Rapid advancements in medical technology offers renewed hope and improved treatment for breast cancer patients.
While there has been much global awareness about breast cancer in recent years, many may still be surprised to hear that it is the most common form of cancer among Malaysian women. According to the Breast Cancer Welfare Association Malaysia, one in 20 Malaysian women is at risk of developing breast cancer, compared to one in eight Caucasian women.
However, in conjunction with the breast cancer awareness initiatives happening this month, we’ve got some great news to share! Tropicana Medical Centre’s Consultant General and Breast and Endocrine Surgeon Dr. Zamzuri Zakaria talked to us about medical advancements in Malaysia which have contributed to improve clinical outcomes and helped provide breast cancer patients with a more positive outcome after diagnosis.
Zooming in on early detection
Firstly, Dr. Zamzuri advises that, like any disease, early diagnosis for breast cancer is crucial – the earlier the detection, the higher the chances of survival. Early diagnosis can be facilitated by methods such as Breast Self-Examination (BSE) and mammogram screenings.
Dr. Zamzuri explains that mammograms used to be conducted with a machine that used low-energy X-rays. An image would then be displayed on a film for the doctor to examine and identify if there is cause for concern. However, with medical technology advancements, the results of mammograms are now available, digitally. “Digital mammograms have also improved the sensitivity of the scan. So a doctor is now able to clearly see the details of the mammogram for a more precise diagnosis,” explains Dr. Zamzuri.
He adds that technological advancements have also introduced the use of digital tomosynthesis which allows medical experts to perform high-resolution digital imaging that captures multiple angles for a 3D rendition of the breast. This device has helped to identify abnormalities with greater precision and accuracy.
Minimising the scope of surgery
For women diagnosed with breast cancer, surgery may be required to remove cancerous cells and cells surrounding the affected area. Depending on the severity of the situation, the doctor may also recommend a mastectomy.
Dr. Zamzuri explains that previously, when a breast cancer patient undergoes mastectomies, her lymph nodes in the axilla (the area surrounding the armpit) are also removed in a procedure known as ‘axillary clearance’. This procedure is done not just when lymph nodes have been affected by cancer cells but also as a precautionary measure to prevent metastasis. “However, with this procedure, patients will tend to experience side effects as it affects the drainage of fluids in that area,” explains Dr. Zamzuri. This leads to long-term symptoms like pain, swelling, numbness and restricted shoulder joint movement which can significantly decrease quality of life.
Fortunately, he also has good news to share. “In recent years, advances in surgery have led to a reduction in morbidities associated with breast surgery. Researchers have discovered a particular lymph node known as the sentinel lymph node.” The sentinel lymph node works as a “connecting bridge” for cancer cells to metastasise. This lymph node also connects the breast to the axilla.
This discovery is significant because it means that if the sentinel lymph node is not affected by cancer cells, there is a likelihood that the lymph nodes surrounding the axilla are also unaffected and therefore, do not need to be removed.
Modern medicine has also had a tremendous positive impact on providing adjuvant therapy for breast cancer patients. Generally, there are four types of breast cancer treatments currently available in Malaysia. They are:
- Chemotherapy – The use of anti-cancer medications administered via intravenous drips and/or oral drugs aimed at eliminating cancer cells. In the process, other healthy cells in the body may also be damaged. This can lead to side effects such as hair fall, dry skin and nausea. However, combination chemotherapy, where different anti-cancer drugs are used concurrently, reduces the risk of mortality by a third.
- Radiotherapy – During the treatment, which lasts about 10 to 20 minutes, radiation is focused onto the affected area to stop the cancer cells from dividing and increasing.
- Hormonal Therapy –This therapy is administered orally and it is recommended when the breast cancer is caused by oestrogen receptors (80 percent of breast cancers are oestrogen receptor-positive). Hormone treatment aims to block these receptors, so that the growth of the cancer cells can be curtailed.
- Targeted therapy – This new form of therapy is developed against a specific target in the breast cancer cells. Before this treatment is administered, a detailed study of the patient’s cells is required. Targeted therapies are generally less likely than chemotherapy to harm healthy cells, and cause fewer adverse effects.
So how would you know which treatment is the best option?
According to Dr. Zamzuri, medical experts have now divided breast cancer into four main groups, each with its own classification and genetic profiling. Several factors such as histological grade will be taken into account to estimate the prognosis and hence the likely benefit from specific therapies. This means that doctors can now tailor cancer treatment to best benefit an individual.
Dr. Zamzuri’s parting advice to all women is to be aware of changes in your body and breasts, to openly discuss any health concerns with a qualified professional and to never sweep questions and worries pertaining to health under the carpet. He also advises women to maintain a healthy lifestyle and pay extra attention if you are at high risk for breast cancer.
A Simple Guide to Breast Self-Examination
A breast self-examination should be conducted monthly, seven to 10 days from the first day of your menstrual cycle. Here’s how.
Step 1: Remove all clothing above the waist and look at yourself in the mirror. Check your breasts in four places, looking for changes in size, shape, colour and texture of your skin and nipples.
- Arms relaxed
- Hand on hip
- Arms raised above your head
- Bending forward
Step 2: Lie flat on your back with a folded towel or sheet under your left shoulder and place your hand under your head. Use your right hand to feel your left breast. Check the area from under the collarbone to the bra line, and from the middle of the chest to the armpit line at the side. Switch sides.
Feel each breast with three fingers, using the flat part of your fingertips and moving your fingers in small circles about the size of a 20-cent coin.
Press gently but firmly, feeling the breast to familiarise yourself with its normal texture.
Imagine your breast as the face of a clock. Start at 12 o’clock and feel along the boundary until you return to your starting position. Move down a finger’s width and repeat until you reach your nipple.
(You may find a ridge of firm flesh under the breast. This is normal and is there to provide structural support to your breast.)
You may also prefer to feel the breast by moving your fingers up and down in a vertical strip.