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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 .

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 . Other 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 ( BCS ), 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 . BCS 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 BCS 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 size of the primary cancer to allow BCS .

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 Transtuzumab 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 .

28 MAY 2022 GlobalHealthAsiaPacific . com