facts of 201923
*Research of breast cancer in Hong kong from Hong Kong Cancer Registry, Hospital Authority
*Research of breast cancer in Hong kong from Hong Kong Cancer Registry, Hospital Authority
Signs and Symptoms
The symptoms of breast cancer may include any of the following:21
Although any of these symptoms can be caused by problems other than breast cancer, if you have any of them, you should visit a doctor to find out the cause.
Types Of Breast Cancer
Risks and causes
The causes of breast cancer are not yet fully understood but certain women have a higher risk of developing it, such as:25
BRCA gene mutations and breast cancer
If a woman inherits a BRCA1 or BRCA2 mutation, the risk of developing breast cancer during her lifetime increases dramatically.26
BRCA stands for Breast CAncer susceptibility gene. There are two BRCA genes: BRCA1 and BRCA2. They are tumor suppressor genes which everyone has. BRCA1 and BRCA2 genes produce proteins that function to repair damaged DNA, thus maintaining the stability of genetic material inside cells. Mutations in these genes mean they do not work properly and damaged DNA cannot be repaired properly, which can lead to cancer, such as breast cancer and ovarian cancer.26
It is estimated that the risk of breast cancer for women in the general population is about 12% in their lifetime.26 By contrast, clinical studies showed that:
- about 72% women
who inherit a BRCA1 mutation will develop breast cancer by the age of 80 years.26 - about 69% women
who inherit a BRCA2 mutation will develop breast cancer by the age of 80 years.26
Women who have a BRCA mutation also have an increased risk of other cancers, such as ovarian cancer.26
In addition, if your family history includes any of the following, you may be at increased risk of BRCA mutated breast cancer.
Diagnoses & Treatment
Diagnosis
Tests used to diagnose breast cancer include:27
Treatment Options
The main treatment options for breast cancer are: surgery, radiotherapy, chemotherapy, targeted therapy, and hormone therapy. These treatments may be used alone, or in combination, to treat breast cancer. Doctors will plan treatment by considering many factors, including:29
- The cancer’s stage;
- The tumor’s HER2, ER, and PR status;
- The presence of known mutations, such as BRCA1 or BRCA2 in inherited breast cancer genes;
- The woman’s age, general health, and whether she has experienced menopause.
Surgery is the removal of the tumor and some surrounding healthy tissue from the body. The types of surgery include:29
Surgery
Surgery is the removal of the tumor and some surrounding healthy tissue from the body. The types of surgery include:29
Radiotherapy is a treatment that kills cancer cells with high-energy X-rays.29 External beam radiation is the most common type of radiotherapy used for cancer treatment, which is radiation given from a machine outside the body.29
Radiotherapy may be given before or after or surgery:29
Radiotherapy
Radiotherapy is a treatment that kills cancer cells with high-energy X-rays.29 External beam radiation is the most common type of radiotherapy used for cancer treatment, which is radiation given from a machine outside the body.29
Radiotherapy may be given before or after or surgery:29
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping their ability to grow and divide.29 It may be given before surgery as a neoadjuvant chemotherapy to shrink the tumor and make surgery easier, or after surgery as an adjuvant chemotherapy to lower the risk of cancer recurrence.29
There are many types of chemotherapy used to treat breast cancer. These drugs can be used on their own or in combination with each other. Drugs commonly used include anthracyclines, taxanes, and platinum agents.30
The side effects of chemotherapy vary from person to person and depend on the drugs used. Common side effects may include nausea and vomiting, infection, anemia, bruising, sore mouth, hair loss, constipation and diarrhea, fatigue, and skin and nail changes.33
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping their ability to grow and divide.29 It may be given before surgery as a neoadjuvant chemotherapy to shrink the tumor and make surgery easier, or after surgery as an adjuvant chemotherapy to lower the risk of cancer recurrence.29
There are many types of chemotherapy used to treat breast cancer. These drugs can be used on their own or in combination with each other. Drugs commonly used include anthracyclines, taxanes, and platinum agents.30
The side effects of chemotherapy vary from person to person and depend on the drugs used. Common side effects may include nausea and vomiting, infection, anemia, bruising, sore mouth, hair loss, constipation and diarrhea, fatigue, and skin and nail changes.33
Hormonal therapy, also called endocrine therapy, is for people who have hormone receptors (ER or PR) on their breast cancer cells (called ER-positive or PR-positive breast cancer).29 Because these types of cancers use hormones to fuel their growth, blocking the hormones can help prevent a cancer recurrence and death from breast cancer.29
Drugs commonly used in hormonal therapy include selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), and selective estrogen receptor down-regulators (SERDs).29 For premenopausal women who have hormone receptor positive breast cancer, ovarian suppression can be used stops the ovaries from making estrogen.29 This type of treatment includes gonadotropin releasing hormone (GnRH) agonists or leutinizing hormone releasing hormone (LHRH) agonists.
Hormonal therapy
Hormonal therapy, also called endocrine therapy, is for people who have hormone receptors (ER or PR) on their breast cancer cells (called ER-positive or PR-positive breast cancer).29 Because these types of cancers use hormones to fuel their growth, blocking the hormones can help prevent a cancer recurrence and death from breast cancer.29
Drugs commonly used in hormonal therapy include selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), and selective estrogen receptor down-regulators (SERDs).29 For premenopausal women who have hormone receptor positive breast cancer, ovarian suppression can be used stops the ovaries from making estrogen.29 This type of treatment includes gonadotropin releasing hormone (GnRH) agonists or leutinizing hormone releasing hormone (LHRH) agonists.
