Early detection
Risk Factors
Myths
Finding Out (Diagnosis)
Treatment Options
Support
Q&A
Comparative Fees for Laboratory Services (Philippines, as of June 30, 2011)

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early detection

The Philippines has the second highest incidence of breast cancer in Southeast Asia (Globocan 2012, International Agency for Research on Breast Cancer). Breast cancer is also one of the leading causes of death among Filipino women. Most women with breast cancer have no known risk factors except that they are women. So no one should be exempt from being vigilant.

Your detection program is a four-part process:

Education

The causes of breast cancer remain unknown. However, early detection has led to the survival of thousands of women and men. The earlier breast cancer is detected, the better the chances of cure.

Here are the symptoms of breast cancer. If you notice any of these, call your physician:

  • A lump or thickening in your breast or under your arm
  • Any change in the size or shape of your breast
  • Any bloody or unusual discharge from your nipple.
  • Change in color or texture of the skin of your breast (i.e. dimpling, puckering or rashes)
  • Swelling, redness, or hot sensations in your breast
  • Inverted nipple in a breast where the nipple previously was not inverted

Breast Self-Examination (BSE)

Regular Breast Self-Examination significantly increases your awareness of changes in your breast. It gives you the opportunity to know what is usual or unusual about the shape, appearance and feel of your breasts, so that you are more likely to notice any changes.

BSE only takes a few minutes, just once a month. It should be done ten (10) days after the start of your period. If you are post-menopausal, select a particular day like the first or last day of the month.

The American Cancer Society recommends that women should begin becoming familiar with their breasts at the age of 20. The Department of Health in the Philippines recommends that women begin examining their breasts monthly at the age of 20. Meager resources, low insurance coverage, and unavailability of affordable diagnostic services point to monthly BSE as the option of least cost for women vigilant about their health.

Clinical Breast Examination

A regular clinic check-up by a healthcare professional skilled in breast examination should be performed at least once a year.

The American Cancer Society recommends that women should begin having annual clinical exams at the age of 30.

Mammography

Mammograms are an important screening technique. They can usually detect breast cancer before any noticeable symptoms occur. However, screening mammograms miss at least 20 percent of all tumors, so you should be aware of what mammography can and cannot do for you.

The American Cancer Society recommends annual mammograms for all women after age 40. The incidence of breast cancer in younger women is lower and mammography is less efficient when breast tissue is more dense. In special cases, screening should be carried out at an earlier age.

According to “The Breast Book,” by Dr. Miriam Stoppard, a woman with a first-degree relative who developed pre-menopausal breast cancer should be screened every two years, starting when she is ten years younger than the age at which her relative developed breast cancer.

Here are some mammography tips:

  • In most cases, you do not need a doctor’s permission or a prescription to obtain a mammogram. But it’s not advisable to simply walk in for a mammography.
  • It is generally a good idea to have your mammogram conducted at the same place every time. If you change facilities, make sure that your films and the written reports are sent to the new location.
  • There are several different kinds of mammograms for screening and diagnosis. Be sure to know which one you are requesting or receiving.
  • Schedule a time when you can discuss the results with your doctor.
  • Make sure you get the results of your mammogram. Do not assume that everything is okay until you hear from your doctor.
  • If there is any doubt about the results of your mammogram and/or tests, take the films to another facility for a second reading.

Remember, you are the owner of your body. You have choices. You have the power to make the decisions that affect your body.

For any phase of breast cancer diagnosis or treatment, you may want to consider a second or even a third opinion. It is very important that you understand that in most cases, there is time to make a careful decision.

Reprinted and slightly revised with permission from the “Breast Cancer Resource Guide” by The Better Health Foundation, printed in California, U.S.A.

risk factors

Risk Factors You Can’t Control

Being a Woman. Although men may also develop breast cancer, male breast cancer is extremely uncommon, occurring at a rate of 1% of its female counterpart.

Aging. The primary risk factor for breast cancer in most women is older age. Overall, 85% of cases occur in women 50 years of age and older.

Family History. Occurrence of breast cancer within the family increases your risk, especially if first degree relatives had it, like a mother, a daughter or a sister.

Personal History. Having had breast cancer before, even if successfully treated, poses the risk of a recurrence of the disease.

