Understanding Breast Cancer: Symptoms, Causes, and High-Risk Groups

• Presence of a lump or changes in breast shape
• Dimpling of the skin (like a dimple), orange peel texture, or visible vein enlargement on the breast
• Nipple bleeding or inversion
• Swelling or lump in the underarm lymph nodes

• Older Age: According to the Hong Kong Cancer Registry’s data from 2020 to 2022, over 70% of newly diagnosed breast cancer cases occurred in women aged 50 or above.
• Unhealthy Lifestyle: Risk factors include obesity, lack of exercise, alcohol consumption, smoking, frequent intake of high-fat foods, and long-term use of birth control pills or hormone replacement therapy for more than 5 years.
• Genetics: Studies show that women with a amily history of breast cancer in first-degree relative have a higher risk compared to those without.

The exact cause of breast cancer remains uncertain. However, various risk factors—such as a family history of breast cancer—are associated with higher chance of developing breast cancer. Our hospital encourages women to undergo regular breast examinations, including self-checks, clinical breast exams, and mammography. By staying alert to changes in the breasts and adopting a three-pronged screening approach, early detection becomes possible, allowing for effective treatment.

If you have a family history of breast cancer or other high-risk factors, consult your doctor first.

Breast Examination Methods and Diagnostic Process

It is recommended that women aged 20 and above perform regular monthly breast self-examinations. For those who have not yet reached menopause, the examination should be conducted on the 7th to 10th day after the start of menstruation. For postmenopausal women, the examination should be performed on the same day each month.

1. Observation
   Stand in front of a mirror with your arms raised above your head. Observe whether there are any abnormalities such as changes in the skin and nipple, or discharge. Place your palms on your hips and press down firmly to tighten the chest muscles, and check if there is any dimpling or indentation of the breasts.
2. Comparison
   Compare both breasts carefully, noting whether there are any unusual differences in size or shape. Pay attention to the overall contour, skin texture, or outline of the breasts, and see if they look different from what you are familiar with in the past.
3. Palpation (Touch)
   Raise your right arm and place it behind your head. Use the flat pads of the middle three fingers of your left hand to make small circular motions over the right breast, moving from the outer side inward toward the nipple. Gently squeeze the right nipple to check for any discharge. Switch hands and repeat the same method to examine the left breast, nipple, and armpit for any lumps, swelling, or hardness.

How is Breast Cancer Diagnosed?

Clinical Examination

A specialist doctor performs a physical examination of the breasts to check for abnormalities, such as lumps or nipple discharge, and then determines whether further tests like mammography or ultrasound are needed.

Mammography

Mammography uses X-ray imaging of the breasts to detect abnormal tissue or tumors that cannot be felt or are not yet formed. It is particularly useful for identifying early-stage breast cancer.

Ultrasound Scan

Ultrasound helps distinguish the location, size, and type of breast lumps.

Magnetic Resonance Imaging (MRI)

In certain circumstances, MRI provides a more detailed evaluation of abnormal areas in the breast.

Biopsy (Needle Aspiration Test)

Also known as a breast needle biopsy, this procedure involves using a fine needle to extract tissue from a lump, as recommended by the doctor, to determine the type of cells present.

Recommended Groups for Regular Breast Examinations

• Women aged 20 to 40 should have a breast examination by a doctor every 3 years.
• Women aged 40 and above should have a breast examination by a doctor and undergo mammography every 2 years.
• Women with close relatives who have had breast cancer should have a breast examination by a doctor and undergo mammography once a year.

Staging of breast cancer is a key factor in determining treatment plans and predicting patient survival (prognosis). Doctors generally use the internationally recognized TNM staging system to assess the extent of cancer spread. The TNM system takes into account three core indicators: tumor size (T), lymph node involvement (N), and distant metastasis (M).

Tumor Size (T) Classification

This indicator evaluates the size of the primary tumor and whether it has invaded the chest wall or skin.

