Breast cancer is the most common cancer of women in Hong Kong. In 2018, there were 4 618 new cases of breast cancer, accounting for 27.2% of new cancer cases of women in Hong Kong. The median age at diagnosis was 57 in female. The crude annual incidence rate per 100 000 women was 114.3. Breast cancer was the third leading cause of cancer deaths among females in Hong Kong. In 2018, a total of 753 women died from this cancer, accounting for 12.4% of all cancer deaths in women.
With medical advances, the cure rate of breast cancer has been improving in the last decade. Still, early detection and treatment are critical for improving the survival rate of patients. According to local statistics, the overall five-year relative survival rate of patients with breast cancer was 84%. Stage I breast cancer had a 5-year relative survival rate of 99%, which means that these individuals had almost the same chance to survive more than five years as the general population. The 5-year survival rate for stage II was 94.6%, and that for stage III was 76.2%. Stage IV breast cancer still had a 5-year relative survival rate of about 30%.
The breasts are made up of glandular tissues comprising mammary gland tissues, fat and connective tissues. During pregnancy, mammary glands will produce and excrete milk for babies.
However, when cells in the mammary gland divide and proliferate in an uncontrolled way, they may eventually develop into tumours which may be benign or malignant. Breast cancer is a malignant tumour developed in the breast.
High risk factors of breast cancer include:
If you have the following symptoms, you may get breast cancer:
* Bloated or lumpy breasts are normal physiological reactions caused by cyclic hormonal changes, which are common among women before menstrual cycles. There is no need to worry about it. If you are in doubt about the existence of lumps, please consult your doctor to check if they are benign or malignant. Many of these lumps are benign cysts (fluid-filled sacs or pockets in tissues) or fibroma (non-cancerous tumours composed of fibrous tissue) which are harmless to human body.
Further, women with family history of breast cancer or ovarian cancer, especially with first-degree relative (i.e. mother, sister or daughter) diagnosed with breast cancer before the age of 50, or those with confirmed carrier (or family history) of certain gene (e.g. BRCA1 or BRCA2) mutations and a history of receiving radiation therapy to the chest before the age of 30 are considered at increased risk of breast cancer.
To reduce the chance of getting breast cancer, members of the public, with women in particular, are recommended to have regular physical activities, avoid alcohol drinking and maintain a healthy body weight and waist circumference. If possible, they are advised to have childbirth at an earlier age and breastfeed each child for a longer duration.
Every woman should be breast aware and familiar with the normal look and feel of their breasts at all time. Be aware of any unusual changes of their breast. If women notice unusual changes in the breast, they should see a doctor as soon as possible.
Based on available international and local scientific evidence, the Government’s Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) makes the recommendations on breast cancer screening for women at different risk profiles as follows:
Of note, all screening tests have their limitations and they are not 100% accurate. There are false-positive and false-negative results. All women who consider breast cancer screening should discuss with doctors on the potential benefits and harms before undergoing screening.
After taking the medical history and physical examination, the doctor will arrange the following check-ups for suspicious cases:
Tissues of the lump are taken out through a fine needle for further microscopic examination to determine the nature of cells in the lump. The procedure is usually performed with local anaesthesia. Ultrasound, X-Ray or MRI may be needed to localise the breast lesion for biopsy.
Patients should provide information concerning the current medications used especially antiplatelet and anticoagulation drugs and any allergic history.
Complications are uncommon. These include bruising, hematoma and wound infection.
Some other tests will also be arranged if necessary:
These may help to determine whether a patient should receive hormonal treatment or targeted therapy.
Especially for patients with high risk of tumour spreading to other organs.
Once the diagnosis has been confirmed, one or more of the following treatments will be recommended to patients:
There are two main types of surgery:
The surgeon removes only the breast tumour and its surrounding tissues; patients should require radiotherapy afterwards to reduce the risk of recurrence. This approach is most suitable for smaller lumps located away from the nipple and there is less undesirable effect on the cosmesis.
