ABOUT BREAST CANCER
70 % of breast cancer patients visit a doctor or hospital at an free advanced stage.
Cancer is a disease caused by abnormal growth of body tissue cells into cells.
a. in 2003, the WHO (World Health Organization) stated that cancer is a very serious health problem because the number of sufferers increased by around 20% per year. Cancer cells can spread to other body parts. Cells that continue to grow into lumps are called tumors.
Breast cancer, dubbed as ‘killer’ no. 2 after cervical cancer, also experienced a significant increase every year.
- In the United States 180,000 new cases per year
- In the Netherlands 91 new cases per 100,000 inhabitants
- In Indonesia alone, an estimated 10 out of 100,000 residents are affected by breast cancer.
The exact cause of this disease is unknown yet. However, there are 3 potential factors:
- Endocrine factors
- Environmental factor
- Genetic factors
In addition, there are several factors that cause delay in treatment and prevention of breast cancer in Indonesia. 70% of patients visit doctors or hospitals in an free-advanced stage.
- Other things that serve as a factor in the patient’s delay:
- Fear of surgery, chemotherapy and radiation.
- Belief in traditional medicine, herbalists, psychics or “smart people”.
- Not believing that breast cancer can be cured.
- Not aware of the illness
Not aware of the need for regular breast check-up. Things above may acculumate the number and severity of breast cancer sufferers.
When a number of cells in the breast grow and develop in a uncontrollable manner, this is called breast cancer. These cells can invade the surrounding tissues and spread throughout the body. This large collection of uncontrolled networks is called a tumor or lump. However, not all tumors are cancer because they are not spread or life threatening. This tumor is called a benign tumor. Tumors that can spread throughout the body or attack surrounding tissues are called cancer or malignant tumors. In theory, each type of tissue in the breast can form cancer, usually appearing in the ducts or mammary glands.
Mammography screening to detect tumors in the breast needs to be done because bit takes years for tumor to grow bigger and be felt by us, but can be detected by a mammogram.
Breasts consist of a collection of glands and fatty tissue located between the skin and breastbone. The gland in the breast will produce milk after a woman gives birth. Mammary glands are called lobules that form lobes or milk-producing bags. There are 15 to 20 milk-producing bags in each breast, which are connected to the milk ducts that accumulate inside nipple. The rest of the inside of the breast consists of fat tissue and interconnected fibrous tissue, which binds the breast and affects shape and size. There are also blood vessels and lymph nodes in the breast.
Symptoms of Breast Cancer
In the early stages of breast cancer, we usually do not feel pain or no signs at all. However, when the tumor gets bigger, the following symptoms may appear:
- Permanent lumps that do not disappear usually do not hurt and feel hard when touched or thicken breast skin or around armpits.
- Changes in breast size or shape.
- Wrinkles on the skin of the breast.
- The discharge from the breast, generally in the form of blood.
- Swelling or the pull of the nipple
Immediately consult a doctor if there are any symptoms. Do not delay any longer because if you are late breast cancer is difficult to cure. Am I at risk for breast cancer?
Risk factors for breast cancer are divided into:
- Unchangeable factor:
Becoming a woman Increasing age
The risk of developing breast cancer will increase with age. Every year, approximately 77% of patients aged over 50 years are diagnosed with breast cancer.
(Mothers, siblings or daughters with breast cancer double the risk of developing breast cancer)
Personal medical history
Women with a history of breast cancer in one breast have a risk of 3 to 4 times higher breast cancer in the other chest. Women with lumps in the breast or those diagnosed with LCIS (lobular carcinoma in situ) are also at high risk of developing breast cancer.
The state of dense breast is normal for young women. In older women, dense breast is a mirror for hormonal stimulation in the breast and increases the risk of breast cancer.
Having done radiation therapy in the chest area.
Initial menstruation (before 12 years old)
Late menopause (after 50 years)
Not having children, or having children after the age of 30 years
Genetic mutations that increase risk occur.
