My aunt was diagnosed with breast cancer last week. She was devastated, even though we tried to give her the usual assurances that cancer is not a death sentence. But is that really true as I have read a lot of horrible accounts on Facebook?
It is indeed true that cancer is not a death sentence, especially if it is detected early. Some forms of cancer are deadlier and harder to detect than others, such as liver cancer and pancreatic cancer.
A patient suffering from these might get a general feeling of ill health and chalk it down to other diseases. Then by the time they are detected, it’s too late. But breast cancer is generally not one of those difficult-to-detect cancers.
So with a lot of progress made in early detection, such as breast self-examination for lumps, and periodic health checks for relatively healthy people, as well as the advent of mammograms, breast cancer can be detected early and cured accordingly.
What is considered early breast cancer? I thought that by the time I feel a lump, it would be too late.
Early breast cancer is any cancer that has not spread beyond a particular breast and its corresponding axillary (armpit) lymph nodes, located on the same side as the breast. This includes cancer that is detected within the nipple ducts (ductal carcinoma in situ) and Stages I to IIIA breast cancers.
Wait. So Stage 3 breast cancer is considered early?
Yes. Staging is simply a way to describe where the cancer is and how much it has grown, as well as where it has spread. Different stages of breast cancer have different treatments, so staging is very important.
Most people use the TNM staging system: T = tumour (for the cancer), N = node (as in lymph node), and M = mestastasis (spread). They put numbers behind each letter to indicate presence.
So what are the stages of breast cancer?
Stage 0 – When the cancer is only in the ducts and lobules of the breast tissue, and has not spread to the surrounding tissue of the breast. It is also called non-invasive cancer (Tis, N0, M0).
Stage IA – The tumour is small and invasive, but has not spread to the lymph nodes (T1, N0, M0).
Stage IB – The cancer has spread to the lymph nodes, and the lymph node tumour is between 0.2mm to 2mm in size. The tumour in the breast is 20mm or smaller, and may not even be detectable (T0 or T1, N1, M0).
Stage IIA – Any one of the following conditions
• No evidence of tumour in the breast, but the cancer has spread to one to three axillary lymph nodes (T0, N1, M0).
• The tumour is 20mm or smaller, and has spread to the axillary lymph nodes (T1, N1, M0).
• The tumour is between 20mm to 50mm, and has not spread to the axillary lymph nodes (T2, N0, M0).
Stage IIB – Either of the following conditions
• The tumour is between 20mm to 50mm, and has spread to one to three axillary lymph nodes (T2, N1, M0).
• The tumour is more than 50mm, but has not spread to the axillary lymph nodes (T3, N0, M0).
Stage IIIA – The cancer of any size has spread to four to nine axillary lymph nodes or internal mammary lymph nodes. It has not spread to other parts of the body (T0, T1, T2 or T3, N2, M0).
The rest is considered advanced breast cancer. Stage IV or metastatic breast cancer is only diagnosed in 5%-6% of cases with today’s modern detection. However, this rate may be higher in Malaysia as not many women come for breast cancer screening early enough once they start experiencing symptoms.
I’m scared for my aunt. What is the cure rate for early breast cancer?
The five-year mark is the definition of a cure. If you have been treated for breast cancer, and there is no recurrence of that breast cancer in five years, you are as good as cured.
In fact, the five-year survival rate for Stage 1 breast cancer is 99%! It usually means the cancer is gone from your body. If there a cancer occurs after the five-year mark, it is usually a new cancer.
What is the treatment for early breast cancer? I’m afraid that my aunt might have to remove her entire breast.
No. That’s also in the past. It is not done anymore for early stages. Usually, only a lumpectomy (removal of the tumour lump and a small margin of breast tissue around it) is needed, along with a few armpit lymph nodes.
Many forms of breast cancer are fuelled by hormones (hormone-dependent), so the doctor might add tamoxifen or an aromatase inhibitor to bind to the oestrogen hormone.
If you have another sub-type known as HER2+ breast cancer, there is tratuzumab, a targeted therapy with very few side effects. If you require radiation, there are less worries today as well. Today’s radiation therapy is targeted at a very focused area, which has much less side effects.