An early detection walk through: the importance of screening

According to statistics, the incidence rates of breast cancer in Thai women are 30 of  every 100,000 Thai women, develop breast cancer. These incidence rates are two times higher than previous statistics, and as of yet, the exact cause of the increase in breast cancer is unknown. One possibility is our drastic changes in lifestyle.

Major General Associate Professor Wichai Vassanasiri, MD, a specialist in breast cancer surgery at Samitivej Hospital, explained that “breast cancer has now become the number one most common type of cancer, whereas originally it was ranked second to cervical cancer. Asian women also appear to develop breast cancer more quickly than European or American women. It has also been found that in Bangkok and parts of the Eastern Seaboard, specifically industrial cities such as Rayong, Chanthaburi and Chonburi, breast cancer incidence rates are higher than in other regions.”

“Some of the important symptoms of breast cancer include a lump or mass in the breast, nipple discharge, dimpling of the skin, or sores on the breast area. If you have any of these symptoms, you should seek medical attention from a doctor immediately, as it could be a sign that you are in the later stages of the disease.”

“In actuality, you should not wait for symptoms to become obvious, as breast cancer in its early stages often has no visible symptoms. Women should undergo breast cancer screening from 40 years of age and onward, with an annual mammogram and ultrasound check performed together. Some people may have the mistaken understanding that undergoing a mammogram can be a cause of breast cancer. In reality, mammograms require very small doses of radiation, approximately equivalent to undergoing a lung x-ray three or four times. Mammography screenings, therefore, definitely do not cause breast cancer.”  

Once you have undergone a mammogram and ultrasound screening, if any abnormalities have been found, your doctor may perform either a needle or surgical biopsy in order to further study the cells or tissue before planning the next steps in treatment.

Dr. Wichai continues, “If a lump or mass is found that is smaller than one centimeter, the surgeon may choose to perform a needle biopsy using digital mammography or ultrasound equipment, in order to pinpoint the exact location of the mass. They will  then insert a needle, advancing it to the location of the abnormality, and removing tissue samples for further testing and diagnosis. If a needle biopsy of this kind is possible, the doctor will recommend it as a first option as opposed to undergoing a surgical biopsy from the very beginning. This is because if tissue from the mass is removed and tested and is revealed to be cancerous, the patient would have to undergo another surgery. Therefore, doctors will first try to recommend a needle biopsy, so that in such a case cancer is present, a treatment plan can first be made and the patient can be spared having to undergo numerous surgeries.”

Doctors are able to tell the stage of the cancer by the size of the mass, whether it has advanced to the lymph nodes, and how far the cancer cells have spread to other parts of the body. Thus, doctors can determine the stage of the disease once surgery has been performed, with the exception of a few cases where they are able to make an immediate diagnosis, such as very large and deep wounds, or a large mass or lump in the lymph nodes in the armpit area.  These symptoms likely indicate an already advanced stage of cancer, in which case doctors may decide to suggest chemotherapy before surgery takes place.

The presence of cancer in the lymph nodes is one of the most important factors that your doctor will consider when determining how aggressive your treatment needs to be. Sentinel lymph node biopsy is performed by injecting dye to locate the position of the lymph node; the surgeon makes a small incision in the overlying skin and removes the node. Then a pathologist will check for the presence of cancer cells. The doctor will use this information to aid in prognosis and in preparation of an effective post-surgery treatment plan.

Treatment methods are divided into two main categories: local treatments, which include surgery and radiation therapy and systemic treatments, which include chemotherapy, hormone therapy (anti-hormone treatment) or other medications. In the case of invasive cancer cells spreading quickly and expanding to the area of the lymph node, the doctor may prescribe chemotherapy and/or radiation therapy, and may provide hormone therapy as well.

“In the treatment of breast cancer, surgery is generally the best chance for a cure,” explains Dr. Wichai. “There are two types of breast cancer surgery: a mastectomy where the whole breast is removed, or breast-conserving surgery. In the case of breast-conserving surgery, there are currently surgical procedures whereby breast reconstruction can be performed at the time of surgery so as to help the patient maintain confidence after surgery.

With breast cancer, the earlier it is detected the more likely it is to be cured; women aged 40 years and older should undergo breast cancer screening annually. For anyone who has just discovered that they have breast cancer, do not despair, as conventional medicine can help, and even in cases of stage four cancer, chemotherapy and hormone therapy can still be utilized.

Dr. Wichai also warned, “Do not refuse conventional medical treatments, as these have undergone research and experimentation over long periods of time, and doctors will be aware of the advantages and disadvantages of each specific type of medication. Deciding to use traditional or herbal medicines alone can be very dangerous, as not only can certain herbal medicines affect the liver and the kidneys, causing liver or kidney failure, but they have also not been properly and accurately researched.  As a result, patients lose the opportunity to avail themselves of the correct treatment methods.”

Photo Credit: Paän Flickr via Compfight cc