Genetic mutations for breast cancer have been a hot topic of research recently. 3 to 10% of breast cancer may be related to changes in the BRCA1 gene or the BRCA2 gene. Women can inherit this change from parents
- Changeable factors:
Following hormone therapy
Using birth control pills
Consuming alcoholic beverages,
Being overweight (especially after entering menopause),and not exercising.
However, please keep in mind that all these factors are still based on the possibility. Someone who does not have a risky factor can still get breast cancer. Early screening and detection is the right tool to reduce the risk of death caused by this disease.
How can I prevent breast cancer?
The most important risk factors in the development of breast cancer cannot be controlled by individuals. There are several factors associated with increased risk, but that is still unclear. Unlike lung cancer which is closely related to tobacco, only a few risk factors can be done to avoid breast cancer such as avoid doing hormone replacement therapy for the long term, having children before the age of 30, breastfeeding, avoiding being overweight by doing exercise and proper diet, limiting alcohol consumption.
For women at high risk, the risk of developing cancer can be reduced to 50% by consuming a medecine called Tamoxifen for 5 years. Tamoxifen has side effects such as vaginal disorders, which are harmless and some unusual side effects that can be life threatening such as blood clots, umbolus pulmonory, stroke, and uterine cancer. Tamoxifen is not commonly used for prevention, but can be useful in some cases. There is data that states that vitamin A, vitamin C, and vitamin E can protect against breast cancer, but further research is needed to prove this.
At present, the most important thing for every woman to reduce the risk of death from breast cancer is to regularly screen mammograms, find out how to do breast self-examination, and check with a doctor regularly.
Self Breast Examination (SADARI)
Take your time only for 7 minutes to check the breast yourself
How to do SADARI?
1. A. Look carefully at your breasts in front of the mirror, with both arms straight down. Note if there are lumps or changes in shape and size in the breast (the right and left breasts are normally not exactly the same).
B. Lift both arms up until both arms are behind the head and press forward, repeat the examination as on the left side.
2. Press your hands firmly on your hips and move your arms and elbows forward while shrugging. This method will strain your chest muscles and changes such as a basin (dekok) and lumps will be more visible.
3. Lift your left arm. Touch left breast with the three ends of the right arm that are tightened.
The strain can be done by :
- rotating movement with a soft but steady pressure, starting from the upper waist (Position 12) clockwise towards the nipples.
- Movement from top to bottom and vice versa.
- Movement from the center to the outside. Do the same on your right breast.
4. Slowly push the area around the nipples of both breasts and observe whether there is an abnormal (unusual) discharge?
5. Lie with your left hand under your head. Put a small pillow under the right shoulder. Touch the entire left breast surface with the movement as described in number 1. Perform on the same check as above for the right breast.
6. Give special attention to the upper breast near the right and left armpits (Superolateral quardrant) as shown in the picture, because there are many breast tumors in those areas. If an abnormality is found or there is a change compared to the condition in the previous month, then immediately consult a doctor for further examination.
The above check can be done while taking a shower, because foam soap will make it easier for you to feel the breast.
Mammograms can detect abnormalities in the breast before they are felt by us. Although some organizations still question the benefits of mammography, mammograms are still the most effective tool for detecting early breast cancer.
During mammography, the breast is pressed by two disc-shaped devices for several seconds in order to get a clear picture of the condition of the breast. Sometimes discomfort arises due to this examination procedure. For this reason, mammography should be done after the menstrual period is complete. At that time the breasts softened slightly. Research shows that it is better not to use deodorants, creams or talcum powder when doing mammography because it can affect the results of mammography.
From the results of the mammogram, the doctor can see any abnormalities in the breast and also know the changes that occur when compared with the results of previous mammograms.
If something suspicious is found, the doctor will suggest biopsy or taking a small amount of tissue in the area suspected of being examined for cancer or not.
