About Breast Cancer

 



Q1. What are the stages and types of breast cancer?
Breast cancer can be classified into four stages: Stage 1 describes a tumour of less than 2cm that has not spread to the axillary lymph nodes. In Stage 2, a tumour is usually between 2cm to 5 cm in size and has already affected the axillary lymph nodes, while in Stage 3 it can be larger than 5cm and has spread to more axillary lymph nodes or reached beyond the armpit, near the collarbone, and above the chest cavity. Stage 4 means that breast cancer metastasis in other organs, such as the bone, lung, liver, etc.
 
It is more important to identify the cancer type than the stage as treatment largely depends on the former. Breast cancer can be classified into three types. If the hormone receptors are positive, the cancer is of the luminal type. If HER2 protein is found on cancer cells, it belongs to HER2 type. When the cancer is hormone receptor-negative and HER2-negative, it is a triple-negative cancer type. These are the three major types of breast cancer.
 
Q2. Is breast cancer preventable with regular breast screening every two years?
While breast screening can help lead to early detection and diagnosis, it cannot prevent breast cancer. Some patients may ask, “I just have had a breast screening. Why do I still get breast cancer?” There are two possible reasons. First, the screening result might not be accurate. Second, the breast cancer could have been growing rapidly right after the previous checkup with symptoms shown within a short period of time, thus leading to its detection and diagnosis.
 
Q3. What are the risk factors of breast cancer?
The risk factors of breast cancer can be categorised into two main types: hereditary or non-hereditary. Hereditary factors refer to problems arising from gene changes. Hereditary breast cancer is caused by an inherited mutation in either the BRCA1 or BRCA2 gene. And the chance of developing breast cancer in life is 70% in patients with a BRCA1 gene, or 50% in those carrying a BRCA2 gene.
 
Apart from hereditary factors, non-hereditary factors should not be overlooked. In women, longer exposure to hormones means more stimulation of the lactiferous ducts, leading to an increased risk of developing breast cancer. Examples of risk factors include early menstruation, late menopause, no childbirth experience or no breastfeeding after childbirth. Others factors such as lack of exercise, chronic stress, alcohol consumption may also contribute to an increased risk of developing breast cancer.
 
Q4. What are the symptoms of breast cancer?
It has to do with body check-up as breast cancer is mostly detected in one of three main scenarios, i.e. asymptomatic, locally symptomatic and metastatic with symptoms. How are they related to body check-up? It is most commonly detected in the form of shadows in the breast during radiological examinations such as cardiac catheterisation, heart and lung X-ray, CT coronary angiogram, etc. Sometimes they are also found when patients undergo ultrasound examinations for stomachache or liver discomfort.
 
The second scenario is the detection of a breast lump, which is palpable or characterised by nipple bleeding. A few patients may feel pain in the breast, and are later diagnosed with breast cancer during a medical check-up.
 
The third scenario is less common and characterised by discomfort due to the spread of breast cancer to other parts of the body. For instance, pain occurs if cancer has spread to the bones. Lung metastasis may manifest itself as shortness of breath, particularly when the patients are climbing stairs and in high demand of oxygen. In cases with a late onset, the cancer may have already spread to liver, leading to liver failure with symptoms such as abdominal swelling, pain and face skin turning yellow. Though uncommon, these symptoms may have prompted patients to seek medical attention resulting in the diagnosis of breast cancer.
 
Q5. How can the risk of breast cancer recurrence be reduced?
Adjuvant treatments are often administered after surgery if there is a high chance of cancer recurrence. These preventive therapies aim to reduce the risk of cancer returning and can be classified into two main types. First, localised treatments are prescribed to lower the risk of local recurrence. Second, whole-body treatments are employed to prevent distant metastasis. For breast cancer, localised treatment typically involves radiotherapy, which can reduce the risk of recurrence to 25% of the original chance. It is highly effective. For patients who have undergone surgery for advanced breast cancer, or those in early stages of breast cancer that do not opt for mastectomy, radiotherapy is recommended as an adjunctive treatment to reduce the chance of local recurrence.
 
For preventing occurrence in the form of distant metastasis, which means the tumour would be spread to other parts of the body, medication is required. As previously mentioned, if the cancer is of the luminal type and the hormone receptors are positive, hormone therapy is recommended. Patients may need to take the medication for a longer time, usually daily for five to ten years. Whereas for HER2-positive breast cancer, targeted therapy and chemotherapy are used to reduce the risk of recurrence. For triple-negative cancer type, which is hormone receptor-negative and HER2-negative, immunotherapy and chemotherapy are prescribed to lower the risk of recurrence.

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