Breast Cancer
Understanding the causes, diagnosis, treatment, prevention, and rehabilitation of breast cancer can improve survival rates.
Breast cancer, also known as breast carcinoma, is the third leading cause of cancer-related deaths among women in Hong Kong and the most common tumor in female cancers. The causes of breast cancer are related to lifestyle factors, reproductive history, personal medical history, and family history. Breast cancer typically has no symptoms until the tumor becomes noticeable and enlarges. Regular check-ups are effective in preventing and detecting the early signs of breast cancer, and immediate treatment can lead to a high survival rate for patients.
It is estimated that 1 in every 14 women in Hong Kong will have the chance of developing breast cancer in their lifetime. Like other cancers, it is characterized by the uncontrolled proliferation of abnormal cells, which destroys healthy tissue in the body and spreads to other organs. Breast cancer can invade breast tissue and spread to the lymph nodes in the armpit, as well as to other parts of the body such as the lungs, bones, liver, and even the brain, thereby impairing the function of the affected organs and threatening the patient's life. However, early detection of symptoms and treatment can not only reduce medical expenses but also prevent unnecessary treatments and their adverse effects on both physical and mental health.
According to an analysis by the Hong Kong Cancer Registry (HKCaR), as of 2019, the survival statistics of breast cancer patients between 2010 and 2017 showed that 84.0% of breast cancer patients were able to survive for more than five years compared to the general population. The five-year relative survival rates for breast cancer were 99.3% for stage I, 94.6% for stage II, 76.2% for stage III, and 29.8% for stage IV.
Symptoms of Breast Cancer
- Breast lumps: changes in shape or size
- Breast skin changes or deformities: Thickened or scaly skin
- Nipples in sunken position or with ‘orange peel skin’
- Discharge of fluid or bleeding from nipples
- Swollen armpits or lymph nodes
- Breast pain
Women may occasionally feel swelling or pain in their breasts, or hard lumps in their nipples due to the hormone changes during menstruation or early pregnancy, which are normal physiological reactions. Breast cancer is usually asymptomatic when the tumor is small and curable, and it is only noticeable when the tumor has grown into a significant lump and proliferated. Patients with suspicious symptoms should seek medical attention as soon as possible to determine whether the tumor is benign or malignant. However, most breast lumps, such as hygroma or benign fibroma, are benign and harmless to the body. Causes of Breast Cancer
Causes of Breast Cancer
Breast cancer is closely related to certain high-risk factors that may increase the chance of developing breast cancer.
- Lifestyles: lack of exercise, stress, excessive consumption of high-fat foods and red meat, frequent overnight work, smoking and drinking
- Reproductive factors: no experience of breastfeeding and pregnancy, first pregnancy after the age of 35, menarche before the age of 12, menopause after the age of 55, the experience of hormone replacement therapy
- Personal medical history: obesity, family history of breast cancer, family members or individual previously diagnosed with breast cancer, the experience of breast biopsy, presence of abnormal cells in aspiration, lobular carcinoma in situ, intraductal papilloma
Breast Cancer Screening
- Self-examination
Women over the age of 20 are advised to self-examine their breasts regularly every month to understand their breast condition and observe any abnormal changes. Women of childbearing age can have a check-up 2-3 days after their menstruation cycle every month. Women in menopause can self-examine on the first day of each month for easy referencing. Observe any dimpling, redness or other colour changes in the breast skin, and any abnormalities, shape and colour changes, bleeding or discharge of fluid in the nipples.
Procedures of self-examination:
- Stand in front of a mirror, take off your clothes and raise your arms over your head to look for any abnormalities in the breasts.
- Gently massage the inner side of your breasts in circling movements to check for any lumps.
- Repeat the procedure on the outer side of your breasts.
- Examine the area between the breasts and the armpits for any lumps.
- Gently squeeze the nipples and look for any discharge of fluid or blood.
- Clinical examination
Patients should, considering their age and family medical history, receive regular breast examinations, including assessment and palpation by medical professionals to better identify breast diseases.
Diagnosis of Breast Cancer
After reviewing the medical history, the doctor will first examine the lymph nodes in the breasts, armpits, and neck to detect any swelling, pain or other abnormalities. The doctor will then conduct a series of tests to make proper suggestions based on the patient’s age, symptoms, clinical findings and the risk of having breast cancer.
Preliminary Tests
If the blood sample contains a chemical substance which are necessary for the growth of cancer cells, it may indicate the presence of cancer cells in the body.
Radiographic test can effectively detect early-stage breast cancer with no tumor or impalpable tumor. Your breast will be placed on an X-ray scanner. The plastic sheets of the machine will move vertically and horizontally to fasten the breast to take a mammogram of the breast tissues.
Ultrasound scan is a safe and painless screening procedure. A probe will emit high-frequency sound waves to the breast tissues, and then collects the sounds that bounce back. The sound waves will be converted into images to examine the condition inside the breast. It is also used to assist radiography in identifying whether the lump is a hard mass or a cyst.
Pathology tests
- Surgical Biopsy
- Excisional Biopsy
Excisional biopsy provides the highest accuracy, but it is a relatively invasive procedure. The doctor will make an incision of 1 to 2 inches on the patient’s breast to remove the entire tumor and the nearby area, and perform follow-up observation.
- Needle Biopsy
- Fine Needle Aspiration (FNA)
- Core Needle Biopsy (CNB)
A thin needle is inserted into the breast to withdraw tissues for laboratory tests. If a benign cyst is identified during the ultrasound scan, the fluid in the cyst can also be removed using FNA.
Similar to the principle of fine needle aspiration, this method uses a thicker needle that can collect enough tissue for cellular examination, providing higher accuracy. If cancer cells are found after the biopsy, hormone receptor testing and HER2 receptor testing must be conducted to determine the appropriate treatment method.