When the breast tumours are too large or found in different parts of breasts, the whole breast has to be removed surgically.
In either procedure, the lymph nodes in the armpit of the affected side has to be sampled or removed for further microscopic examination. Nowadays suitable patients would be offered sentinel lymph node biopsy. If no tumour cells are detected in the sentinel lymph node, patients could be spared the operation of axillary dissection. This will reduce the chance of post-operative lymphoedema of the upper limb.
For patients undergoing mastectomy, the patient may choose to have breast prosthesis or breast reconstructive surgery. The reconstructive surgery generally uses the fat from the belly or specially made saline implant to restore the contour and shape of breasts. It is recommended to seek further advice from experienced surgeons and nurse specialists before and after breast surgery.
For more aggressive tumours or potential residual tumour cells around the surgical wound (e.g. in breast conservation therapy), radiotherapy (treatment using high energy X-ray beams) may also be needed as an adjuvant treatment to reduce the risk of recurrence.
Neoadjuvant or adjuvant chemotherapy is often provided before or after surgery. Anti-cancer drugs will be used to destroy and disrupt the growth of cancer cells, shrink the tumour to facilitate surgery (in the neoadjuvant setting), and reduce the risk of recurrence. For patients with advanced breast cancer, chemotherapy can also be used in the palliative setting.
Estrogen will stimulate the growth of breast cancer cells. Therefore, doctors may prescribe drugs to block the effect of female hormones to stop the growth of breast cancer cells. However, this approach is only effective in tumours with positive hormonal receptors. The drug can be used alone or started after chemotherapy.
For HER2-positive breast cancers, targeted therapy drugs will further improve the effectiveness of adjuvant chemotherapy.
Breast cancer may turn out to be fatal if it spreads to other parts of the body, such as lungs, liver, and brain, etc. Treatments may also lead to side effects or complications, including:
Although treatments may induce some side effects with variable degree of severity, modern treatment has been improved to reduce the associated discomfort and side-effects. Nursing care, medications as well as support from relatives and friends can help to relieve discomfort caused by treatments.
Patients should keep in mind the following before and after surgery and during recovery::
Regular follow-up and examinations are required after treatment. If patient experience persistent bone pain, shortness of breath or numbness of the limbs with weakness, she should inform doctor immediately. In general, the risk of relapse will decrease with longer disease-free period.
This will also decrease the risk of arm swelling after surgery.
With instructions from doctors and physiotherapists, patients should have simple arm exercise for upper limbs training so as to maintain the mobility of shoulder joints and reduce the risk of arm swelling.
Mammography is an x-ray imaging procedure to screen for cancer and suspected pathology in the breast.
After the examination, patient may have pain for a short period of time. In rare situation, bruise may occur in some patients. The examination report will be sent to the referring doctor. If further investigations are needed, the doctor will conduct further examination or arrange ultrasound scanning with or without needle biopsy.
For further information please contact your doctor.
Breast cancer may spread from the breast to involve the lymph nodes in the axilla. Axillary dissection is frequently included in the operation for breast cancer. This operation can make a definite diagnosis and treatment for axillary lymph node metastasis.
The extent of resection in lumpectomy/partial mastectomy includes the primary tumour with adequate margins. In selected cases the nipple areolar complex will be removed with the primary tumour. This operation conserves the breast. This operation results in less deformity when compared with mastectomy.
This operation is usually performed at the same time of axillary dissection or sentinel lymph node biopsy. Radiotherapy to the breast is usually required after the operation. Not every patient is suitable to undergo this operation and adequate removal is not guaranteed. Re-operation may be necessary for some patients.
The extent of resection in modified radical mastectomy includes the involved breast together with the nipple areolar complex and the lymph nodes in the axilla. This operation results in significant deformity with a linear scar on the chest wall. This operation is sometimes performed in conjunction with immediate reconstruction.
Simple mastectomy will remove all the breast tissue. This operation results in significant deformity with a linear scar on the chest wall. This operation is sometimes performed in conjunction with immediate reconstruction.
For further information please contact your doctor.