THE CANCER WOMEN MUST HEED
Play
Seksan Kittivanakul, MD Samitivej Srinakarin Hospital
Today, breast cancer is more common than cervical cancer in Thailand. That’s not necessarily because there are more patients but rather because the technology has improved to a point where it is impossible to detect a tiny cancer in asymptomatic patients.
Women’s breasts consist of tissues which have many milk ducts, surrounded by tissues that include fat cells. The amount of breast tissue on each individual is different, as does the amount of the tissue at each stage of life. As women get older, the amount of tissue decreases.
The signs and symptoms of breast cancer are as follows:
- A lump in the breast
- Unusual colour of the milk, especially bloody content
- Skin dimpling
- Dimpling or distortion of the nipple
- Sore nipples or scarring
Among the risk factors for breast cancer to watch for are:
- Family history of breast or ovarian cancer, especially in direct relatives (higher risk if those relatives were afflicted before age 50)
- Unusually high oestrogen levels for a long time due to postmenopausal treatment by hormones, hormone treatment as a
- stimulant for infertility, birth control pills, lack of children or not breastfeeding children, late menopause, first menstruation before age 12
- A biopsy or operation finds lobular carcinoma or atypical ductal hyperplasia
- Personal history of breast cancer
- Age
- BRCA1, BRCA2 gene
Breast cancer mammogram screenings should start at age 40. If the results are clear, the screenings should be continued once every year. Beginning at age 20, women should do self-checks every month.
Compared to Westerners, Asian women are starting to develop breast cancer at a younger age, often around 40 years. If a member of your direct family has a history of breast cancer, then it is recommended you start mammogram screening at least 10 years before the time breast cancer was identified in direct relative. For example, if breast cancer was found in the relative when she was 48, you should start the mammogram screening when you are 38.
Before a mammogram:
- Patients should apply no powder, lotion or perfume to the chest or armpits - it can affect the mammogram imagery.
- Bring earlier mammogram images for comparison.
- Undergo screening when the breast isn’t sore or tender. Just before menstruation the level of oestrogen is high and the milk ducts are tense. The most appropriate time is seven to 14 days after menstruation, when the breasts hurt less during screening.
Early-stage breast cancer can be cured by removing the cancerous lump (breast conservation treatment). The operation leaves a small scar. So getting an examination early is very important.
Many people wonder why ultrasound breast scans are combined with mammograms. This is because most Thais have denser breasts than Westerners, and therefore if there is a lump, it may be hidden on the mammogram.
The ultrasound is also helpful in detecting small lesions. However, the ultrasound has low specificity, and benign lesions can mimic cancers and vice versa. This is why a follow-up ultrasound is recommended every three to six months, to check for any shape and size changes.
Dr Seksan Kittivanakul
is a radiologist at Samitivej Srinakarin Hospital.
