Breast cancer gets a lot of attention, and there’s a good reason for it. It is the most common cancer in women worldwide, with numbers rising fast among Southeast Asian women.
Here’s what you should know.
What is breast cancer?
Breast cancer is a type of cancer that starts in the breast. It happens when mutated breast cells grow out of control. There are many types, and the type determines which breast cells turn cancerous.
In women, a breast is made up of three main parts:
- Lobules: milk glands
- Ducts: tubes that transport milk to the nipple
- Connective tissue: fibrous and fatty tissue that holds everything together
Most breast cancers begin in the ducts or lobules and can spread beyond the breast through blood vessels and lymph vessels. When breast cancer spreads to other body parts, it is said to have metastasised. Metastatic breast cancer, or stage IV breast cancer, most commonly spreads to the liver, brain, bones, or lungs.
Is it true only older women or those with a family history of breast cancer are at risk of breast cancer?
While it is true that ageing and genetics contribute to the development of breast cancer, most people diagnosed with breast cancer do not have a family history. This suggests that other factors contribute to the development of breast cancer, but doctors can’t explain why one person gets breast cancer while another does not.
What is causing an increase in breast cancer amongst Southeast Asian women?
The increase in breast cancer amongst Southeast Asian women has been linked to adopting a more Western lifestyle and diet. This includes developments such as having children later in life or having fewer children, breastfeeding for a shorter duration, a more sedentary lifestyle, and consuming more fat and less traditional foods like rice, fresh vegetables, and soy (associated with reducing the risk of breast cancer). Singapore, for instance, has the highest rate of breast cancer in Southeast Asia (65 per 100,000).
Does this mean a healthy lifestyle and a good diet can eliminate breast cancer risk?
Eliminate, no, but maintaining a healthy lifestyle and a good diet can lower the risk of breast cancer.
Since risk cannot be eliminated, only reduced, it’s essential to get regular screenings/mammograms, perform breast self-exams, and pay attention to any unusual changes in the breasts, as early detection.
Changes to look out for include:
- A lump or tissue thickening that feels different
- Breast pain and pulling
- Red, pitted skin over the breast
- Swelling in all or part of the breast
- Discharge from the nipple
- Peeling, scaling, or flaking of skin
- An inverted nipple
- Changes to the appearance
- Swelling under the arm
Women over 40 are highly encouraged to get mammograms annually, especially if they have a family history of the disease.
Will wearing a bra and using antiperspirant deodorant increase the risk of breast cancer?
There are theories that an underwire bra and antiperspirants can affect the flow of lymph fluid and cause a buildup of toxins in the lymph nodes. There is, however, no evidence to back claims that underwires restrain how toxins are eliminated from the body through the lymphatic system. On the other hand, studies about antiperspirant deodorants indicate a higher aluminium buildup in breast tissue but are not directly linked as a definitive cause of breast cancer.
Risk factors that increase the chances of breast cancer include:
- Inherited genetic mutations: Mutations to the BRCA1 and BRCA2 genes are inherited. These mutations increase the risk for breast and ovarian cancers.
- Reproductive history: How long a woman menstruates, i.e. early menarche and late menopause, extends a woman’s exposure to hormones produced in the ovaries (endogenous estrogen and progesterone) and increases the risk of breast cancer. Hormonal birth control, having a first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy are also factors that increase the chances of breast cancer.
- Having dense breasts: Dense breasts have more connective tissue than fatty tissue making it difficult to see tumours on a mammogram.
- Personal history of breast cancer or other breast diseases: Women with breast cancer are more likely to get breast cancer again. Some non-cancerous breast diseases, such as atypical hyperplasia or lobular carcinoma in situ, are also associated with a higher risk of breast cancer.
- Family history of breast or ovarian cancer: A woman’s risk for breast cancer is higher if first-degree relative or multiple family members on either parent’s side of the family have had breast or ovarian cancer.
- Not being physically active: Women who are not physically active have a higher risk of getting breast cancer.
- Being overweight or obese after menopause: Older women who are overweight or obese have a higher risk of getting breast cancer than those at an average weight.
- Taking hormones: Some forms of hormone replacement therapy that include estrogen and progesterone during menopause can raise the risk for breast cancer.
- Drinking alcohol: Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.
Why is early detection so important?
Early detection provides the best chance of effective treatment and the types of treatments possible. This, in turn, increases the chances of survival and improves the patient’s quality of life.
