AN OUNCE OF PREVENTION

BY DR JENDANA CHANYAPUTHIPONG

Everyday, we do something that we believe is important to us — like discovering our talents, making a living, or developing a career. However, health is only important when we — or someone we know — face a problem. The better way to manage one’s health is to remain proactive (preventive) rather than to look for a solution only when a problem has occurred (treatment).

Building breast cancer awareness empowers the public to take charge of their breast health and help decrease deaths related to breast cancer. Understanding of the risk factors of breast cancer, as well as signs and symptoms, means knowing what to look out for when one does breast self-examination. Awareness of screening tools and ageappropriate screening recommendations make people more certain about what to do even when they do not detect any changes. Regular self-checks and screenings are a way to take responsibility for breast health.

There are many reasons why many people remain unaware of breast cancer and its severe implications for individual health and society. It used to be a ‘hidden disease’ — one that women were afraid or embarrassed to talk about. Like victims of abuse, they often suffered in silence. Today, more voices are heard, and real efforts are made to build awareness of breast cancer. Every October, the world unites in ‘pink efforts’ to raise awareness of breast cancer. Various campaigns and events in Singapore support this. I am privileged to take part in raising breast cancer awareness.

Breast Cancer Facts

Breast cancer is a worldwide public health problem. In Singapore, it is the most common form of cancer among females, and the number one cause of cancer death in women. It is estimated that one in 15 women in Singapore will develop breast cancer. Men are also at risk, although the incidence of male breast cancer is lower. With up to 80 per cent of breast cancer occurring in patients without known personal or family history of cancer, early diagnosis and timely treatment are crucial.

Not all types of breast cancer are the same; despite that, these facts remain: screening saves lives. The earlier the cancer is diagnosed, the better the prognosis will be. Screening makes the early detection and treatment of cancer possible, which allow for a better quality of life. No one knows the exact causes of breast cancer; hence, early detection is important in the fight against it.

Risk Factors

Some factors increase an individual’s risk of getting breast cancer, including accumulative exposure to female hormones, genetic mutation, and environmental factors. Environmental factors, which are mostly lifestyle-related, include lack of exercise, unhealthy diet and obesity, alcohol consumption, and excessive smoking. Some groups that are at higher risk include females, especially older ones and those who have a history of breast cancer or high-risk, biopsyproven lesions, previous radiation therapy to the chest at a young age, and women who have dense breasts.

The risk of developing breast cancer can be reduced through proper education and preventive measures such as adopting healthy habits regarding diet and exercise, as well as keeping one’s weight in check. It also helps to avoid alcohol, prolonged use of oral contraceptives, hormone-replacement therapy, and taking medications or undergoing risk-reduction surgeries for individuals with proven breast cancer gene mutations.

While women need to know how her breasts usually look and feel, a woman should still get her regular mammogram screening and clinical breast exams as they help to detect breast cancer before a

symptom becomes apparent. Breast cancer screening detects disease when a person has no symptoms. Early breast cancer changes such as microcalcifications, distortions within the breast tissue, and small lumps that cannot be felt or detected on a mammogram.

Stages and Survival

At Stage 0, when cancer is present but is still contained within its origin, and has not gained the ability to invade the surrounding tissues, the survival is almost 100 per cent for five years. With increasing stages, the survival rate reduces. At Stage 4, when cancer has spread to other organs, the five-year survival drops to below 40 per cent.

Women who are aware of their family history, conduct regular mammograms and/or ultrasound according to doctor’s recommendations, and undergo genetic testing for gene mutations if they are high risk, have the best opportunity for early diagnosis and life-saving treatments — when they are most effective and aimed with curative intent.

Technological advances help breast cancer detection at an early stage. The irony of it is that the uptake of screening remains low despite technological advancement and better treatment options. Some claim that they feel well and have no family history of cancer, and thus unlikely to get cancer themselves. Some believe that screening can wake up the ‘hidden tiger’ or that tests can worsen the cancer condition.

Having cancer is a situation where there can be a lot of tension, but it is also one where there is unity in the one common goal — to get the patient through it. We are not made the same. Different things affect different people at different intensities. To some, cancer is a wake-up call. After undergoing treatment, they change the way they live and take charge of their lives. They find purpose in living and not let life go by. Cancer is just a phase they go through; it does not define them.

To others, cancer seems like a death sentence. Although there are effective treatments against cancer, the thought of having surgery, chemotherapy and/or radiation is overwhelming. Fear and anxiety cripple them, leading to delay in treatment, the progression of the disease, and ultimately the worst outcome.

It is normal to feel scared. The important thing is how we respond to the threat. What choices do we have? What are the treatments for it? Instead of shying away from, or delaying treatment, I’d like our readers to encourage themselves or their loved ones to focus on why they should fight cancer – for whom they are living, and how to better prepare themselves for the treatment they need.

PA breast surgeon, Dr Jendana Chanyaputhipong is a specialist for endoscopic intervention in acute gastrointestinal bleeding at Khoo Teck Puat Hospital, where she has also served as a general surgeon in the Acute Care Unit.