Mammograms Prevent Malignancy in Breast Cancer
Breast cancer is 1-3% of the causes of cancer deaths in women worldwide. Since mammography has been used widely as a screening method, the size of the tumor when it was first detected and the death rate from breast cancer has decreased quite sharply to 20% in the last 10 years. Breast cancer in Indonesia is currently the second most common cancer in women after mouth cancer of the rahin. With the incidence of breast cancer around 100 per 100,000 people per year and more than 50% of them are found in advanced stages, mammography is still a reliable tool in detecting breast cancer. The small number of case discoveries in the early stages causes early detection and screening efforts to be very important. Mammography is one of these efforts, in addition to other methods, namely SADARI (Self Breast Check) and clinical examination by a doctor. Mammography itself is very useful in finding very small lesions, up to 2 mm, which are not palpable in clinical examinations (usually under 1 cm in size).
With the screening program it is expected that basic mammography checks are carried out every 2-3 years for women over the age of 35-50 years, and every one year or two years for women over 50 years. This basic examination will provide preliminary data on a woman’s breast tissue. If mammography is done routinely it is expected that if there are only a few changes from the female breast tissue it will be immediately identified. Unfortunately this kind of mindset is not found among women in general. Hardly a woman comes with her own awareness and asks for mammography. Almost all patients present with complaints of pain or lumps, and almost all carry a reference letter.
The low awareness of self-examination does not only occur in women with low educational background or economy, but also in highly educated or well-established ones, even among the medical professionals themselves. Dissemination of information regarding the benefits of early examination (mammography) or breast cancer risk factors may be less extensive in the society. Realizing this, the Jakarta Breast Health Foundation collaborates with several institutions to provide mammography car units. The aim is to encourage women to carry out mammography examinations. The Mammography Car Unit can be an efficient unit that can reach remote areas, and offer economical costs. With this mammography car, it is expected that breast cancer malignancy can be prevented.
Besides mammography, actually BSE (Breast Self-Examination) technique is quite helpful. At least, encourage women to seek treatment immediately if they find a lump in their breasts. However, this technique has its weaknesses. BSE depends on the accuracy, sensitivity and level of intelligence of women. Therefore, all returns to the awareness of the woman about the risk factors and dangers of breast cancer. Without awareness, women will not do the examination, whether it is BSE or mammography, even if it is not charged, from year to year the number of breast cancer sufferers at the RSCM has not changed, and still with a fairly high stage. This happens because the awareness to check up and seek the right treatment is still not common in Indonesia
The high mortality rate of Indonesian women due to breast cancer will continue to increase. How do we handle it? Start by prioritizing health, through early detection and screening.
OPTIONS FOR THERAPHY
Breast Cancer Diagnosis and Stadium
Once a patient has symptoms of breast cancer or a mammogram screening showing abnormalities in the breast, it is usually advisable to do a diagnostic mammogram. Diagnostic mammograms are another set of x-ray devices, which are more complete by detailing suspicious areas. Or if your doctor suspects you have a cyst or you are young or have a dense breast, the doctor recommends ultrasound. Ultrasonography uses high frequency sound waves in areas suspected of breast. Ultrasonography is not painful and is often useful to distinguish between malignant or benign lesions.
Based on the results of the mammogram and / or ultrasonography, the doctor will recommend a biopsy. A biopsy is the only way to determine if you have cancer, because with a biopsy, the cell is taken and examined under a microscope. There are several types of biopsy, depending on how much tissue is taken. There are biopsies that use fine needles, thicker needles or need a small surgical procedure to lift more tissue. The team of doctors will determine the type of biopsy needed that is adjusted to your breast mass.
After tissue removal, pathologist will examine the specimen that can be identified as either cancerous or not. If cancer, the pathologist will classify it through the origin of the type of tissue, abnormal appearance (known as level), spread to surrounding tissue. And if all the lumps have been removed, the pathologist can find out if there are cancer cells left on the lifting boundary (called margins). Pathologists will also examine the presence of estrogen and progesterone receptors or HER-2 / neu in cancer cells. This is important because cancer with receptors can take hormonal therapy. There are also other therapies that can be done depending on HER-2 / neu.
In order to determine treatment and provide prognosis, breast cancer is divided into 5 stages. Staging is done before the operation and after the surgical procedure to remove the lymph nodes so that it can be examined for signs of cancer. Staging systems are complex and here is a simplified version.