The earliest detection method taught to every woman from puberty is breast self-examination. Although there is no evidence performing this examination every month reduces mortality, it does help women become more aware of the normal appearance and feel of their breasts so that any changes are easier to detect and diagnose.
Are mammograms safe?
Having one may hurt, especially as the breast tissue is compressed during a mammogram. However, a mammogram, or x-ray of the breast, cannot increase the risk of breast cancer or cause it to spread. Although small doses of radiation are associated with mammography, the risk of harm from this radiation exposure is very low. It remains the gold standard in detecting breast cancer early.
Other methods of detection include:
Breast ultrasound
Breast ultrasound uses sound waves to make a computer picture of the inside of the breast. It can show specific breast changes, like fluid-filled cysts, that are harder to identify on mammograms.
Breast MRI
Breast MRI (magnetic resonance imaging) uses radio waves and strong magnets to make detailed pictures of the inside of the breast.
Biopsy
A biopsy is the only definitive way to diagnose breast cancer. A tissue sample is taken and sent to a laboratory for analysis. The lab then determines if the cells are cancerous, the type of cells involved, the aggressiveness of cancer, and whether the cancer cells have hormone receptors that may influence treatment options.
What are the types of breast cancer, and what treatments are involved?
Many types of breast cancers are determined by the specific breast cells affected. The patient's treatment also depends on the type of cancerous cells and how far it has spread.
There are two main categories:
Invasive - Has spread from the breast ducts or glands to other parts of the breast
In situ (noninvasive) - Has not spread from the original tissue.
These two categories describe the most common types of breast cancers:
- Ductal carcinoma in situ (DCIS) - Non-invasive cancer confined to the ducts of the breast.
- Lobular carcinoma in situ (LCIS) - Cancer begins in the breast’s milk-producing glands that have not yet spread to nearby tissue.
- Invasive ductal carcinoma (IDC) - The most common type of breast cancer that begins in the milk ducts and spreads to nearby breast tissue, increasing its chances of spreading to nearby organs.
- Invasive lobular carcinoma (ILC) - This cancer first developed in breast lobules but has invaded nearby tissue.
- Triple-negative breast cancer (TNBC) - An aggressive and invasive breast cancer that is very difficult to treat. The cancer cells do not have estrogen or progesterone receptors, nor do they make too much protein called HER2 (a growth-promoting protein outside of all breast cells). The cancerous cells test “negative” for all three tests.
- Inflammatory breast cancer (IBC) - A rare breast cancer that does not look like typical breast cancer. Instead of a lump, symptoms show up as an inflamed rash. It causes breast swelling and dimpling or thickening of the skin of the breast so that it may look and feel like an orange peel. It is also more aggressive—it grows and spreads faster than more common breast cancers.
- Paget disease of the nipple - A breast cancer that begins in the ducts of the nipple and affects the skin and areola.
- Phyllodes tumour - A rare breast cancer that grows in the connective tissue. Most are benign, but some are not.
- Angiosarcoma - Cancer that grows on the breast’s blood vessels or lymph vessels.
Each patient’s treatment plan is tailored to their needs and may include one or more types of treatments. The most common are:
- Surgery - An operation where doctors cut out cancer-affected tissue.
- Chemotherapy - Using particular medicines to shrink or kill cancer cells. The drugs can be pills you take, medications given in your veins, or sometimes both.
- Hormonal therapy - Blocks cancer cells from getting the hormones they need to grow.
- Biological therapy - Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.
- Radiation therapy - Using high-energy rays (similar to X-rays) to kill the cancer cell
Women of all ages need to pay attention to their breasts, perform self-exams, report any unusual changes to their doctors and insist that breast cancer be ruled out if there’s a concerning symptom. Although breast cancer is often associated solely with women, men, too, can be affected. Approximately 1% of all breast cancer diagnoses are in men.
It is essential to realise that breast cancer can recur, and there can be side effects even after treatment. Pain and tightness, fatigue, skin changes, tingling and numbness in the hands and feet, menopausal symptoms, mental and emotional side effects such as anxiety, fear of recurrence, and relationship changes can affect a patient’s quality of life.
This article was brought to you by Naluri’s Mental Health Coaches. Naluri empowers you to develop healthy lifestyle habits, achieve meaningful health outcomes, and be healthier and happier through personalised coaching, structured programmes, self-guided lessons, and health tools and devices. Download the Naluri App today or contact hello@naluri.life for more information on utilising digital health coaching and therapy to become a happier, healthier you.