Estrogen Levels. High estrogen levels marked by starting menstruation before age 12, having menopause after 55, or exposure to estrogen in the environment increases risks.

Risk Factors You Can Control

Weight. Being overweight increases your risk, especially after menopause. Having more fat tissue means having higher estrogen levels, which can increase risk.

Diet. Experts recommend observing a balanced diet that is particularly low in fat and rich in fruits and vegetables.

Exercise. Regular physical activity – around 45-60 minutes, five or more days a week – is recommended.

Alcohol Consumption. Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which can increase risk.

Smoking. Smoking is associated with increasing the risk of developing breast cancer by around one-third. Smoking also increases the risk of other diseases.

myths

Breast cancer happens only to single unmarried women. One’s marital status is not among the factors that affect the risk of developing breast cancer.

Breast cancer only affects older women. While it’s true that the risk of breast cancer increases with age, breast cancer can occur at any age.

Using deodorants causes breast cancer. No studies have ever proven a connection between deodorants and breast cancer.

Using a tight underwire bra increases your risk of breast cancer. Neither the type nor the tightness of your bra or other clothing has any connection to breast cancer risk.

Trauma from being hit in the breast area causes breast cancer. Some women later diagnosed with breast cancer happened to have noticed the lump as they took time to examine themselves after a trauma. But no studies have found trauma to be a riskfor breast cancer.

Having breast implants increases your chances of developing breast cancer. Women with breast implants are at no greater risk of getting breast cancer, according to research.

Herbal remedies and dietary supplements can treat breast cancer. There is insufficient evidence that alternative therapies are safe and effective against breast cancer.

Having STDs (sexually transmitted diseases) increases your risk for breast cancer. Breast cancer and STDs are different types of diseases and are unrelated.

Grilled and fatty foods cause breast cancer. While excess weight is a risk factor, grilled and fatty foods have not been proven to increase risks.

Surgery will make the cancer cells spread. No increased spread of cancer has been found whether patients undergo surgical procedures or not.

Breast cancer is communicable. Breast cancer is a non-communicable disease. It is not contagious. It is not passed from one person to another like an infectious disease.

You will die if you have breast cancer. Even women with bad cases of cancer can live a long time. Treatments today give much hope.

finding out (diagnosis)

Breast Biopsy

When you discover a lump or other changes in your breast, it is important to find out what it is. It is normal to be alarmed, but you have reasons to be reassured:

    • Most women, at sometime in their lives, will develop lumps in their breasts.
    • Most lumps are NOT breast cancer. In fact, 8 out of 10 lumps are harmless.
    • To be sure that a lump or other change is not breast cancer, you need to have the lump partially or entirely removed (a biopsy). A diagnosis can then be made by a pathologist – a doctor who looks at the cells under a microscope – to find out if the tissue is normal or cancerous.
        • When Your Lump Can Be Felt
          • Fine Needle Aspiration Biopsy (FNAB). A thin needle is placed into the lump. If fluid comes out, and the lump disappears, it means that the lump is a cyst and is usually not cancer.
            • Advantage: You can avoid scar and surgery. If cancer is found, you can start to plan your treatment.
            • Disadvantage: If the needle removes only normal cells, and the lump does not go away, then you may need more tests to make sure that the lump is not cancer.
          • Core Biopsy. A larger needle is used to remove a small piece of tissue from the lump.
            • Advantage: Your scar will barely be noticeable. Even if the lump is cancer, you will have avoided the stress of one surgery.
            • Disadvantage: If this biopsy finds cancer, you will need more surgery to remove the part of the cancer that is still in your breast. If this biopsy does not find cancer, you may still need a surgical biopsy to make sure that the lump that is still in you breast does not contain any cancer cells.
          • Surgical Biopsies. A surgical biopsy is the surgical removal of tissue for microscopic examination and diagnosis. There are a number of types of surgical biopsies:
            1. Incisional Biopsy. An incisional biopsy removes only a portion of the lump. An excisional biopsy removes the entire lump. These may both be done under local anesthesia.
              • Advantage: Excision biopsies are definitive. You will know with certainty if your lump is harmless or cancerous.
              • Disadvantage: You will have a scar on your breast, which will heal with time. There may be some changes in the shape or size of your breast. If an incisional biopsy does not find cancer, you may still need further surgery to determine if the remaining lump in the breast does not contain any cancer cells.
            2. Frozen Section Biopsy. In frozen section biopsy, doctors cut a portion of a woman’s lump and the tissue is immediately sent to the pathologist for examination. If breast cancer is found, the doctors remove the patient’s breast in the same operation while the woman is still under general anesthesia. A woman goes into the operation giving consent that if cancer is found during biopsy, the doctors should proceed to remove the breast.
              • Advantage: If cancer is found, the woman only undergoes one operation for both biopsy and surgical treatment (removal of the affected breast).
              • Disadvantage: Although the patient already gave consent prior to surgery for the procedure, a woman found to have breast cancer wakes up in the recovery room without the affected breast. This may lead to emotional stress or self-doubt about earlier decisions made. Even if the biopsy does not find cancer, the woman will have already exposed herself to general anesthesia and its after-effects.

