TUESDAY, March 19, 2024
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The importance of screening

The importance of screening

According to statistics, 30 in every 100,000 Thai women develop breast cancer. These incidence rates are two times higher than previous statistics, and the exact cause of the increase in breast cancer is unknown. One possibility is our drastic changes in lifestyle.
“Breast cancer has now become the most common type of cancer, whereas originally it was ranked second to cervical cancer,” says Associate Professor Wichai Vassanasiri, MD, a specialist in breast cancer surgery at Samitivej Hospital.
“Asian women also appear to develop breast cancer more quickly than European or American women. It has also been found that in Bangkok and parts of the Eastern Seaboard, specifically industrial cities such as Rayong, Chanthaburi and Chonburi, breast cancer incidence rates are higher than in other regions.
“Some of the important symptoms of breast cancer include a lump or mass in the breast, nipple discharge, dimpling of the skin, or sores on the breast area. If you have any of these symptoms, you should seek medical attention from a doctor immediately, as it could be a sign that you are in the later stages of the disease, he says.
In actuality, you should not wait for symptoms to become obvious, as breast cancer in its early stages often has no visible symptoms. Women should undergo breast cancer screening from 40 years of age and onward, with an annual mammogram and ultrasound check performed together.
If any abnormalities are found during screening, your doctor may perform either a needle or surgical biopsy in order to further study the cells or tissue before planning the next steps in treatment.
“If a lump or mass is found that is smaller than one centimetre, the surgeon may choose to perform a needle biopsy using digital mammography or ultrasound equipment, in order to pinpoint the exact location of the mass. He or she will then insert a needle, advancing it to the location of the abnormality, and remove tissue samples for further testing and diagnosis. If a needle biopsy of this kind is possible, the doctor will recommend it as a first option as opposed to undergoing a surgical biopsy from the very beginning. This is because if tissue from the mass is removed and tested and is revealed to be cancerous, the patient would have to undergo another surgery,” Dr Wichai explains.
Doctors are able to tell the stage of the cancer by the size of the mass, whether it has advanced to the lymph nodes, and how far the cancer cells have spread to other parts of the body. Thus, doctors can determine the stage of the disease once surgery has been performed. 
However, immediate diagnosis can often be made if very large and deep wound are found, or a large mass or lump in the lymph nodes in the armpit area. These symptoms likely indicate an already advanced stage of cancer, in which case doctors may decide to suggest chemotherapy before surgery takes place.
The presence of cancer in the lymph nodes is one of the most important factors that your doctor will consider when determining how aggressive your treatment needs to be. Sentinel lymph node biopsy is performed by injecting dye to locate the position of the lymph node; the surgeon makes a small incision in the overlying skin and removes the node. Then a pathologist will check for the presence of cancer cells. The doctor will use this information to aid in prognosis and in preparation of an effective post-surgery treatment plan.
Treatment methods are divided into two main categories: local treatments, which include surgery and radiation therapy and systemic treatments, which include chemotherapy, hormone therapy (anti-hormone treatment) or other medications. In the case of invasive cancer cells spreading quickly and expanding to the area of the lymph node, the doctor may prescribe chemotherapy and/or radiation therapy, and may provide hormone therapy as well.
“In the treatment of breast cancer, surgery is generally the best chance for a cure,” explains Dr Wichai. “There are two types of breast cancer surgery: a mastectomy where the whole breast is removed, or breast-conserving surgery. In the case of breast-conserving surgery, there are currently surgical procedures whereby breast reconstruction can be performed at the time of surgery so as to help the patient maintain confidence after surgery.
 “Do not refuse conventional medical treatments, as these have undergone research and experimentation over long periods of time, and doctors will be aware of the advantages and disadvantages of each specific type of medication, “ he advises.
“Deciding to use traditional or herbal medicines alone can be very dangerous, as not only can certain herbal medicines affect the liver and the kidneys, causing liver or kidney failure, but they have also not been properly and accurately researched. As a result, patients lose the opportunity to avail themselves of the correct treatment methods.”

ASSOCIATE PROFESSOR WICHAI VASSANASIRI |is a breast surgeon at Samitivej Sukhumvit Hospital. Call (02) 022 2585-7. 
 

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