Doctors may recommend further tests to determine the location, size, and extent of the tumor, assisting doctors in staging breast cancer and determining the appropriate treatment method for the patient.
Survival Rate of Breast Cancer
Breast Cancer Diagnosis and Treatment
The treatment methods for breast cancer can be divided into three main categories: surgical treatment, radiotherapy, and drug treatment.
- Surgical Treatment
- Lumpectomy
- Mastectomy
- Breast reconstruction
This method is suitable for patients whose tumor covers only a small area of the breast. The surgeon will remove the tumor and some of the surrounding lymph nodes.Resection will leave a scar, of which the size depends on the location and the size of the tumour.
If the tumor is large or the cancer cells are widely dispersed, doctors may remove the entire breast, and even the lymph nodes under the armpit and part of the pectoral muscles. Patients who undergo a total mastectomy may need to undergo reconstructive surgery.
Patients can opt for breast reconstruction to maintain the appearance of the breast after surgery. Two main types of breast reconstruction surgeries are breast implants and flap reconstruction. Breast implants involve saline or silicone implants, while flap reconstruction uses the patient’s body tissue such as the skin and fat from the abdomen or buttocks to rebuild the breast.
- Radiology
Radiation therapy, also known as Radiotherapy, uses high-energy rays to target and kill cancer cells. After surgical procedures, radiotherapy can be used to eliminate any remaining cancer cells in the body, reducing the chance of recurrence. Additionally, when breast cancer reaches an advanced stage and the tumor becomes excessively large, causing significant blood vessel growth and bleeding, radiotherapy can serve as a palliative treatment, particularly effective for controlling bleeding.
- Medication Therapy
- Chemotherapy
- Hormonal Therapy
- Targeted Therapy
Chemotherapy, also known as ‘Chemotherapy, primarily involves the intravenous injection of cytotoxic drugs, which are transported through the bloodstream to destroy cancer cells. In the past, chemotherapy for breast cancer was used in early-stage cases as adjuvant therapy after surgery to reduce the risk of recurrence. In recent years, it has been found that some breast cancer patients, especially those with the HER2 gene gene and triple-negative breast cancer, can undergo chemotherapy (with targeted therapy if they have the HER2 gene) before surgery to shrink the tumor, making the surgical procedure easier and potentially allowing for breast conservation.
This aims to suppress estrogen production, thereby preventing cancer cell growth. Hormonal therapy medications inhibit hormone production to prevent hormones from attaching to cancer cells. Patients may also choose to have their ovaries removed or use radiotherapy to stop estrogen secretion, as a lack of estrogen makes it less likely for cancer cells to recur.
This targets specific genes involved in cancer cell growth, blocking their development and repair. HER2-targeted drugs for breast cancer are among the earliest developed targeted therapies, having been in use since 2000. They are generally used for advanced breast cancer to control tumor growth or as adjuvant therapy after surgery for early-stage breast cancer. In recent years, it has been discovered that patients with the HER2 gene can receive chemotherapy combined with targeted drugs before surgery to shrink the tumor, increasing the chances of breast conservation.
Additionally, for advanced HER2-positive breast cancer, there are new generation antibody-drug conjugates (ADCs), which are chemotherapy drugs that can identify HER2 receptors. These drugs attach accurately to HER2 cancer cells, and the entire drug enters the cell nucleus before releasing a high dose of chemotherapy, providing precise treatment and reducing side effects on healthy cells.
Recovery and Rehabilitation of Breast Cancer
After undergoing various treatments, breast cancer patients need regular follow-up visits and examinations to allow doctors to understand their recovery progress. If symptoms such as persistent bone pain, shortness of breath, or limb numbness persist, medical attention should be sought immediately. In addition, patients should perform simple arm exercises as instructed by their doctor to maintain joint flexibility and reduce swelling, but should avoid lifting heavy objects to prevent arm injury and slow down the recovery process.
Prevention of Breast Cancer
There is no certain way to prevent breast cancer, but scientific research has confirmed that some important factors related to breast cancer can reduce the risk of cancer and its recurrence.
- Healthy Lifestyle
Relieve stress, exercise moderately, refrain from smoking
- Weight control
Maintain a healthy diet, drink less alcohol, consume less saturated animal fat and more vegetables
- Regular women’s health checks
Have regular check-ups to identify illnesses and abnormal conditions of body functions as soon as possible, and to take follow-up actions for effective prevention.
Breast Cancer FAQ
Should I receive breast cancer screening during COVID-19?
Many people have missed their mammogram appointments because of the pandemic. If you are going to have a mammogram, please seek medical help. If you have any symptoms of breast cancer, contact your doctor immediately. Receiving a regular mammogram is the best way to detect breast cancer in its early stage.
Please note that if you have received COVID-19 vaccination, and want to receive a breast screening, you should avoid conducting the screening within 4-6 weeks after the vaccination. Otherwise, you may have swollen lymph nodes that may lead to misinterpretation of the mammogram. However, if you suspect that you have a breast tumor, such as feeling a hard lump, you should schedule a mammogram as soon as possible, regardless of the circumstances.
Will frequent hair colouring increase the chance of breast cancer?
Researchers have long been studying the possible link between hair dyes and cancer, but the results have been inconsistent. A recent study published in 2019 by the National Institutes of Health suggests that the risk of having breast cancer increases with the more frequent use of chemical hair care products. The study found that women who used permanent hair dyes and chemical hair straightening products had a higher risk of having breast cancer than women who did not.
Can breastfeeding reduce the risk of breast cancer?
Breastfeeding can reduce the risk of breast cancer.
