Any lump that is detected by mammogram or on clinical examination needs to be confirmed to be either a benign (non-cancerous) or malignant (cancerous) mass.
This is done by taking a piece of it to investigate further. This procedure is known medically as a biopsy.
A biopsy under the guidance of an ultrasound scan is the recommended diagnostic approach for a newly diagnosed breast lump.
This can be done by sticking a needle under ultrasound guidance into the mass and sucking a piece of it into a syringe to be examined by a pathologist in the laboratory.
This is called a fine needle aspiration biopsy. The biopsy can also be done by a tru-cut method, where a solid piece of the mass is taken and sent for microscopic examination and, in some cases, special staining to characterise the nature of the mass.
The last method is removing the whole mass at surgery, called excision biopsy. The mass is then sent to the pathologists to examine and determine whether it is cancerous or non-cancerous.
After the cancer is diagnosed, certain factors are used to determine the exact prognosis of the disease.
This helps in holistic management aimed at improving outcomes of the disease. These prognostic factors include:
Axillary lymph node status: The axilla is the scientific name for the armpit, and because of its proximity to the breast, lymph node involvement in the axilla portends a worse outcome of the disease.
Tumour size: The bigger the size of the tumour, the poorer the prognosis
Lymphatic/vascular invasion: If the tumour has invaded blood or lymphatic vessels at the time of diagnosis, prognosis tends to be poor.
Histologic grade: Certain types of cancers are more aggressive than others depending on their nature under the microscope. The histologic grade is usually reported by the pathologist.
Response to therapy: Prognosis is better if the tumour is responsive to medications used to treat breast cancer and vice versa.
Receptor status: ER /PR status, which is a target for some medications in the treatment of breast cancer. A positive status of either ER (Estrogen Receptor) or PR (Progesterone Receptor) is favourable.
Surgery and radiation therapy, along with hormone or chemotherapy when indicated, are now considered primary treatment for breast cancer.
Surgical therapy may consist of removal of the lump (lumpectomy) or total breast removal (total mastectomy).
Radiation therapy may follow surgery in an effort to eradicate residual disease and reduce recurrence rates. It can also be done to reduce the tumour size before surgery.
Hormone therapy and chemotherapy are the two main interventions for treating breast cancer that has spread to other organs (metastatic breast cancer).
Chemotherapy employs certain medications which target and kill rapidly growing cells.
Cancers are rapidly growing cells, and so are other cells such as hair, blood cells and others which are targeted as side effects of these medications.
Two hormonal therapies - selective estrogen receptor modulators, tamoxifen and raloxifene- are given for reduction of breast cancer risk in high-risk women.
In very advanced cases, certain medications are given as support medications for bone when there is spread to the bones.
Herceptin (trastuzumab), a monoclonal antibody that targets the HER2 receptor, is currently in wide use to treat breast cancer.
It works by blocking growth signals and flagging cells for the immune system to destroy the cancer cells.
It is used for early-stage cancer to reduce the risk of recurrence after surgery and also to reduce growth in cases of advanced breast cancer.
The good news is that this medication, as expensive as it is, is covered under the National Health Insurance Scheme, welcome news for patients battling breast cancer.
Since the best way of treating breast cancer is early detection and treatment, a lot of effort is put into ensuring early detection.
World No Bra Day and Breast Cancer Awareness Month are some of the ways to put the spotlight on the disease. Education through print, mass or social media is also effective.
For those who are living with the disease or have survived the cancer, support groups are very helpful in fighting this cancer.
As is expected of a developing country, there are certain myths and misconceptions about breast cancer. Hearing from survivors of the disease and what they came against by way of misconceptions about breast cancer reaffirms the strength and pivotal roles these support groups play in the fight against the disease.
Breast cancer is curable if detected early; let us continue to remember October as Breast Cancer Month, and every woman over 40 years should have their breasts regularly examined.
The writer is a member of the Paediatric Society and the Director of Medical Affairs, Korle Bu Teaching Hospital.