      If your lump can be felt, you will most likely have one of the following types of biopsies:

        • When Your Lump Can Be Seen But Not Felt
            Needle Localization Biopsy. Using a mammogram or an ultrasound as guide, a doctor places a needle or fine wire into the suspicious area. The area is then removed with a surgical biopsy. A second picture of the biopsy area may be taken later to make sure that the area of concern was entirely removed.
          • Read more and think through the information.
          • Get a second opinion.
          • Talk to other women who have had breast cancer.
          • Have a complete study of your breast tissue, and, if needed, of other parts of your body.
          • Prepare yourself and loved ones for your treatment.
          • Do you think I need to have a biopsy? If not, why?
          • What type of biopsy do you recommend? Why?
          • How soon will I know the results?
          • What will the scar look like after the biopsy and after it heals?
          • Do you suggest local or general anesthesia? What are the advantages of each?
          • Want to confirm your diagnosis or treatment.
          • Have concerns about your treatment plan.
          • Feel uncomfortable with your doctor.

      Sometimes you can have an area of concern that cannot be felt in the breast but shows up on pictures of the inside of the breast. These pictures are taken by either mammography (a type of x-ray) or ultrasound, a process that shows harmless soundwaves as they travel through a breast. In these cases you may have:

      Studies show that it is safe to start treatment within several weeks after your biopsy. This two-step procedure gives you time to:

      Ask your doctor the following questions:

      Second opinions are your right and are commonly asked for today. Get a second opinion if you:

Classification of Tissue

After your biopsy, it can now be determined whether the tissue extracted is benign or malignant. Benign means that your lump or other problem was NOT cancer; malignant means that your tissue DOES contain cancer cells and may either be:

  • In Situ Cancer – Today, fifteen to twenty percent of breast cancers fall into this category.
    Two types exist:

    • Ductal carcinoma in situ (DCIS) is noninvasive, which means it is limited to the milk ducts of the breast. It has NOT spread beyond the breast, to the lymph nodes in the armpit, or to other parts of the body. However, there are several types of DCIS. If it is not removed, some types may in time change and develop into an invasive cancer. Some may never progress to an invasive cancer.
    • Lobular carcinoma situ (LCIS) is a noninvasive growth limited to the milk lobules of the breast. It is NOT cancer – only a warning sign of increased risk of developing cancer, according to the National Cancer Institute. Women with LCIS have about a 1% risk of developing invasive breast cancer equally in either breast per year. After 20 years, this risk is about 18%.
  • Invasive Cancer HAS SPREAD to surrounding tissue in the breast and MAY HAVE SPREAD to the lymph nodes in the armpit or to other parts of the body. All breast cancers, except in situ, are invasive.
  • Metastasized cancer HAS SPREAD to other parts of the body, such as the bones, lungs, liver,
    or brain.