Lymph Node (N) Metastasis Status

This indicator assesses whether cancer cells have spread to nearby lymph nodes, typically the axillary lymph nodes.

Distant Metastasis (M) Status

This indicator is used to assess whether cancer cells have spread to other distant organs in the body.

Correlation Between Breast Cancer Staging and Survival Rates

Based on TNM classification, breast cancer is divided into stages 0 to IV, which are directly related to treatment strategies and prognosis. In general, the earlier the stage, the higher the relative five‑year survival rate.

Preparation Before Treatment

1. Maintain healthy lifestyle habits, including a balanced diet and regular routines, without making drastic changes.
2. Inform the anesthesiologist of any drug allergies and the medications you are currently taking.
3. Consult your doctor about possible post‑surgery complications and how they can be managed.
   

Treatment Methods

The treatment and prognosis for breast cancer depend on staging of breast cancer. Physicians will recommend treatment options based on the staging and types of breast cancer. The main treatment approaches include the following: upfront surgery, neoadjuvant treatment, i.e. use of chemotherapy, targeted therapy, hormone therapy, and/or immunotherapy before operation, and adjuvant treatment i.e. use of chemotherapy, radiotherapy, hormonal therapy after operation.

Surgical Resection

• Surgical resection includes:
  
  • Breast-conserving surgery
    • If the tumor is relatively small, the surgeon will remove the tumor along with surrounding tissue, followed by radiotherapy.
  • Total mastectomy
    • If the breast lump is large or when patient is not suitable for radiotherapy, the entire breast needs to be removed.
  • Sentinel lymph node biopsy
    • This procedure involves removing the sentinel lymph node and analyzing it to determine whether cancer cells are present. The sentinel lymph node refers to the first (few) lymph node(s) in the axilla; when cancer cells spread from the breast tumor into the lymphatic system, they typically accumulate in the sentinel node before spreading to other axillary lymph nodes.

Chemotherapy

Chemotherapy uses anti‑cancer drugs to destroy or suppress cancer cells in the body. Treatment courses generally last about three to six months. It could be administered as neoadjuvant therapy before operation or adjuvant therapy after surgery to reduce the risk of recurrence.

Radiotherapy

Radiotherapy uses ionizing radiation to kill cancer cells. The radiation damages cancer cells at the genetic level, preventing them from reproducing. Treatment courses generally last about three to four weeks. Radiotherapy is often combined with surgery and chemotherapy to enhance effectiveness and reduce the risk of recurrence.

Immunotherapy

Immunotherapy uses own immune system’s cells fight against cancer cells.

Targeted Therapy

Targeted therapy uses drugs to selectively attack cancer cells. It is designed to enhance the effectiveness of chemotherapy and is particularly effective for HER2‑positive breast cancer. The treatment course typically lasts about one to one and a half years.

Hormone Therapy

Hormone therapy involves taking anti‑estrogen medications to prevent cancer cell growth. It is suitable for patients whose tumors show a positive hormone receptor response, and may also be used as treatment following chemotherapy. The duration of therapy varies by individual and can last up to 5-10 years.

Breast cancer treatment choices are complex decisions. If you have any questions, you should consult your doctor as soon as possible. For professional advice, you may contact the Breast Surgery at Hong Kong Adventist Hospital.

• Physical care:
  • Arm exercises: Use exercise bands to perform stretching movements of the upper arm to help prevent postoperative lymphedema and restricted shoulder movement.
  • Physiotherapy: Breast cancer surgery or radiotherapy may damage lymph nodes. Early physiotherapy, such as exercise and lymphatic drainage, can reduce the risk of lymphedema after axillary lymph node removal and restricted shoulder movement.
  • Balanced nutrition: Adjust lifestyle and diet to promote recovery.
• Psychological care:
  • Emotional support: Seek encouragement from partners, family, friends, and support groups.
  • Regular follow‑up: Attend scheduled medical reviews to regain normal life.