Derived from an interview on the Happy & Healthy program, during the Health Talk on FM.102 every Saturday from 09:00 to 10:00 AM, titled "Being Informed & Preventing Breast Cancer."
Derived from an interview on the Happy & Healthy program, during the Health Talk on FM.102 every Saturday from 09:00 to 10:00 AM, titled "Being Informed & Preventing Breast Cancer."
Being informed & Preventing Breast Cancer
Breast cancer is a global public health issue that leads to a significant loss of life and healthcare expenditures. It ranks second among cancers affecting Thai women, following cervical cancer. Breast cancer originates from cells that undergo unfavorable changes and spread to other organs, similar to general cancer. In essence, breast cancer is no different from other types of cancer as it is influenced by genetics and genes. Individuals with cancer-related genes may have a higher risk of developing breast cancer compared to others. Genetic predisposition, family history, or having relatives with the disease are factors that indicate increased susceptibility. Currently, gene testing is available to examine one's genetic makeup, although it is not widely practiced.
Breast cancer is primarily caused by an excessive amount of the hormone estrogen. For example, having an early or late menstrual cycle can result in an increased risk of breast cancer. People who receive high levels of estrogen, such as those who take hormonal supplements like birth control pills for 10 or 20 years, or individuals with a history of in vitro fertilization (IVF) that involves high hormone usage, are at a higher risk of developing breast cancer. Additionally, using hormones during menopause, even after the menstrual cycle has ceased, can also increase the risk. However, individuals who have been pregnant or have breastfed their children can reduce the risk of breast cancer, especially if they had children at a relatively young age, such as before the age of 35. Nonetheless, the risk remains similar for individuals who have had children at an older age. Other factors that can contribute to the risk include exposure to radiation, cellular changes, and certain dietary habits.
Breast cancer examinations usually focus on two main methods: manual examination and machine-based examination. It is a common misconception that machine-based examinations alone are sufficient. In reality, the palpation done by a skilled surgeon or specialist provides significant benefits, as it complements the use of machines. In some cases, when breasts are small, the machine may not effectively capture the entire breast but only the nipple area. In these situations, relying solely on the machine may yield inconclusive results. Manual examinations, by using palpation around the edges of the breast, can help identify characteristics of cancerous growths, such as firmness, attachment, or the presence of lumps. Machines, on the other hand, serve as a component to confirm the diagnosis. Our machines conform to standard mammograms, which use ultrasound to examine calcifications. Ultrasound determines measurements in centimeters and distinguishes between fluid-filled cysts and solid masses. Using both methods together maximizes their benefits.
Regarding calcifications, it is important to note that cancerous calcifications differ from typical calcifications. For instance, if a person has cysts or fluid-filled sacs in the breasts due to aging, calcifications can occur. However, these calcifications will have a round shape and be evenly distributed, rather than forming clusters. They maintain a visually appealing appearance. In the case of breast cancer, however, cells undergo adverse changes, resulting in accelerated cell degeneration. Consequently, cancerous calcifications appear irregular, with a scattered and distorted pattern, forming clusters. This leads to suspicion of cancer. Nowadays, the use of MRI provides clearer images than before. However, it is not a standard procedure for everyone; rather, it is performed in specific cases, particularly for those who have previously undergone breast surgery and have hard lumps that need differentiation between scars and new growths. MRI can differentiate well due to its ability to visualize blood vessels, unlike mammograms. Nonetheless, MRI is not conducted for every case, only for those with genuine concerns, as it is a costly procedure to perform annually for individuals who have normal examination results.
According to general standards, for individuals who are not at risk and are 35 years old, it is recommended to have a mammogram examination every year. This is because these diseases do not have a definitive formula for the growth of abnormal tissues. However, what is commonly observed is that unhealthy tissues grow at a rate of approximately 1 millimeter per month. If we do not detect them or if we find small ones that grow up to 12 millimeters, they could potentially be malignant. However, if we undergo annual examinations, we will notice that we are still in the early stages. If at stage 1, the lump does not exceed 2 centimeters, and if we perform the examination every 2-3 years, we may not encounter it in the first year, but it will gradually grow within the following three years. Therefore, it is better to undergo the examination annually, which does not require much effort, similar to screening for cancers such as cervical cancer and lung cancer. However, in cases of suspicion, the doctor may schedule more frequent appointments. For example, repeat ultrasounds every 6 months to observe if the suspected lump is growing. If it does not grow, we may not need to undergo the examination every 6 months, but rather continue with the annual examination as before.