Stages of Breast Cancer

Breast cancer is a complex disease so there is no right treatment for all women. Your breast cancer will be placed into one of 5 stages. How your cancer is staged and your treatment choices will depend on:

  • How small or large your tumor is and where it is found in your breast.
  • If cancer is found in the lymph nodes in your armpit.
  • If cancer is found in other parts of your body.
Stage 0 Very early breast cancer or pre-invasive cancer. This type of cancer has NOT
spread within or outside of your breast (also called in situ or noninvasive cancer).
Stage 1 Tumor smaller than 2 cm. (1 inch), no cancer is found in lymph nodes in the armpit, or outside the breast.
Stage 2 Tumor smaller than 2 cm. (1 inch), cancer is found in the lymph nodes in the armpit;Tumor between 2 and 5 cm. (1 and 2 inches), cancer may or may not be found in the lymph nodes in the armpit;Tumor larger than 5 cm. (2 inches), cancer is not found in the lymph nodes in the armpit.
Stage 3 Tumor smaller than 5 cm. (2 inches) with cancer also in the lymph nodes that are stuck together;Tumor larger than 5 cm. (2 inches) OR cancer is attached to other parts of the breast area including the chest wall, ribs, and muscles.Inflammatory breast cancer – In this rare type of cancer, the skin of the breast is red and swollen.
Stage 4 Tumor has spread to other parts of the body, such as the bones, lungs, liver, or
brain.

treatment options

Once diagnosed with cancer, you will need a team of medical experts. No one doctor is able to provide all the services you may require. Here are some of the experts you may need to consult with regard to the right treatment for you and for other concerns:

Anesthesiologist – a doctor who gives medications that keep you comfortable during surgery

Oncologist – a doctor who uses chemotherapy or hormone therapy to treat cancer

Pathologist – a doctor who examines tissue and cells under a microscope to decide if they are normal or cancer

Physical Therapist – a medical professional who teaches exercises that help restore arm and shoulder movements after surgery

Radiation Oncologist – a doctor who uses radiation therapy to treat cancer

Radiologist – a doctor who reads mammograms and performs other tests, such as x-rays or ultrasound

Social Worker – a professional who can talk with you about your emotional or physical needs

Surgeon – a doctor who performs biopsies and other surgical procedures such as the removal of your lump (lumpectomy) or your breast (mastectomy)

Be sure to choose a team you trust and to seek a second opinion should you:

  • Want to confirm your diagnosis or treatment
  • Have concerns about your treatment plan
  • Feel uncomfortable with your doctor

Surgery

Due to decades of education on early detection, most women in developed countries who have breast cancer today are diagnosed with Stage 0, I, or II breast cancer. Many of these women will live a long life. Most of these women can choose to undergo lumpectomy with radiation therapy, or mastectomy.

Studies show that both options provide the same long-term survival rates. However, neither option gives you 100% guarantee that cancer will not return at the treated site. Whichever choice you make, you will still need medical follow-up and monthly breast self-exams for the rest of your life. Here is a closer look at today’s most common breast surgeries:

    • Lumpectomy

With a lumpectomy, a surgeon removes the breast cancer, a little normal breast tissue around the lump, and some lymph nodes under the arm. This procedure tries to totally remove the cancer while leaving you with a breast that looks much the same as it did before the surgery. Women who choose a lumpectomy almost always have radiation therapy as well. Radiation decreases the risk of cancer coming back in the remaining breast tissue.

Possible Problems: Infection, poor wound healing, bleeding, and a reaction to the drugs (anesthesia) used in surgery are the main risks of any kind of surgery, including lumpectomy. Women may have a change in the shape of the breast that was treated

    • Mastectomy
      • Total Mastectomy. This surgery removes as much breast tissue as possible, the nipple, and some of the overlying skin. The lymph nodes in the armpit are not removed.
      • Modified Radical Mastectomy. This surgery removes as much breast tissue as possible,the nipple, some of the overlying skin, and some lymph nodes in the armpit.
      • The cancer is found in numerous areas in the breast.
      • The breast is small or shaped so that the removal of the entire cancer will leave little breast tissue or a deformed breast.
      • The woman does not want to have radiation therapy.
      • How large will my scar be? Where will it be?.
      • How much breast tissue will be removed?
      • Will I need radiation or chemotherapy? Why? When should it start?

A mastectomy – the surgical removal of the breast – used to be the only treatment for breast cancer. Today a woman who has a mastectomy is likely to have either:

A mastectomy is needed when:

Possible Problems: Infection, poor wound healing, drug reactions, and a collection of fluid under the skin are possible complications.

