Health & Fitness

Friday October 23, 2009

Empower Yourselves

By Punitha Yogaratnam

No woman in Malaysia or the world is safe from breast cancer. This disease knows no race, size or religion of its victim. Its choice is random, but there are ways to lessen one's risk of getting the disease. Professor Dr Yip Cheng Har from the department of surgery, University Malaya Medical Centre says there are several ways a woman can lower her risk of getting breast cancer. One of the easiest method is regular exercise. The other would be early detection.

In our continuing discussion with Prof Yip, she reveals that although one's gene does play a role, only five percent of beast cancer patients carry the genetic mutation while the other 95 percent have no identifiable genetic mutation.

Is breast cancer hereditary?

Only five percent of women with breast cancer carry the mutated gene, BRCA1 or BRCA2 which can cause breast cancer. Such women are usually prememopausal and have a family member with breast or ovarian cancer. The other 95 percent have no identifiable genetic mutation.

What are some of the tell-tale signs of breast cancer?

The commonest sign or symptom is a painless breast lump that can move around and which causes no skin changes. There's also the retracted nipple or a blood-stained nipple discharge. A nipple ulcer is very rare. In the late stages of breast cancer, the lump will involve the skin, so there will be some discoloration of the skin and also skin changes.

Is there any one type of woman who is more susceptible to the disease in Malaysia in terms of race and age?

The commonest women who get breast cancer are Chinese women and the prevalent age group is between 40 to 49 years of age. One third of women with breast cancer are in this age group.

Is there any way one can prevent breast cancer? What are the dos and don'ts?

There is no way of preventing the disease. However there are modifiable factors which can reduce the risk of breast cancer. Having children early; have more children (it's not easy to do, but having more children reduces the risk); breast feed for longer periods; exercise more (studies show that women who exercise regularly have a lower incidences of the disease); keep your weight down; avoid postmenopausal hormone replacement therapy if there are no problems with menopausal symptoms and do not drink too much alcohol are some of these factors.

Dietary factors seem to work in childhood that is increasing soy intake in childhood and adolescence reduces the risk. There are no evidence that fat increases risk, or that antioxidants/vitamins reduces the risk.

There are also not modifiable risk factors to take into account. This includes early menarche, late menopause and the height of a woman – taller women are more likely to have breast cancer.

Does the size of the breast matter when it comes to breast cancer?

The size of the breast is not a risk factor for developing breast cancer, but in practical terms, perhaps breast cancer is detected later because it can be difficult to feel a lump in a big breast if the lump is deep-seated.

If a lump is found to be benign, must it be removed? What are the possibilities that it will turn into a tumor?

There are many types of benign lumps. Some have a risk of turning into cancer and some are not. Breast fibroadenoma (a common benign tumor) does not turn into cancer. Some types of fibrocystic disease like atypical ductal hyperplasia have a rick of turning into cancer. Overall, only five percent of women with fibrocystic disease (which affects almost 75 percent of women) have a type of pathology with increase the risk of cancer. I would advise women over 40 to have any lump removed, even if it was benign. Around 12 percent of women with breast cancer are under 40 and about two percent under the age of 30.

The option to have breast implants is available for women who have had mastectomies. Can this procedure be done the same time the breast is removed or must a patient first heal?

Immediate breast reconstruction after mastectomy is safe. There are two methods – implants or autologous, where the patient's own tissues are used. Implants give more complications and need to be changed after several years. Autologous reconstruction is technically more difficult but it feels more natural. The decision for immediate re-constructive surgery is a personal choice. In UMMC, less than 10 percent of mastectomies have immediate reconstruction done. Women are usually worried about additional surgery and complications.

Are there cases when a breast implant is not advisable?

If radiotherapy is required, it is not advised as radiotherapy may lead to complications with the implant. Generally reconstruction is also not advised in patients with diabetes.

Does having a mastectomy mean one is free of cancer?

Having a mastectomy or a lumpectomy does not mean the cancer will not return. Breast cancer cells could have entered the blood stream even with it it only one cm, and surgery only treats the local disease. Systemic treatment like chemotherapy or hormone therapy or targeted therapy is required to treat any cancer cells which may be hiding somewhere in the body. These are called micrometastases and they cannot be detected by any test, but is assume to be present when the tumor is large enough.