Let’s Get Intimate – Women and Breast Health
What every woman should know about her breast.-By Dr. Y M Wong
To encourage more women to come forward for screening, Singapore launched in 2002 its national breast cancer screening programme, emphasising on public education and screening about breast cancer.
Below are the factors that increase a woman’s cancer risks:
• Estrogen – Endogenous estrogen: Early menarche (<12 years of age), late menopause after the age of 50 and nulliparity increase lifetime exposure to estrogen in premenopausal women, while obesity increases estrogen levels in postmenopausal women.
• Exogenous estrogen in the form of oral contraceptives and hormone replacement therapy (HRT).
• Decrease fertility with first child after the age of 30 or never ever pregnant (nulliparity).
• Family history of breast cancer: The relative risk is 1.5-2 times with one affected first-degree relative; four to six times with two affected first-degree relatives; six times with first-degree relative having bilateral cancer.
• Ethnic difference in cancer risk may be related to genetic susceptibility, estrogen metabolism, estrogen receptor binding sites and dietary factors.
• Sedentary lifestyle; obesity or weight gain after menopause.
• Dietary factors (high protein, low fibers), excessive alcohol consumption, tobacco usage.
Factors to help diagnose cancer early:
1. Identify factors that will encourage women in their 50s to participate in screening.
2. Improve screening and early diagnostic tools.
3. Improve personal risk prediction.
Signs of Breast Cancer
Most women do not feel any lumps in their breasts. At times, there could be a painless lump; swollen, thickened, dimpled or puckered skin; a persistent rash around the nipple, bleeding or unusual discharge from the nipple; or retracted nipple(s). A woman with a lump in her breast needs urgent clinical evaluation.
Early detection remains the primary defense in preventing the development of life-threatening breast cancer.
Monthly Breast self-examination / annual clinical breast examination: methods are inexpensive and non-invasive.
Breast thermography is the latest imaging. FDA has approved it in 1982 as an adjunctive screening procedure for breast cancer. It uses infrared technology to measure breast blood flow based on the principle that metabolic activity and vascular circulation in both pre-cancerous and cancerous tissue are almost higher than that in normal tissue.
Mammography: Singapore’s Ministry of Health recommends annual mammography for women aged 40 to 49, thereafter once 2-yearly.
Ultrasonography (US) can be particularly useful in younger women with fibrocystic change. It is used to distinguish solid from cystic lesions. US is currently not recommended for population breast screening but as an adjunct to mammography or thermography.
Magnetic resonance imaging (MRI) is being used for the screening, diagnosis, and treatment of breast cancer. MRI is very useful for screening for high risk women with a personal history of breast cancer not visualized by mammography and women with a strong familial or genetic predisposition (carriers of BRCA1 or BRCA2) for breast cancer.
Other imaging modalities include CT and position emission tomography (PET).