Consult your doctor which surgery is best. Here are some questions you may consider asking as well:

Removal of Lymph Nodes

Whether you have a lumpectomy or mastectomy, your surgeon will usually remove some of the lymph nodes under your armpit. This procedure (an axillary node dissection) is most often done at the same time as the breast surgery. If cancer is found in the lymph nodes, your doctor will talk to you about additional treatments. These additional therapies are designed to control and kill cancer cells that could be in other parts of your body.

Possible Problems: Stiffness of the arm, numbness under your arm, and swelling of the arm (lymphedema). Physical therapy is often helpful to restore full motion of your arm.

The lymph nodes in your armpit filter lymph fluid from the breast and your arm. Both radiation therapy and surgery can change the normal drainage pattern. This can result in a swelling of the arm called lymphedema. The problem can develop right after surgery or months to years later.

Treatment of lymphedema will depend on how serious the problem is. Options include an elastic sleeve, an arm pump, arm massage, and bandaging of the arm. Exercise and diet also are important. Should this problem develop, talk to your doctor and see a physical therapist as soon as possible. In the Philippines, contact ICanServe Foundation (info@icanservefoundation.org or +632 636 5578) for a referral to a US-certified lymphedema therapist.

To avoid lymphedema or to protect your arm after treatment:

  • Avoid sunburns and burns to the arm or hand.
  • Have shots (including chemotherapy) and blood pressure tests done on the other arm.
  • Use an electric razor for shaving underarms.
  • Carry heavy packages or handbags on the other arm or shoulder.
  • Wash cuts promptly, apply antibacterial medication, cover with a bandage, and call your doctor if you think you have an infection.
  • Wear gloves to protect your hands when gardening and when using strong detergents.
  • Avoid wearing tight jewelry on your affected arm or elastic cuffs on blouses and nightgowns.

Radiation Therapy

In most cases, a lumpectomy is followed by radiation therapy. High-energy radiation is used to kill cancer cells that might still be present in the breast tissue.

In standard therapy, a machine delivers radiation to the breast and in some cases to the lymph nodes in the armpit. The usual schedule for radiation therapy is 5 days a week for 5 to 6 weeks.

Sometimes a “boost” or higher dose of radiation is given to the area where the cancer was found.

During treatment planning, your chest area will be marked with ink or with a few long-lasting tattoos. These marks need to stay on your skin during the entire treatment period. They mark where the radiation is aimed.

Possible Problems: Side effects may include feeling more tired than usual and skin irritations, such as itchiness, redness, soreness, peeling, darkening, or shininess of the breast. Radiation to the breast DOES NOT cause hair loss, vomiting, or diarrhea. Long-term changes may include changes in the shape and color of the treated breast, spider veins, and heaviness of the breast.

Radiation after Mastectomy

I. Radiation may be suggested after a mastectomy if:

  • The tumor is larger than five centimeters or 2 inches.
  • Cancer is in many lymph nodes in the armpit.
  • The tumor is close to the rib cage or chest wall muscles.

II. Thoughts to Remember about Radiation Therapy

      • You often will be alone in a room, but your radiation therapist can hear you and see you on a television screen.
      • The treatment lasts a few minutes. You will not feel anything.
      • The radiation is only delivered to a small area for treatment.
      • You are NOT radioactive during or after your therapy.
      • You CAN hug, kiss, or make love as you did before your therapy.

Chemotherapy & Hormone Therapy

Research suggests that even when your lump is small, cancer cells may have spread beyond your breast. Most of these cells are killed naturally by your body’s immune system. When the growth of cancer cells is large enough to be detected, it means that your immune system is having difficulty fighting the cancer and needs additional help.

Help in killing cancer cells comes from two other forms of therapy – chemotherapy and hormone therapy. Now, more than ever before, these treatments are chosen for your individual case: your age, whether you are still having your menstrual period and how willing and able you are to cope with the possible side effects.

These therapies are used to:

  • Prevent cancer from coming back in women who are newly diagnosed with breast cancer, especially if they are at high risk for spread of the disease to other organs of the body
  • Control the disease when cancer is found in the lungs, bones, liver, brain, or other sites Control the disease in women whose cancers have come back one or more time
  • Control the disease when cancer is found in the lungs, bones, liver, brain, or other sites
  • Control the disease in women whose cancers have come back one or more time
    • Chemotherapy
      • Do I need chemotherapy? What drugs do you recommend?
      • What are the benefits and risks of chemotherapy?
      • How successful is this treatment for the type of cancer I have?
      • How long will I need chemotherapy?
      • Can I work while I’m having chemotherapy?
      • How can I manage side effects like nausea?
        • Preparing for Chemotherapy

      Before you start your therapy, you may want to have your hair cut short, buy a wig, hat, or scarves that you can wear while you are going through treatment. Be sure to finish necessary dental work as well. You cannot have any dental work during chemotherapy as you will be more prone to infections.

