BREAST cancer not only sparks the fear of death in women, but also the loss of their femininity.
This fear, driven by the prospect of losing their breasts due to treatment, often leads to delayed diagnosis and treatment.
Women tend to ignore a lump in their breast or wait until it becomes bigger before seeking further investigation or treatment.
Ironically, the longer they wait and the larger the tumour gets, the more likely they are to lose their breast through a mastectomy, explains UM Specialist Centre consultant oncoplastic breast surgeon Associate Professor Dr Suniza Jamaris.
According to latest data from the Malaysian National Cancer Registry, nearly half of the women diagnosed with breast cancer are presenting at advanced stages (stage 3 and stage 4), she adds.
At Stage 3, the tumour is already more than 5 centimetres in size, making treatment more complex.
"If women do regular breast self-examinations and get screened regularly, we can find cancer early and help them keep their breasts."
With early diagnosis, a lumpectomy is still possible and the breast can be saved.
Dr Suniza says a lumpectomy involves removing the cancerous lump and a 1cm margin of normal tissue. The patient would also need to undergo radiotherapy after the procedure as part of her treatment.
With a mastectomy, the cancerous breast will be removed and a mastectomy is called for in certain situations, says Dr Suniza. The most obvious reason is when the tumour is large, or the cancer is at an advanced stage.
Sometimes the tumour may be small, but it's widespread, meaning there are multiple tumours within the breast and in such cases, a lumpectomy is not possible and a mastectomy would be required.
"Some patients also come with inflammatory breast cancer, with redness on the skin and this would also call for a mastectomy."
Women with BRCA1 and BRCA2 gene mutations, which increase their risk of developing breast cancer, are often recommended a mastectomy instead of a lumpectomy if they are diagnosed with cancer. This recommendation is due to their higher risk for the disease.
A prophylactic mastectomy may be suggested to further reduce the risk of developing breast cancer.
In certain cases, if a lumpectomy does not achieve clear margins (meaning some cancerous cells remain in the breast tissue), a mastectomy may be necessary.
Furthermore, for breast cancer patients who cannot commit to radiotherapy after a lumpectomy, a mastectomy would be the preferred treatment option.
Dr Suniza says that after a lumpectomy, women typically need to undergo between 15 and 23 cycles of radiotherapy, which can span over three weeks. If women are unable to commit to this for any reason, doctors may recommend a mastectomy instead to prevent the spread of cancer and protect their lives.
However, with advancements in technology, the number of radiotherapy cycles can potentially be reduced through intraoperative radiotherapy, which is only available at certain centres.
Tailoring Solutions to Individual Needs After a Mastectomy
With advances in breast cancer treatment, women undergoing a mastectomy can opt to have breast reconstruction done at the same time as surgery to remove their breast. This procedure is typically performed by a breast oncoplastic surgeon. In certain cases, the expertise of a plastic surgeon may also be utilised to enhance the surgical outcome.
This approach ensures that breast cancer patients can undergo surgery with immediate reconstruction, allowing for a single surgical procedure that achieves a natural contour and texture. This option helps women heal and recover both physically and psychologically from the impact of breast cancer.
"During breast reconstruction, every effort is made to ensure the reconstructed breast appears as natural as possible as we are aware that women associate the loss of a breast with the loss of femininity and it impacts their confidence."
Patients also have the option of delayed reconstruction, which involves undergoing the mastectomy first and then having the reconstruction a few months later, after completing their breast cancer treatment.
Breast reconstruction is an integral part of breast cancer treatment, aimed at enhancing surgical outcomes and helping women maintain their sense of femininity after a mastectomy.
Ideally, to ensure they don't lose their breasts to breast cancer, women should maintain a routine of breast self examinations and mammogram screening to ensure breast cancer is detected early and treated early.
"Breast self-examination (BSE) should start at 18 years to help individuals recognise normal breast appearance and feel. Early detection of abnormalities, even 1cm, is crucial," explains Dr Suniza.
Breast Cancer
• Breast cancer is the most common cancer among Malaysian women.
• One in 27 Malaysian women will develop breast cancer in their lifetime.
• Almost half of all cases are diagnosed at stage 3 or 4 in Malaysia.
• An increasing number of women below 40 years old are being diagnosed with breast cancer.
• Smoking, alcohol, obesity and a sedentary lifestyle are modifiable risk factors for breast cancer.
• Women with BRCA1 and BRCA2 gene mutations are more likely to develop breast cancer during their lifetime.
• Not all breast lumps are cancerous; only about one-third are diagnosed as cancer.