Prevention and early detection in breast cancer

Breast cancer incidence is increasing due to improved disease awareness and a rise in screening. In parallel, mortality is steadily decreasing due to earlier diagnosis (around 40 to 45 years of age) and more effective treatments. In countries like France, the prognosis is considered favourable in most cases, with the 5-year average survival rate reaching 85 per cent. However, due to its high frequency, breast cancer remains a major killer in most countries. 

Breast cancer can also affect men, although very rarely. 

A lump in one breast or in the armpit is one of the most common symptoms of breast cancer. Other abnormalities can include changes in the breast shape, inversion of the nipple or nipple discharge, skin modifications and inflammation on part of the breast. Even though most of breast tissue changes are linked to benign conditions, it is advisable to promptly seek medical opinion in the event of any recent breast anomaly. Breast cancer is often discovered during a mammogram and despite past controversies as to the risks and benefits, screening should be maintained at a regular interval.

A breast tumour requires systematic investigations to confirm the diagnosis, determine the most appropriate therapeutic approach and assess the prognosis. Accurate diagnosis is made by tissue analysis of the suspicious mass, which can be either punctured (needle biopsy) or removed (tissue biopsy). When found positive for cancer, the test also determines the type of cancerous cells and their ability to disseminate to other parts of the body (grade aggressiveness). In addition, the presence of hormonal receptors on these cancerous cells is studied to evaluate the benefits of specific treatment interacting with these receptors. 

When the pathologic report confirms the diagnosis, a careful evaluation of the cancer extension (staging) needs to be performed to determine the optimal treatment approach. The cancer staging requires a thorough clinical exam, some blood tests and imaging techniques, often including CT scans and MRI. In some cases, surgery of the breast cancer is required to complete its staging. There are 4 stages from 0 (no or minimal extension) to IV (the most advanced cancer development). The cancer is also classified in the TNM system, which considers the size of the Tumour (T), the presence of infiltrated lymphatic Nodes (N) and the existence of Metastasis (M). Breast cancer cells may spread to other organs via the lymphatic system and generate distant tumours (metastasis) within other organs such as bone, liver, lungs and brain. 

Treatment needs to be carried out in a specialised centre under the care of a multidisciplinary team with medical oncologists, breast surgeons, radiation oncologists, gynaecologists, internists and pathologists. Each breast cancer patient is a unique case and should benefit from a specific, individually tailored therapeutic procedure, which may include surgery, radiotherapy, chemotherapy and hormonotherapy. 

Besides ageing, breast cancer has other “non-controllable” risk factors: family history of breast cancer, previous radiotherapy treatment and the presence of specific genes that increase the risk of breast cancer occurrence. There are “controllable” risk factors, which include prolonged postmenopausal hormonal treatment, being overweight and consuming alcohol. 

Prevention, like for all for cancers, remains the most logical methods: self-breast exam, annual gynaecological check-up, annual mammogram and breast ultrasound after 40 years of age (as recommended by the American Cancer Society) and maintaining a healthy life style. 

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].