        • Managing Nausea
          • Ask for new drugs that reduce nausea and vomiting.
          • Eat small meals often; do not eat 3 to 4 hours before your treatment.
          • Eat popsicles, gelatin desserts, cream of wheat, oatmeal, baked potatoes, and fruit juices mixed with water.
          • Chew your food thoroughly and relax during meals.
          • Learn stress reduction exercises.

      Feeling nauseous, or as though you have to vomit, is a common side effect of chemotherapy. The following suggestions may help:

        • Fighting Infections
          • Stay away from large crowds and from people with colds, infections, and contagious diseases.
          • Bathe daily, wash hands often, and follow good mouth care.
          • Wear work gloves to protect hands against cuts and burns.
          • If you cut yourself, keep the wound clean and covered.
          • Have a healthy diet and get plenty of rest.

      Your body is less able to fight infections while you are on chemotherapy. The following steps can help you stay healthy:

        • Pregnancy and Early Menopause

      During chemotherapy, you may stop having your period or enter into an early menopause. You can still get pregnant, however, so talk to your doctor about birth control. The effect of chemotherapy on an unborn baby is unknown. After your treatment has stopped, your ability to get pregnant will vary, depending on the drugs you received. If you plan to become pregnant after treatment, discuss it with your doctor even before beginning treatment.

Chemotherapy drugs are designed to travel throughout your body and slow the growth of cancer cells or kill them. Most often, the drugs are injected into the bloodstream through an intravenous (IV) needle that is inserted into a vein. Some are given as pills. Treatments can be as short as 4 months or as long as 2 years. The drugs you take will depend on the stage of the cancer at the time you are diagnosed, or if the cancer returns.

Ask your doctor the following before considering chemotherapy:

Chemotherapy is usually given in cycles. You get one treatment and are given a few weeks to recover before your next treatment. The drugs are usually given in a doctor’s office or in an outpatient department of a hospital or clinic.

Possible Problems: The most common side effects are fatigue, nausea, vomiting, diarrhea, constipation, weight change, mouth ulcers, and throat soreness. Some drugs cause short-term hair loss. Hair WILL grow back after or sometime during treatment.

    • Hormone Therapy

Tests are routinely done on breast cancer cells to decide if the cancer is “sensitive” to natural hormones (estrogen or progesterone) in the body. If the tests find that the cancer is “positive,” it means that cancer cells may grow when these hormones are present in a tumor. You may be given a hormone blocker (a drug called tamoxifen) that will prevent your body’s natural hormones from reaching the cancer. These drugs are taken daily in pill form.

Possible Problems: Hot flashes, nausea and vaginal spotting are common. Other side effects may include depression, vaginal itching, bleeding or discharge, loss of appetite, headache,and weight gain. Studies show that there is a slightly increased risk of uterine cancer and blood clots for women on this drug. You should have an annual pelvic exam and notify your doctor if you are taking tamoxifen.

Risk Factors for Recurrence

Some women are at higher risk for the spread and return of breast cancer. Remember, the risk factors for recurrence are complex. They ARE NOT absolute forecasts of what your future will be.

The factors are:

  • Do I need chemotherapy? What drugs do you recommend?
  • What are the benefits and risks of chemotherapy?
  • How successful is this treatment for the type of cancer I have?
  • How long will I need chemotherapy?
  • Can I work while I’m having chemotherapy?
  • How can I manage side effects like nausea?

support

Breast cancer afflicts not only the patient, but her/his entire family. Link to a network of supporters to find solace, friendship, hope and help. Visit The Community here.

q&a

Send in your queries, and your breast cancer network in the Philippines will reply as best as we can. Check out The Community here.

Comparative Fees for Laboratory Services

(Philippines, as of June 30, 2011)
Click here to download the excel file.