Those of us who aren’t really affected by breast cancer don’t think or worry about it. That’s pretty understandable since we can get caught up in the daily grind and other issues out there. And that’s why there’s Breast Cancer Awareness Month: It at least gives us some time to know more about breast cancer, which can develop in us and in the women closest to us. The best-case scenario, of course, is that we take what we learn about the cancer and do what we can to lower our risk of being diagnosed with it—because most of us still can. Take it from Dr. Maria Luisa Tiambeng, an oncologist at Cardinal Santos Medical Center, who gives us what we need to know about breast cancer, from the causes to the treatments, to how we can prevent the deaths.
What causes breast cancer?
Most breast cancers are sporadic. Meaning, they develop by chance from damage in a person’s genes. There is no risk of passing this gene to one’s children.
Inherited breast cancers are less common, making up five to 10 percent of all breast cancers. Inherited breast cancer occurs when gene changes called mutations are passed down within a family from one generation to the next. The most common genetic mutations that cause breast cancer are BRCA1 and BRCA2 mutations. (BRCA1 and BRCA2 are genes that produce tumor-suppressing proteins. When they mutate, DNA damage is not repaired properly, and cells can develop alterations that lead to cancer.)
How does breast cancer start?
Breast cancer starts when cells in the breast grow uncontrollably. The cells then form a tumor that can be seen on X-ray (mammography) or ultrasound or felt as a lump. This tumor is malignant (cancerous) if it is capable of invading surrounding tissues or spreading to other parts of the body.
What are the symptoms?
Palpable breast lump, breast tenderness, nipple retraction or discharge, and breast discoloration or hardening.
How do I know my risk of getting it?
Multiple risk factors may raise a woman’s risk of developing breast cancer:
Age. The risk of developing breast cancer increases as a woman ages.
Personal history of breast cancer. A woman who has a history of breast cancer in one breast has a higher risk of developing breast cancer in the other breast.
Family history of breast cancer. Inherited risk or genetic predisposition such as BRCA1 and BRCA2 mutations. Those are the most common inherited gene mutations linked with an increased risk of breast cancer. Other less common genetic mutations include Lynch syndrome, Cowden syndrome, and Li-Fraumeni syndrome.
Personal history of ovarian cancer. Ovarian and breast cancers can be caused by certain gene mutations that cause a family cancer syndrome, which increases the risk of breast cancer.
Estrogen and progesterone exposure. This includes early menarche, late menopause, first pregnancy after age 35, no history of full-term pregnancy, hormone replacement therapy, and oral contraceptive use.
There are some breast cancer cases that are affected by hormones. This is called hormone receptor-positive breast cancer. Breast cancers that have estrogen receptors are often referred to as ER+ cancers, while those containing progesterone receptors are called PR+ cancers. These breast cancer cells have receptors (proteins) that attach to estrogen or progesterone, which help them grow.
How can I lower my risk of breast cancer?
Maintain an ideal body weight. Studies have shown that post-menopausal women who are overweight or obese have an increased risk of breast cancer.
Be more active. Increased physical activity is associated with a decreased risk of developing breast cancer by helping women maintain a healthy body weight, by lowering estrogen levels, and by improving a woman’s metabolism or immune factors.
Limit alcohol intake. Current research suggests that having more than one or two alcoholic drinks per day raises the risk of breast cancer.
There is no reliable research that confirms that eating or avoiding specific food reduces the risk of breast cancer. However, eating more fruits and vegetables and less animal fat is linked with many health benefits.
Do most women diagnosed with breast cancer die from it?
According to the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute in the U.S., five-year survival rates* per stage of breast cancer are as follows:
- localized to the breast (sometimes referred to as stage 1 breast cancer): nine percent
- breast cancer that has spread to the lymph nodes (sometimes referred to as stage 2 or stage 3 breast cancer, depending on the tumor size): two percent
- breast cancer that has spread to other organs (stage 4): nine percent
*This means surviving five years or more after being diagnosed with breast cancer.
This data assumes that the patient has received appropriate treatment. In the Philippines where breast cancer is oftentimes diagnosed late, the five-year survival rate across all stages is only 57 percent, according to the “2015 Philippine Cancer Facts and Estimates.”
What are the different treatments for breast cancer?
Treatment for breast cancer includes surgery, chemotherapy, and radiation. A multidisciplinary team of experts determines which treatment or treatment approaches are best for each patient.
Treatment is based on several factors including stage of the disease, age and functional capacity of the patient, and biological factors of the disease like grade, estrogen and progesterone levels, and status of HER2/neu, which are growth-promoting proteins outside the breast cells. (Breast cancer cells that have high levels of HER2/neu will grow and spread faster than other breast cancers).
What are the side effects of the different kinds of treatment?
Each treatment has its own side effect profile. For surgery, side effects include pain at the operative site and lymphedema or swelling of the arm where the lymph nodes were taken.
Chemotherapy may cause hair loss, decrease in white blood cell count, skin or nail discoloration, diarrhea, and oral ulcers.
Radiation may cause skin darkening and a burning sensation in the radiated field.
For those undergoing chemotherapy and other painful treatments, how can they alleviate the pain and the side effects?
Whatever the side effects are, these are best discussed with the patient’s physicians. What is important to know is that the side effects are frequently temporary and reversible, and the benefits of the treatment far outweigh the risks of having these side effects.
Is getting treated for breast cancer worth all the expenses if the rate of survival is low?
The cost of treatment varies. It depends on the stage and the biological profile of the disease. As stated, survival rates are high with appropriate treatment. Therefore, the answer to whether it is worth the expense is a resounding YES.
Can I prevent myself from getting breast cancer?
While we cannot prevent breast cancer, we can certainly do something to diagnose it early and therefore prevent death from breast cancer. This is through breast cancer screening, which involves an annual mammogram starting at the age of 40 and a monthly self-breast exam. Mammography may be painful for some women, but this is generally well tolerated and temporary.
How about for women in their 20s?
Regular breast self-exams are encouraged. Plus: living a healthy lifestyle, exercising, eating a balanced diet, lessening consumption of processed food, smoking less, and getting more sleep.
Editors' Note: We originally wrote "Women in their 20s can already get a mammogram or breast ultrasound." We have since corrected this error to state that a woman can get a mammogram when she hits 40.
How much are the mammography and the ultrasound?
In Cardinal Santos Medical Center, the digital mammography costs P3,200; the 2D breast ultrasound costs P2,100. The two, packaged together, costs P4,243.