Warning bells on breast cancer

Dr Raden Mas Jeffri bin Raden Mas Ismail, PJSC Oncologist Medical Consultant

October is the designated Breast Cancer Awareness (BCA) month. It is celebrated worldwide and in some countries, it is called Pinktober in view of the designated pink ribbon sign that represents it. It started in 1985 in the United States (US) and is now celebrated worldwide to commemorate the lives of breast cancer patients past and present and their families.

Breast cancer is the most common cancer afflicting Bruneian women.

Though it mainly affects women, men are not completely excluded as one in every 99 to 100 cases of breast cancer is a male.

The incidence of breast cancer is increasing over time in Brunei. In the Southeast Asia region, Brunei has among the highest incidence for breast cancer compared to other countries with estimated 55.9 cases per age standardised per 100,000 populations.

In a local nationwide study on 847 evaluable breast cancer patients diagnosed from 2007 to 2017 in Brunei published by Dr Leong and colleagues in 2019, the average age of diagnosis of breast cancer in Brunei is 52 years of age.

Around 13 per cent of those diagnosed with breast cancer were below the age of 40. The majority of the breast cancer cases were from the Brunei-Muara District (70.6 per cent) and of Malay ethnicity (72.8 per cent).

SIGNS AND SYMPTOMS OF BREAST CANCER

Early signs of breast cancer may present as a lump in a breast, a painful breast or lump in the armpit, or a discharge from the nipple. It is best to visit a doctor.

A doctor will most likely perform a manual exam and send you for a mammogram. A mammogram examination is painless and only takes about 10 minutes.

Another effective way to detect sign and symptoms of breast cancer is by doing breast self-examination regularly.

Women can do breast self-examination at the comfort of their home. However, it is advisable to avoid doing breast self-examination during menstrual period. In most cases, pain or a lump in a breast can be perfectly harmless. The pain can be a sign of a cyst or the lump can be benign. Some individuals may have inverted nipple and this may be normal for them. But to be absolutely sure, it is always better visit your doctor.

WHAT ARE THE CAUSES FOR BREAST CANCER?

There are multiple factors contributing to the breast cancer.

RISK FACTORS THAT YOU CANNOT CHANGE:

Sex. Though breast cancer is primarily a cancer affecting women, it can also
affect men.

• Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.

Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.

• Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.

• Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumours on a mammogram. Women with dense breasts are more likely to get breast cancer.

• Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.

• Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who has had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.

• Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts before age 30 have a higher risk of getting breast cancer later in life.

Women who took the drug Diethylstilbestrol (DES), which was given to some pregnant women in the US between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

RISK FACTORS YOU CAN CHANGE:

• Not being physically active. Studies have shown that women who have a sedentary lifestyle without regular physical activity have a higher risk of getting breast cancer.

• Being overweight or obese after menopause. There is a higher incidence for breast cancer in women who are overweight or obese compared to those at a normal weight especially after menopause.

• Taking hormones. Some forms of hormone replacement therapy (HRT, those that include both oestrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. This practice is less common nowadays and HRT is mainly used for women with difficult hot flushes.

• Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.

• Reproductive history. Having the first pregnancy after age 30 (late first pregnancy), not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.

Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer also may increase breast cancer risk.

WHAT WAYS TO GET BREASTS CHECKED?

The most effective screening method is mammography. However mammography is most effective in women ages 40 and above. Below this age (women < 40 years), the breast is denser and a mammogram is not indicated. In young women, an MRI of the breast and/or an ultrasound breast are good alternative as screening.

Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital is the main referral service for symptomatic breast cases. Patients with established breast cancer diagnosis are referred to The Brunei Cancer Centre in PJSC for treatment other than surgery.

WHAT IS THE BEST WAY TO TREAT BREAST CANCER?

Early detection by screening and healthy lifestyle to reduce risk of cancer development is the best way to treat breast cancer.

CAN BREAST CANCER PATIENTS GET VACCINATED WITH COVID-19 VACCINES?

Breast cancer patients who are on anticancer treatment are at risk of reduced immunity system with reduce white cell counts. This is especially true for chemotherapy and newer hormonal therapies. For those patients who are on active chemotherapy, the best time for vaccination is in the week preceding the
next chemotherapy. Breast cancer patients on surveillance with or without hormonal therapy may have COVID-19 vaccination at any time and advised to proceed to have it soon (if not already done so) in line with MoH’s target for vaccination.

Breast cancer patients on Herceptin or any similar anti-HER2 therapy may also receive COVID-19 vaccination.

BCA is an annual campaign to improve awareness of the public with regards to breast cancer, its causes, detection and treatment. As the national cancer centre, The Brunei Cancer Centre (TBCC) of Pantai Jerudong Specialist Centre (PJSC) plays a key role in educating and spreading awareness on breast cancer as it remains the number one cancer among women in the country.

Commemoration event and various activities are held with cooperation between governmental and non-governmental organisations (voluntary organisations or private companies or individuals) to disseminate information on increasing breast cancer awareness in Brunei.

The campaign is promoted through public events, information pamphlets, booklets, walks, roadshow, talks and presentations breast cancer patients, survivors and doctors and social media platforms.