As for the treatment process, it is similar to treating other types of cancer. The first step is to remove the cells. However, removing the cells does not mean removing the entire breast; it means removing the cancerous cells. Currently, there are various methods available, but the standard method remains the same: we need to know the results of the tissue first, whether by using a needle to puncture, extract, or biopsy small pieces for examination. If it is indeed cancer, its growth depends on the location, age, and size of the lump. If it is not extensive, minimal, and distant, and the breast still appears healthy, sometimes we may not need to remove the breast entirely; we can just remove the cancerous tissue and conduct a lymph node check and remaining breast imaging. However, the standard method is still breast removal if we are not particularly concerned about preserving the breast or if the lump is large. Nevertheless, some people may not want to lose their breasts, and nowadays there are surgeries available to enhance the appearance of the breast. It can be done using one's own tissue or by using silicone bags. It varies from case to case. However, in any case, the cancer cells must be removed first. The remaining steps depend on the cancer cells, where chemotherapy and hormone therapy are used accordingly. The principle is to use whatever methods are effective and beneficial, regardless of the extent.
For individuals who have been diagnosed and treated for breast cancer on one side, it is necessary to undergo the same mammogram checkups. This is because there is a chance of recurrence. It is similar to individuals who have had breast cancer before; they may experience it again. However, if it is a small lump, the cells are likely to die after chemotherapy. Nevertheless, we still need to check the other side because there is a 20-30% chance of recurrence. Mammogram examinations should be conducted annually as before. We continue to monitor the situation, possibly through X-rays or repeat ultrasounds, similar to general cancer screenings, and we follow up continuously.
The duration following surgery and chemotherapy, in most cases, will conclude within six months. Once the surgery is completed, if it is not truly satisfactory, chemotherapy is required. Some individuals undergo chemotherapy every three weeks, six times in total. Afterward, the tissue is examined to determine if there are hormone receptors present. If there are, it becomes a matter of hormone pills for another five years. Alternatively, some individuals have gene-related issues, which involve a gene turn tool associated with genes on the embryonic tissue. In this case, monthly injections may be required once a year, depending on the type of embryonic tissue. However, these are all secondary matters. The main focus should be on regular annual check-ups because early detection is crucial. Treatment methods may change every year, as new medications and chemotherapy treatments emerge, along with new hormone options. The treatment schedule also continues to evolve.
It must be noted that breast cancer is externally visible and can be surgically removed, making it easier to detect and clearly visible compared to liver cancer or lung cancer, which are internal and often asymptomatic. Sometimes, they only become apparent in the advanced stages. In the case of breast cancer, if women pay attention and thoroughly examine themselves once a month, noticing anything unusual, they should promptly visit a hospital. This allows for various predictions to be made, especially in the early stages, unlike cervical or uterine cancer. Additionally, breast cancer tends to spread through the lymphatic system, which is the path of the cancer itself, often reaching the axillary lymph nodes. Therefore, during surgery, breast cancer is addressed first, and then the nearby lymph nodes are examined to determine if it has spread. Unlike liver cancer or lung cancer, which have many blood vessels, the spread to adjacent organs is easily accomplished. For example, lung cancer is close to the bronchial tubes, close to the major blood vessels, and close to the heart. When it spreads, it directly affects those areas and spreads rapidly. If breast cancer is detected in the early stages, it can almost be said to be 100% curable.
With this in mind, it is important to regularly self-examine the breasts. This can be done by palpating the breasts every month while bathing or lying down. To examine the left breast, use the opposite hand and raise the arm above the head. When palpating, avoid using a massaging motion and instead use three fingers to make a flat, sweeping motion while pressing the breast. This allows you to feel the rib cage. If you encounter the rib cage, it indicates that there is nothing obstructing it. However, if you feel a lump or something unusual, you will sense something like a glass bead blocking the path between your hand and the rib cage. But do not massage it, as it could be breast tissue, which cannot provide any information, as everyone has breast tissue. That lump could be breast tissue as well. If you palpate and discover something unusual, consult a physician. It is recommended to start examining from the age of 20 and above. In most cases, the lumps will be cysts or normal tissues that are soft and can be rolled and flattened. This is the characteristic of normal or good tissue. However, if it is malignant tissue, it will only grow, not flatten, and it will be firm. The edges will not be clear, and it will not roll smoothly. These are the characteristics of early-stage cancer. But if it becomes severe, it will develop nodules and become immobile, not moving with the breast.
In summary, if abnormalities are detected, it is advisable to promptly consult a physician for early evaluation. This way, the treatment will yield better results.
Written by Dr. Thanet Phuapornphong,
Resident Surgeon at Vibhavadi Hospital
