breast lumps detected when no BSE is practiced is 38mm . This is reduced to 14mm when BSE is practiced and to 5mm with regular mammography . BSE should be performed monthly from the age of 20 , and screening mammographies yearly from 40 years of age . Between the ages of 20 and 40 , women are advised to undergo an examination by health professionals once every three years .
Breast cancer survival depends on the size of the primary cancer , the extent of spread ( to the lymph nodes and other organs ), and the aggressiveness of the cancer itself ( grade of tumour ). The earlier patients present with breast cancer , the more likely they can be cured .
Besides better survival , early detection can enable patients to undergo breast�conserving surgery ( �CS� , or surgery without removal of the entire breast . This preserves the image of the patient and avoids the psychological stress that accompanies complete removal of the breast . �CS involves removal of the cancerous lump in the breast with an adequate margin together with removal of the lymph nodes in the armpit through a separate incision . All patients who choose �CS will also have to undergo radiotherapy to the remaining part of the breast for complete treatment .
Chemotherapy is usually given after surgery if it is anticipated that there may be a chance of spread to other organs , which is undetectable by current imaging techniques . The function of chemotherapy is to attempt to destroy any small secondary spread and achieve a cure . It has also been used before surgery to reduce the si�e of the primary cancer to allow �CS .
Hormonal therapy can be used for a subgroup of patients with hormone-sensitive breast cancer . This treatment will further reduce the likelihood of cancer recurrence and emergence of new breast cancer . Additionally , immunotherapy with the targeted breast cancer drug Transtu�umab offers another option for patients with HER2 / neu positive breast cancer , which occurs when a certain protein promotes the growth of cancer cells .
Dr Goh Tiong Meng is a consultant general surgeon at Island Hospital in Malaysia .
96 JULY 2022 GlobalHealthAsiaPacific . com