October marks Breast Cancer Awareness Month, a time to remind loved ones about the importance of screenings.
Breast cancer is the most common cancer among women worldwide, but early detection and treatment can greatly improve outcomes. Here Dr Du Plessis clarifies some of the key aspects of breast cancer diagnosis and treatment by answering the below questions:
What Should You Do If You Feel a Lump?
If you find a lump in your breast, don’t panic, but act quickly. You need to see a doctor who can perform an examination and order imaging investigations of the lump to be done – a mammogram and an ultrasound of the breast will be performed. Based on these findings, a biopsy is usually recommended to determine whether the lump is cancerous.
If cancer is diagnosed, the next step is to determine the stage of the disease, as this will guide the treatment plan. Early-stage cancers (stages one and two) typically require surgery first, while more advanced stages often start with chemotherapy to shrink the tumour before surgery.
What is a Biopsy and How is it Done?
A biopsy is a procedure where a sample of tissue is taken for testing to confirm if cancer is present. Surgery is not always required for a biopsy. The biopsy is almost always done by the radiology team under ultrasound guidance, or by using a mammogram machine to locate the lump. This minimally invasive procedure allows for a more accurate diagnosis.
Is Surgery Always the First Step in Treatment?
Not always. While surgery is a crucial part of breast cancer treatment, it is often accompanied by other therapies such as chemotherapy, radiotherapy, and, in some cases, hormonal therapy. Treatment of breast cancer is multifaceted. The approach depends largely on the stage of the cancer and whether it has spread to other areas, such as the lymph nodes or other organs.
For stage one or two cancers, surgery alone may be sufficient, but additional treatments like radiotherapy or hormonal therapy may be recommended afterward. In cases of more advanced cancer (stage three), chemotherapy is often the first step, followed by surgery. In most cases with stage three breast cancer, the patient will also have radiotherapy after the surgery has been done.
The Role of Hormonal Therapy
Hormonal therapy is used for breast cancers that are sensitive to oestrogen or progesterone. This is picked up by the pathologist when they test the tissue from the biopsy. If the cancer cells show sensitivity, hormonal therapy is prescribed to block the hormones that may fuel tumour growth.
Chemotherapy: When is it Needed?
Chemotherapy can be administered either before or after surgery. When given before surgery, it’s known as neoadjuvant chemotherapy, aimed at shrinking the tumour to make surgery more effective. Adjuvant chemotherapy is administered after surgery if tests reveal a higher stage of cancer than initially expected or if the cancer type is particularly aggressive.
Is Self-Examination Still Important?
With modern mammography technology, very small lumps can be detected, often before a patient even feels them. However, self-examination still plays a very valuable role. Sometimes a patient will feel a lump, and that abnormality does not show up on the mammogram. Self-examinations can help detect irregularities that might not be visible through imaging.
The Mastectomy vs. Lumpectomy Debate
A common concern for breast cancer patients is whether a full mastectomy is necessary. A double mastectomy is not always required unless the patient carries the BRCA1 or BRCA2 genetic mutations, which significantly increase the risk of future breast cancer. In most cases, a lumpectomy – removal of only the tumour – can be just as effective, provided the tumour is small enough.
Mastectomy is not superior to a lumpectomy regarding oncological outcomes or the chance of cure. However, patients opting for a lumpectomy must be willing to undergo radiotherapy afterward to minimise the risk of recurrence.
Survival Rates and Prognosis
The good news is that breast cancer survival rates have dramatically improved with advances in medical treatment. After completing all the available modalities of breast cancer treatment, the five-year survival rate of stage one and stage two breast cancer is between 90 to 100 percent. Even for stage three cancers, the five-year survival rate is around 70 percent.
Key Takeaways
- Early detection is critical: If you feel a lump, see a doctor immediately for testing.
- Biopsy confirms cancer and the treatment plan, often done without surgery.
- Treatment plans vary by stage, including surgery, chemotherapy, radiotherapy, and hormonal therapy.
- Self-examination remains important, even with advanced mammography.
- Mastectomy vs. lumpectomy: Both options are effective, but additional factors, such as genetics, may influence the decision.
- Survival rates for early-stage breast cancer are very promising, with up to a 100% five-year survival rate for stage one.
You can read more about mastectomy, breast reconstruction and post-surgery options, on our website page about mastectomy.