Stadium 0 (called carcinoma in situ)
Lobular carcinoma in situ (LCIS) are abnormal cells found in the glands in the breast that have a risk of developing breast cancer. Ductal carcinoma in situ (DCIS) are abnormal cells in the ductal duct. Women with DCIS have a high risk of spreading cancer in their breasts. The choice of treatment is the same as stage 1 breast cancer patients.
Early stage breast cancer, tumor size is less than 2 cm and has not spread beyond the breast.
Early stage breast cancer, tumor size is less than 2 cm and has spread to the lymph nodes under the arm; or tumor size between 2 and 5 cm (with or without spread in the lymph nodes under the arm); or the tumor is more than 5 cm long and has not spread from the breast yet.
Free advanced stage of breast cancer, the size of the tumor is more than 5 cm and has spread to the lymph nodes under the arm, or the cancer is in the lymph nodes under the arm, or the cancer has spread near the breast bone or other tissues around the breast.
Breast cancer whin which there has been spread outside the breast to other body organs. Based on the stage of your cancer, your doctor may take additional tests to determine the spread of cancer. If you are already in stage III, you may need to do chest X-ray, abdominal ultrasound and bone scan to see the spread. Treatment for everyone is different. Your doctor will decide what needs to be done based on your cancer stage.
Treatment for Breast Cancer The type of treatment for everyone is not the same. To determine the right treatment, it is necessary to know first the stage of breast cancer. The stage is determined by the size and type of tumor cells, and the spread of cancer. The type of therapy to be used must be consulted with the doctor first.
Surgery is the most common treatment for breast cancer. The goal of surgery is to remove as much cancer tissue as possible. There are 2 types of operations, namely:
Surgery to remove the tumor and a little breast tissue around it, but does not lift the entire breast, also called Breast Conservation Therapy. This treatment is combined with radiotherapy.
Lifting most of the breast (partial mastectomy) or all parts of the breast (radical mastectomy). This treatment also needs to be combined with radiotherapy. Although all parts of your breast are removed, you don’t need to worry because you can do breast reconstruction.
Even though you have removed the tumor through surgery, there is a possibility that there will be a spread of cancer in other parts of the body. Therefore, breast cancer sufferers have the option of chemotherapy which is useful to reduce the risk of cancer spread. Chemotherapy is the use of anti-cancer drugs. The higher the stage of cancer, the more important chemotherapy becomes. In some cases, patients with stage i also benefit from chemotherapy. However, chemotherapy also has side effects such as hair loss, nausea, and others.
Breast cancer sufferers usually also need radiotherapy. Radiotherapy is a treatment that uses high energy ray (almost the same as x-ray) that can kill cancer cells. Radio therapy only takes 8 minutes and does not hurt. Within a week, patients must come 5 times. Treatment lasts for approximately 6 weeks. Radiotherapy is carried out by all patients who undergo it. Breast Conservation Therapy. Radiation is important to reduce the risk of cancer spread. Discuss with your radiation oncologist about the benefits, processes, and side effects of radiotherapy.
After the pathologist tests the tumor specimen, it can be determined whether the tumor in your body is estrogen and progesterone receptors. Patients with estrogen receptor tumors are suitable for estrogen-resistant drug therapy called Tamoxifen which can reduce the risk of cancer spread drastically. Common side effects on the use of Tamoxifen are weight gain, vaginal disorders, and others. Another unusual side effect is blood clots, strokes or uterine cancer that might scare patients to choose this treatment. What you need to know is the possibility of the spread of cancer is higher than the occurrence of serious side effects due to the use of tamoxifen for you. A breast cancer patient must routinely do a check-up that aims to prevent or know the spread of cancer. For starters, go to the doctor every 3-4 months. The longer you are declared clear of cancer, the lesser your visit to the doctor. After 5 years, a visit to the doctor becomes once a year. You also have to do mammography for both the affected and healthy breasts every year because the risk of breast cancer remains even if you have been affected. If you are taking Tamoxifen treatment, do a pelvic exam every year and if there is abnormal bleeding in the vagina, immediately see a doctor.
