Your breast friend

Your breast friend

There was a time when losing one or both breasts was the only treatment option that was available for women who were diagnosed with breast cancer.

Healers of ancient times removed growths and the affected breasts with tools that looked like torture instruments.

Later, for almost a century after surgeon William Stewart Halsted performed his first radical mastectomy in 1882 (the removal of a woman's breast, surrounding lymph nodes, and part of her chest wall muscles), the procedure had been the treatment of choice.

However, 50 years ago, things started to change for the better.

First, radiation therapy came along, and more surgeons decided to leave their patients' chest wall muscles alone. Women still lost their breasts, but they could at least keep the contour of their chests intact.

Then, it got better in the past decade when surgeons started to preserve as much of their patients' breast tissue as they could through breast-conserving surgery.

Now, more and more women are able to keep the appearance of their breasts, even after the tumours or part of their breasts are removed.

Yet, despite all these improvements, women are still afraid of losing their breasts.

"One of the first questions women always ask is 'Do I need to remove the whole breast?'" notes Dr Tee Shin San, a general surgeon at the Assunta Hospital in Petaling Jaya. Fortunately, for him and his colleagues, it is now often possible to answer, "no".

Be an early bird

A mastectomy is not the end of the world.

The catch is, to qualify for breast conserving surgery, women have to show up at their doctors' offices earlier.

According to Dr Tee, about seven out of 10 women whose breast cancer is picked up (in the early stages) by mammograms can be offered breast-conserving surgery. Even for women who see their doctors when they can feel a mass or lump in their breasts, there is a 50 per cent chance that they would be eligible for breast conserving surgery as well.

The problem is, there are still a lot of women who seek treatment late.

In 2007, statistics by the National Cancer Registry showed that among the 2,114 women who had their breast cancer staged upon diagnosis, about 41 per cent of them came to their doctors at the late stages of 3 or 4.

One of the reasons, says consultant clinical oncologist and radiotherapist Dr Manivannan A. B., may be due to the fact that most breast lumps are painless at early stages. And because breast cancer is more likely to occur at a time when women are usually busy with their families and careers (above 40 years old), these early changes are likely to go unnoticed, or dismissed.

"Sometimes, women talk to other women, who tell them these changes are normal at their age," says Dr Manivannan. The truth is, they are not.

He stressed that it is important to get any lump in the breast or discharge (fluids that seep out) from the nipples checked by a medical doctor.

The newly published clinical practice guidelines for the management of breast cancer by the Health Ministry recommends that screening mammography (for women without symptoms) may be done once in two years in all women between 50 and 74 years of age. (The guidelines can be downloaded from the Health Ministry website, www.moh.gov.my)

However, for women who are at high risk for breast cancer (like those who have a personal history of breast cancer or have siblings or a parent with breast cancer), screening should be done from the age of 30 with both a mammography and an MRI of the breast.

The test is not recommended as a routine for women in between 40 and 49 years old, but those who wish to do so should not be denied the test.

While there is no sufficient evidence that breast self-examination alone is effective in changing the outcomes of breast cancer, the guidelines recommend its use to raise awareness among women as its practice appears to encourage them to take responsibility for their own health.

The possibility of finding something amiss during a breast self-examination or mammogram may be scary to some, but women should bear in mind that the sooner they find out about their cancer, the better their chances of surviving are.

Breast alternatives

While surgery is usually the first line of treatment for breast cancer, it is often combined with other therapies, like chemotherapy, radiotherapy, hormone therapy and targeted therapy.

Unfortunately, in some circumstances, surgeons would not be able to offer breast-conserving surgery to their patients. These include situations when the tumour is too large in relation to the breast, located in several areas in the breast, or when the tumour is centrally located and surgeons may need to remove the nipple and areola as well.

However, there are still options available to help women preserve the appearance of their breasts.

First, their doctors can give them radiotherapy to shrink their tumours so that they can still go for breast-conserving surgery. If that is not an option and a mastectomy has to be done, surgeons can also help reconstruct their breasts with implants or natural tissue with breast reconstruction surgery.

Women also have the option of using breast prostheses or special bras that come with the prostheses so that they could maintain their former appearance even after the surgery.

"(A mastectomy) is not the end of the world," says Dr Tee.

Reaching out

In many ways, breast cancer is considered one of the "better cancers", says Dr Tee. The chances of surviving it are higher and in many instances, it does not stop women (or a small number of men) who have it from carrying out their normal activities.

However, like any other cancer, it can be a harrowing experience for those who are diagnosed with it.

That is why in the new guidelines, psychosocial support is strongly recommended for women with breast cancer. Regardless of its form - therapy, support groups, the help of a breast care nurse, or counselling - emotional support is important to help breast cancer patients cope with the challenges of living with the disease.

The good thing is, thanks to the countless awareness campaigns about breast cancer, help is available almost everywhere. Beyond the compounds of a hospital, there are non-governmental organisations and breast cancer support groups that are able to provide useful advice.

All a breast cancer patient needs to do is to reach out.

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