Targeted therapy is a cancer treatment that uses drugs. It works by targeting the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.29 This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells, making it very different from traditional chemotherapy.29
Studies show that not all breast tumors have the same targets. To determine the most effective treatment, doctors may need to do specialized tests to identify genes, proteins, and other factors specific to a tumor.29
Targeted therapy
Targeted therapy is a cancer treatment that uses drugs. It works by targeting the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.29 This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells, making it very different from traditional chemotherapy.29
Studies show that not all breast tumors have the same targets. To determine the most effective treatment, doctors may need to do specialized tests to identify genes, proteins, and other factors specific to a tumor.29
A cancer diagnosis and treatment can have a huge impact on patients, both psychologically and physically. For example33: pain at the surgical site; feeling unwell after chemotherapy, such as vomiting and loss of appetite; burning sensation of the skin after radiotherapy, etc. Although hormone therapy and targeted therapy have less side effects, some patients may still experience hot flushes, bone ache and fatigue.
However, through fighting against breast cancer, many patients have found different meanings of life, and they can start a new life after recovery through appropriate adjustment.
Rest: Patients often experience fatigue after surgery, chemotherapy or radiotherapy. They should get plenty of rest, and do not do too much. It is important to pace their life and take things slow.33
Diet: Some patients may experience gastrointestinal discomforts, such as constipation or diarrhea. Food high in fiber can help with constipation; drinking plenty of water can also help to ease the condition, and help to prevent dehydration if you have diarrhea. Dieting tips34:
- Avoid greasy, spicy and heavy food
- Reduce the consumption of pickled and cured food, such as cured sausages, meat and fish
- Divide your meal into a few smaller meals of small portions, and to avoid overeating
- Choose food easy to digest
- Choose food with high protein and high calories
- Have more fresh fruits, vegetables, grains and beans
Exercises: Generally patients can carry on with their daily routines and maintain regular exercises. Avoid carrying heavy items for a sustained period of time; use tools to help to lift and ask family members to share the chores.35
Lymphedema Prevention: Patients receiving axillary lymph node dissection may experience lymphedema, which may cause swelling in hands, numbness in arms and stiff shoulders. Tips to avoid lymphedema:35
- Avoid tight clothing or accessories to prevent suppressing lymph circulation which may cause swelling.
- Avoid taking blood pressure readings from the affected arm, as the pressure used during blood pressure measurement may affect lymph circulation.
- Avoid taking blood samples, or have injections and acupuncture on the affected arm, since any wound may cause infection or lymphedema.
- Avoid direct sunlight, carrying heavy loads or strenuous exercise.
- If redness or abnormal swelling occurs or feeling hot on the affected arm, you should seek medical help immediately.
Skin care: If your skin is discolored, peeling, getting dry, irritated or sensitive to sunlight after chemotherapy, appropriate skin care and clothing may help. For example, apply moisturizers on dry skin; wear a hat, long-sleeved clothing and pants when going out, and use appropriate sunscreen products if necessary.35 36
Be positive: Staying positive and calm can help patients to deal with stress and physical, emotional and daily challenges during the treatment. Share your feelings with friends, family and other patients also help to release negative emotions.35
For breast cancer patients with certain risk factors such as the following, NCCN guidelines recommend that they should be tested for BRCA.37 (Note: The list below is not all-inclusive and is provided to present as examples only.)
- Diagnosed ≤45 years
- Diagnosed 46-50 years with an additional breast cancer at any age, or with ≥1 close blood relative with breast cancer at any age/li>
- Diagnosed ≤60 years with triple-negative breast cancer (TNBC)
- Diagnosed at any age with ≥1 close blood relative with breast cancer diagnosed ≤50 years
Importantly, patients should have genetic counseling before taking germline BRCA test.
Before any genetic test is done, doctors and nurses with specialized training or genetic counseling specialists will carry out genetic counseling with the patients. This is to explain the testing procedures, risks and clinical significance of different test results, and to discuss the impact of the result on the patients and their family, including emotional effects, parenting and birth control, screening and decisions on treatment. After the genetic counseling, patients will decide whether they would want to receive the genetic test.38
(Note: Hong Kong Academy of Medicine would like to remind the public, any genetic test without appropriate advice, counseling and data analysis may lead to additional medical risk and inaccurate test results, and the lack of professional interpretation and advice may also cause unnecessary anxiety or a false sense of security.)
FAQ
For Caregivers
If you are a caregiver to a breast cancer patient, you are playing an important role! You are the one taking care of the patient and her medical care during and after the treatment. But do not forget to look after yourself, as you have to be strong enough to go through this journey with the patient. The following suggestions may help you as a caregiver:
Understand breast cancer
The process of breast cancer diagnosis and treatment is a difficult journey for patients, and they need understanding, care and empathy from people around them. Gathering the latest information on breast cancer can help you to understand the physical change and conditions of the patient, thus facilitate better communication.
Try to de-stress
As a caregiver, surely you are under huge stress. Learn how to de-stress and to deal with your own emotions, such as anxiety, nervousness and negative feelings.
Seek help
Caregivers are just ordinary people - we only have limited energy, and there is something that we are not capable to do. When caregivers find it difficult to deal with the caregiving work, they should be more open and seek help from other relatives, professionals or community resources. Remember that you are not alone as a caregiver.
Talk to others
It is reasonable to have lots of feelings and emotions when seeing our beloved one suffers, or when you have to take over the responsibility as a caregiver. You should share your feelings or pressure with your friends, family members, professionals or patient's groups, and avoid the accumulation of negative emotions.
Be considerate
If the patient is your partner, you should understand that your sex life may be affected when your partner is undergoing chemotherapy, after the surgery or when the condition is more advanced. Be considerate and treasure the time together.