Sometimes the disease cannot be detected physically or cannot even be solved by conventional means. Scientific studies show that psychological factors such as independence and optimistic views can affect a person’s health and longevity.
Body and mind techniques can reduce doctor visits, speed up healing, reduce medication use, reduce hospital care and improve senses to control one’s health. Moreover, a greater positive impact on health compared to diet, exercise and others.
For example, someone who lives a quiet life, looking at life optimistically and eating a cheeseburger every day may have a greater chance to live healthier and live longer than someone who is full of tensions, pessimistic, insists not to eat fatty foods and exercise every day.
Maybe everyone can live a healthy life and have a long life. If everyone always thinks positively and faces everything calmly.
The philosophy of traditional Chinese medicine considers that the health of our body, mind and spirit of life are all equally important. These three things are part of a continuous circle, not only in the form of individually related things. It often happens, if we talk about health, many people only focus on physical health. So we take steps to stay healthy more than those who are outside. For example, choosing to consume special foods.
MYTH & FACT
Myth : Lumps in the breast means you have breast cancer
Fact : 8 out of 10 lumps found in the breast are benign or do not have cancerous properties. However, if you find a permanent lump in the breast, immediately see a doctor to make sure that the lump is not dangerous. This action will free you from prolonged fear because of uncertainty or can also save your life. Because if detected early, breast cancer treatment will be more optimal. Let’s take care of breast health by doing BSE (Breast Self-Examination) every month, regularly visiting a doctor or doing mammography regularly (if you are over 40 years of age).
Myth : Men are free from breast cancer
Fact: Men can also get breast cancer even though the percentage is smaller than women. Breast cancer in men is also dangerous. The spread of breast cancer in men is faster because the tissue around the male breast is thinner than the female so that at the initial stage there may have been attachment to the surrounding tissue. Therefore, it is recommended that men also do BSE so that every change is known quickly.
Myth : Mammogram can cause breast cancer to spread
Fact : Mammograms are the standard test for breast examination using x-rays to take tissue photos. X-rays and mammogram machine pressure on the breast do not cause cancer to spread. Don’t let the stories and experiences of other people cause you not to do a mammogram. Take decisions based on doctor’s recommendations. You can ask anything about mammograms to your doctor.
Myth: If your family has breast cancer, you will also get breast cancer
Fact : Women with a family history of breast cancer have a high risk of developing breast cancer. If your mother, child, sister or grandmother has breast cancer, do a mammography examination 5 years before they are diagnosed with cancer. However, most women who have breast cancer do not have a family history of cancer.
Myth: Chemotherapy causes hair loss.
Fact : Hair loss depends on the type of chemotherapy, the dose used, and the amount of medication. This is a side effect of chemotherapy which usually occurs 3 weeks after the seizure begins.
Myth: Anti-perspirant can cause breast cancer.
Fact : This topic has been a hot topic on the internet for several years, but there is no concrete evidence to prove that. Research in the United Kingdom shows the presence of parabens in breast tissue. Parabens are chemicals used in many cosmetics. Of the 20 breast patients studied, 18 contained parabens. Although research shows the presence of parabens in the breast, this does not prove parabens are the cause of breast cancer. Please note that anti-perspirant / deodorant is currently free of parabens. The main risk factors for breast cancer are increased age.
Myth: Patients with tumors in the breast when breastfeeding will increase the risk of cancer in their children
Fact : Studies conducted show that cancer cells cannot be carried through breastfeeding. Cancer cells are not found in milk so they will not be carried away.
Myth: Breast cancer can be caused by a wound in the breast.
Fact : There is no evidence that collision in the breast can increase the risk of developing breast cancer.
Myth : Small breasted women are not at risk of developing breast cancer.
Fact : Small breasts do not reduce the risk of developing breast cancer.
Myth: Breast examination prevents breast cancer.
Fact : A breast examination aims to detect breast cancer early and cannot prevent breast cancer.
Myth: Breast cancer primarily affects women aged between 30 and 50 years.
Fact : Fact: Research shows 77% of breast cancer cases appear in the age above 50 years.