Cancer doesn't have to mean losing the breasts

Yet, for the most part, a mastectomy can be avoided if the cancer is caught early and that means regular screening. All women know that breast cancer can be cured in its early stage so why it is that the majority of Thai women do not consult a doctor until their cancer is already at stage 3?

Part of the reason is that many women do not take enough care of themselves and fail to go for regular health check-ups. That’s shame as in those who are checked regularly, any cancer is detected in its early stage or in stage 0 when abnormal cells are found in the lining of the breast milk duct before they have spread to normal tissue. In this stage, the breast cancer can be 100-per-cemt cured. Also, in its early stage, the cancer can be cured without removing the breasts. This is called breast-conserving surgery. 

Although breast-conserving surgery has been performed for more than 20 years, there remains a misconception that the entire breast must be removed to prevent the risk of the cancer returning in that breast. Breast-conserving surgery and a mastectomy provide a similar outcome. The most important difference, however, is that breast-conserving surgery must be combined with radiotherapy. Cancer is considered as a problem of tissue organisation. After the cancer has been removed, the abnormal tissue may reoccur. Therefore, breast-conserving surgery must be followed by radiotherapy, so as to destroy the abnormal cells completely and prevent the cancer from reoccurring.

In the past, the goal of breast-conserving surgery was to keep the breasts. To achieve this, it was necessary for the patient to have reasonable sized breasts and for the tumour to be very small in order for the breast shape to be maintained and any deformity minimised post- surgery. However, modern surgical techniques have resulted in improvements to the available treatments. Oncoplastic surgery is a surgical technique that removes cancer and maintains the natural beauty of the breasts. Oncoplastic surgery combines oncology, which focuses on the treatment of the cancer, and plastic surgery to restore appearance. It allows wider excisions, and if the breasts are left misshapen after the removal of the tumour, reconstruction can be performed by using tissue taken from the patient’s back or fatty component so as to restore the beauty of the breasts.

At present, breast-conserving surgery can be performed in stage 3 when the tumour is very large or extends up into the armpit. The treatment must include chemotherapy or systemic treatment so as to prevent the spread of cancer and reduce the tumour size. Effective breast cancer surgery involves the removal of the tumour and surrounding tissue to ensure that all the cancer is removed.

Tumour size relative to breast size is used to determine suitability for breast- conserving surgery. Asian people should not have a tumour larger than 4 cm and not more than 2-4 tumours located in the same area – not too far apart from each other. Tumour multicentricity is defined as the presence of two separate tumours far apart from each other in different parts of the breast. In such cases, there is a high probability of recurrence due to biological significance, and the entire breast should be removed.

Breast-conserving surgery is not complicated. Without reconstruction, breast-conserving surgery is in fact less time consuming and more minimally invasive with fewer complications and anaesthetic risks than entire breast removal. As previously mentioned, radiotherapy must be performed after breast-conserving surgery, and this radiotherapy should be delivered to the whole breast in 25-33 daily sessions lasting about 15 minutes each. Some people mistakenly assume that the radiotherapy after breast-conserving surgery is time consuming and painful and decide to have their entire breasts removed rather than undergo the treatment. However, latest developments in radiotherapy mean fewer risks of complications and less pain. Some patients do not even feel any pain.

All women should have breast-screening tests every year. Remember, the earlier we find cancer, the easier it is to treat. However, if we do get cancer, then proper treatment, the right decisions, and a positive attitude can help us beat it.

 

Shinawatt Visutdiphat, MD is a Breast Surgeon with Samitivej Srinakarin Hospital. Call (02) 378 9304-5.