Cancer, a disease that no one wishes to hear that they’re diagnosed with. Unfortunately, the cold hard truth is, cancer doesn’t discriminate and anyone can ultimately be a victim of it. And yes, I’m well aware that it’s a hard pill for everyone to swallow. I’m pretty sure most of us are familiar with it as well. It may be because you know someone who is a cancer patient, or you know someone who is a survivor or you’ve lost someone you loved dearly to the deadly disease.
Inspired by my recent visit to the Breast Care clinic at Subang Jaya Medical Centre (SJMC) and taking into consideration that October is Breast Cancer Awareness Month, I thought it would be a good idea to talk about breast cancer and how early detection plays a vital role which can help in obtaining optimal treatments, as well as increasing chances of survival.
Approximately 1 in 19 Malaysian women are at risk of being diagnosed with breast cancer in comparison to the 1 in 8 in Europe and the United States, according to the Breast Cancer Foundation in Malaysia. Based on the Malaysian National Cancer Registry Report (2012-2016), of all the cancer cases among the Malaysian female population, breast cancer accounts for 34.1% of them which ultimately makes it the most common cancer. The report also shows that cases are more prevalent among Chinese subsequently followed by Indians and Malays.
Hence, with these numbers in mind, I’m going to explore a few areas: what is breast cancer, where does it start, the various types, the symptoms, and how to detect it early.
What is breast cancer?
To know what breast cancer is, it’s necessary to know what cancer is all about. To put it simply, cancer is the rapid growth of abnormal cells in an uncontrolled manner. The group of cells would then subsequently form a mass of tissue, like a lump, known as a tumor.
The tumor can either be benign or malignant. Benign tumors are non-cancerous and don’t spread to other body parts. Normally they don’t grow back when removed, however malignant tumors, on the other hand, are cancerous which could spread and thus, invade organs in other parts of the body to form new tumors via the bloodstream or the lymph system. This process of breaking off from the original tumor is called metastasis.
Hence, if the tumor is located in the breast, it is known as breast cancer. If a lump is discovered in the breast, to determine whether it is benign or malignant, it is recommended to get it checked out by a health professional.
Where does breast cancer start from?
As breast cancer starts from the breast, they can also start from different parts of it. The two most common parts are the milk ducts (carries milk to the nipples) and the lobules (they produce the milk).
Types of Breast Cancer
The choices of treatment available to you and how your body will respond to them will depend on whether the cancer is non-invasive or invasive. The main types of cancer can be broken down into the following categories:
1. Non-invasive cancer
Growth of abnormal cells take place inside the lobules or milk ducts but have not spread to surrounding tissues or the area beyond it and this is known as carcinoma in situ. The term “in situ” basically means “in place” as it describes the condition of the cells being in place where they first developed, inside the lobules or ducts.
Carcinoma in situ can be further categorised into ductal carcinoma in situ and lobular carcinoma in situ. As they have yet to develop their ability to metastasize, the cells associated with carcinoma in situ aren’t wholly cancerous. With the possibility of developing or raising the risk of invasive cancer, they are referred to as pre-cancerous conditions.
- Ductal Carcinoma In Situ (DCIS)
DCIS is the most common (90%) form of non-invasive breast cancer which originates from the milk ducts.
- Lobular Carcinoma In Situ (LCIS)
LCIS is less common, originating from the lobules and it is taken to be considered as a marker for increased breast cancer risk.
2. Invasive cancer
Invasive breast cancer is where the cells spread outside the lobules or ducts and into the surrounding breast tissues. The cells in this case can potentially spread outside of the breast to other parts of the body via the bloodstream or the lymph system. Like carcinoma in situ, invasive carcinoma can be either ductal or lobular.
- Invasive Ductal Carcinoma (IDL)
IDL, another common form of breast cancer (80%) which originates from the milk ducts however, in this case it has spread to the surrounding tissues instead of being inside the ducts.
- Invasive Lobular Carcinoma (ILC)
With regards to ILC, it has already spread from the lobules (where it originated from) to the surrounding tissues in the breast and makes up about approximately 10% to 15% of breast cancer cases. However, it is best to note that ILC can be difficult to detect via physical examination or mammography.
There are other types of breast cancers as well such as Medullary Carcinoma, Paget’s Disease of the Nipple, Mucinous Carcinoma, Inflammatory Carcinoma, etc. The common trait shared among them is that they are rare diseases.
Signs and Symptoms
Now that you’re well-informed about what breast cancer is and the various types of breast cancer that exist, let’s take a look at the common signs and symptoms of breast cancer to look out for. However, do note that these would differ between individuals and thus, it is recommended to bring this up and discuss it with your doctor.
The common signs and symptoms:
- a lump in the breast or around the underarm
- changes in the size or the shape of the breast
- changes in appearance of one or both of the nipples
- sudden occurrence of nipple discharge (other than milk)
- skin changes such as swelling, redness, and other noticeable differences
- a sharp, general pain in any part of the breast which doesn’t subside
Early detection of breast cancer
Like most cancers, when breast cancer is detected earlier, the better are your chances of survival as you will be able to obtain optimal treatment depending on the type of breast cancer you’re diagnosed with as per your respective consultant breast surgeon. This is because as it’s still small and has yet to spread, it will be much easier to treat before it develops.
Even Dr Saunthari Somasundaram, president of the National Cancer Society Malaysia (NCSM), told The Star in a news article, “Early detection is so important, I can’t stress this enough. The earlier you catch it, the better the outcome, not just in the number of years you will live but the quality of life you will enjoy. All the research shows that late-stage breast cancer exponentially increases your mortality rate.”
The American Cancer Society has stated that regular screening is one of the most reliable methods in detecting breast cancer early. This is so that they can find it before the symptoms shows (ie. a lump which can be felt) as it is likely for it to be smaller and still confined to the breast when the breast cancer is found through screenings. Early detection would include performing breast self-exam, regular visits for clinical breast exam and conducting mammograms.
Mammograms are essentially x-rays for the breast. From the mammogram, a specialist would detect any abnormalities in the breast tissue. Oftentimes, they can show a breast lump before it can even be felt. Women who are over the age of 40 are recommended to go for these mammograms annually or every 2 years. For women below the age of 40 and display high risks for breast cancer, it is recommended to seek advice from your healthcare professional on whether undergoing mammograms are necessary or not.
In short, I would certainly recommend – ladies, especially – to get yourself checked out if you do show any of the symptoms mentioned above. At least it puts your mind at ease and you can go about with your daily life, while you continue to monitor the conditions of your breast, looking out for any peculiar changes.
(PS: If you’re wondering about the verdict from my recent visit to the breast care clinic, I’m fine. It was merely a false alarm and the breast surgeon consultant advised me to conduct a breast self-exam every once in a while.)
By Joey Yap