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BREAST CANCER - EARLY DETECTION AND TREATMENTS

Filed on October 20, 2020 | Last updated on October 21, 2020 at 04.22 pm

October, the breast cancer awareness month marked in countries across the globe widely informs communities about a deadly disease - Breast Cancer, that impacts many lives each year. It will be helpful to know the key aspects of early detection and prevention of this cancer. Treatments are advanced and ensure full recovery in certain cases. Here are frequently asked questions on the screening methods and surgeries answered by Dr. Humera Bint Raees, Specialist Obstetrician and Gynecologist in Zulekha Hospital Sharjah and Dr. Sheela Prince, General Laparoscopic and Breast Surgeon in Zulekha Hospital, Dubai. The hospital also offers free screenings for the full month.

When does a woman need to check on her breasts for breast cancer? What are the symptoms to watch out for?

- Women aged 40-44 should start annual breast cancer screening. These women should get a mammogram done every year.

- Women above 55 years should get a mammogram done every two years.

- Women with strong family history of breast cancer can have the breast check at any age if any symptoms.

- Symptoms to watch out for: Lump in the breast or underarm, thickening or swelling of part of breast, pulling in of the nipple or pain in the nipple area, nipple discharge other than milk.

How do gynecologists diagnose breast cancer in women? How is it investigated and confirmed further?

Breast cancers are recognized usually by gynecologists. Most gynecologists perform breast palpation examination routinely along with the pap-smear test. Tests carried out for detection include breast examination, mammogram, breast ultrasound, biopsy (Examination of breast cell), breast MRI

After breast surgery, is breast feeding possible and permissible? What precautions are advised for a feeding mother?

After breast surgery, feeding is permissible if there is milk in the breast. If the patient is on chemotherapy / hormone therapy, breast feeding is permissible only after the treatment is complete.

What is the difference between X-ray mammogram and breast ultrasound? When is each on applicable and why?

X-ray mammogram is a screening procedure. This procedure is used to detect no palpable nodes / mass. Breast ultrasound is not a screening procedure. It is used to detect suspicious nodes / mass and is operation dependent in order to determine the nature, site and size of the node / mass.

How should a patient prepare for before a breast cancer surgery? What types of investigations are carried out before the surgery?

Breast is a beautiful organ of feminity and sexuality. The breast cancer diagnosis can be a lightning bolt to a lady. Breast cancer is a family affair and everyone needs support and understanding. It is not a journey to travel alone. A burden shared is easy to carry .You must be aware of your body changes when you feel that something is physically wrong in your body , You do have to be assertive and be an advocate for yourself. No one else can truly know how you feel. So educate yourself, select a skilled medical team, find support and proceed with hope. When you choose your best medical team you will go through triple assessment evaluation.

Clinical evaluation by your doctor, imaging includes base line mammogram, breast ultrasound and breast MRI (to assess multi focality and multi centricity), pathological evaluation by FNA or core biopsy. Core biopsy is ideal with or without clip placement during biopsy. If your tumor is non-palpable and detected by imaging, then a stereotactic biopsy with or without seed placement will be arranged. If your tumor is invasive type you have to go through further evaluation to assess the spread to axillary (underarm) lymph nodes chest and collar bone lymph nodes and to check any spread to bones, liver and lungs. For that you need a CT scan of the chest and abdomen and bone scan. A PET scan can substitute both. In addition to this you will be undergoing your basic blood investigations and cardiac evaluation also if necessitated.

What are the various types of breast cancer surgeries and how does one choose between these?

After you get the treatment plan from your doctor take your time to study your treatment options. Talk to those closest to you. Make thoughtful informed decisions that are best for you. Each treatment option has risks and benefits to consider along with your own values and life style. Breast cancer treatment can be divided into local and systemic therapy. Local therapy removes the cancer from limited (local) area such as breast, chest wall or lymph nodes in the underarm area. Local therapy involves surgery with or without radiation therapy to the breast and nearby lymph nodes. The goal of systemic therapy is to get rid of cancer cells that may have spilled from the breast to the other parts of the body. Your breast cancer surgery depends on various factors like whether it is screen detected (nonpalpable), size and stage, grade, hormone receptor status and HER2 status. For non-palpable image detected tumors you can choose either a wire localization surgery or seed localization surgery. For palpable tumors you can choose either Breast conservative surgery with radiation or Mastectomy (removal of whole breast). In both these surgeries you will be going through a procedure called Sentinel lymph node biopsy (a method by which we check the presence of cancer spread in the underarm lymph nodes ) at the time of surgery and decision for removal of underarm lymph nodes will be made as per the sentinel lymph node biopsy report intraoperatively.

When does one need to opt for a breast cancer surgery? How long does it take to complete the post-surgery treatments as well?

When you are diagnosed with a breast cancer the primary goal of treatment is to get rid of all the cancerous cells that are in your body. In general the two ways of accomplishing this are loco regional therapy and systemic therapy. Loco regional therapy is targeted directly at the tumor and the nearby tissues surrounding it. Loco regional therapy includes surgery with or without radiation therapy. Systemic therapy is aimed at treating cancer cells throughout your body. It involves chemotherapy, immune therapy and hormone therapy. Surgery is the first line treatment. In addition to removing the cancerous mass, surgery provides additional information about the type and extent of cancer that is present. Surgery may be followed by systemic therapy which is called adjuvant therapy. The goal of surgery and adjuvant therapy is to cure your cancer. Post-surgery adjuvant treatment and its duration vary from person to person depending on the size, stage and grade of your tumor and your response to treatment.

How effective is the breast cancer surgery? Is there any risk of recurrence?

Every person with breast cancer deserves the best possible care. The goal of breast cancer surgery in early and locally advanced stages is to remove the cancer and keep it from coming back (recurrence). Most people who underwent breast cancer surgery and completed post-surgery treatment will never have breast cancer recurrence. However individuals who have had breast cancer are at risk of recurrence. The risk of recurrence varies from person to person. Breast cancer can recur at original site (local recurrence). It can also return as spread to other parts of the body (metastasis or distant recurrence). Local recurrence after lumpectomy (breast conservative surgery) can most often be treated successfully. Local recurrence after mastectomy can return in the chest area even though the entire breast is removed in mastectomy. If you notice any change around the mastectomy scar inform your doctor. The more the lymph nodes with cancer at the time of mastectomy, the higher the chance of breast cancer recurrence. So continue your follow up with your doctor.

So stay safe, stay healthy and get screened periodically.

Although the exact treatment of breast cancer varies from person to person, guidelines help to ensure high quality care. These guidelines are based on the latest research and agreement among experts .The National comprehensive cancer network (NCCN) and The American society of clinical oncology (ASCO) are respected organizations that regularly review and update their guidelines.

This content comes from KT Engage, the brand marketing unit of Khaleej Times.