Breast cancer is considered the number one deadly threat, with the highest statistics among cancers in other female organs. Therefore, every woman should regularly observe and seek opportunities for breast cancer risk screening. If you have any of the following symptoms or signs, you should see a doctor immediately.
These symptoms may indicate breast cancer
- A hard lump is felt in the breast
- Discharge from the nipple, especially if it comes out spontaneously without squeezing
- Newly inverted nipple
- Changes in the breast skin such as raised areas or dimples, or a lump in the breast spreading to the skin causing ulceration, hard nodules on the skin, skin swelling resembling orange peel, ulcers or rashes on the nipple and areola
- Swollen, red, chronic inflamed breast; some cases may feel lumps in the armpit
- Most breast cancers do not cause pain; a few may have pain
- Self-breast examination and annual mammogram screening from age 40 or younger if at risk are important, and you should see a doctor immediately if you feel a lump in the breast without waiting for pain to occur
Does mammogram screening cause breast cancer?
Compression from mammogram or even trauma to the breast from various causes does not cause cancer. However, many patients discover a lump after trauma, leading to the misconception that trauma causes cancer.
Frequent or high-dose radiation exposure, such as for radiology staff without proper protection, can cause cancer. Mammograms expose patients to radiation similar to chest X-rays, bone X-rays, or CT scans, but the radiation dose in mammograms is low, equivalent to about 7 weeks of normal environmental exposure (depending on geographic location) and 50-100 times lower than CT scan radiation. Therefore, annual mammogram screening for breast cancer is considered safe and has not been found to cause breast cancer. It is recommended for women aged 40 and above or younger if at risk.
What do mammogram results mean?
Mammogram results are usually reported as numerical categories from 0 – 6 (BIRADS categories 0 – 6)
| BIRADS 0 | The image is incomplete; a repeat or additional images are needed |
| BIRADS 1 | Normal; recommended to have annual check-ups |
| BIRADS 2 | Benign findings such as common calcifications, simple breast cysts; annual check-ups recommended |
| BIRADS 3 | Probably benign abnormality with less than 3% chance of cancer; follow-up every 6 months recommended, e.g., round or oval benign tumors with smooth surfaces |
| BIRADS 4 | Suspicious abnormality with more than 3% chance of cancer; biopsy recommended, subdivided into BIRADS 4a, 4b, and 4c |
| BIRADS 5 | Highly suggestive of malignancy with more than 90% chance of cancer; biopsy recommended |
| BIRADS 6 | Known biopsy-proven malignancy, e.g., cancer diagnosed before mammogram |
Stages of breast cancer
Breast cancer stages are classified as follows: non-invasive stage or stage 0 (Stage 0/ Ductal Carcinoma In Situ/ DCIS) *Some cancer insurance policies may not cover this stage
- Invasive stages include
- Stage 1: Tumor ≤ 2 cm and no lymph node spread
- Stage 2: Tumor > 2-5 cm with spread to ≤ 3 lymph nodes, or tumor > 5 cm without lymph node spread
- Stage 3: Tumor spreading to the skin and/or chest wall, or cancer spread to 4-10 lymph nodes, or spread to 1-3 lymph nodes with tumor > 5 cm
- Stage 4 or metastatic stage: Cancer spread to other organs such as liver, bone, lungs
Chances of recovery from breast cancer at different stages
Patients with non-invasive stage have a very high chance of cure, with a ≥ 10-year survival rate of nearly 100%
- Stage 1: ≥ 5-year survival rate = 98%
- Stage 2: ≥ 5-year survival rate = 93%
- Stage 3: ≥ 5-year survival rate = 72%
- Stage 4 or metastatic stage: ≥ 5-year survival rate = 22%
Once metastasized, survival rates drop significantly. Therefore, early diagnosis and treatment are very important.
Breast cancer treatment
Treatment of breast cancer includes
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- Surgery
- Cancer medications including chemotherapy, hormone therapy, or targeted therapy
- Radiation therapy
The main treatment for breast cancer is surgery, and most patients will receive additional cancer medications depending on the stage, type, and characteristics of the breast cancer. Some patients may also require radiation therapy, such as those undergoing breast-conserving surgery, those with tumors 5 cm or larger, or cancer spread to more than 1-3 lymph nodes.
Is it necessary to remove the entire breast for breast cancer?
There are several surgical methods for breast cancer. It may not be necessary to remove the entire breast while achieving good treatment outcomes. Patients with small tumors and large breasts often undergo breast-conserving surgery. Those with relatively large tumors may have the entire breast removed and undergo breast reconstruction, or receive chemotherapy first to shrink the tumor before considering breast conservation.
- Complete mastectomy is usually performed in cases with large tumors, extensive involvement, multiple sites, contraindications to radiation after breast-conserving surgery, or patient preference for total breast removal
- Breast-conserving surgery
This involves removing the entire cancerous area with clear margins along with radiation therapy after surgery. Patients suitable for this method usually have small tumors and can receive radiation therapy postoperatively.
- Breast reconstruction
Patients who undergo total mastectomy can have immediate breast reconstruction during the same surgery using tissue from other parts of the body or silicone implants. Immediate reconstruction during cancer surgery is easier than delayed reconstruction.
Common donor sites for tissue reconstruction include the abdomen or the back (latissimus dorsi). Using abdominal tissue provides a larger volume for reconstruction but may weaken the abdominal wall. Using back tissue is smaller and often used for partial reconstruction after breast-conserving surgery.
Silicone implant reconstruction is beneficial for patients without sufficient abdominal fat or who do not want abdominal scars. However, radiation therapy may increase the risk of complications.
Patients with large tumors near the nipple require removal of the breast and nipple, with reconstruction using abdominal tissue and possible nipple reconstruction later.
Why are breast cancer patients advised not to have blood drawn or blood pressure measured on the same side as the cancer?
In addition to breast surgery, patients undergo lymph node surgery in the armpit. In the past, all lymph nodes in the armpit were removed, causing scarring and a high risk of arm swelling and shoulder stiffness. Therefore, activities that may cause arm swelling, such as blood draws, blood pressure measurement, or heavy lifting on that side, are avoided.
Currently, sentinel lymph node biopsy is performed by removing only some lymph nodes for examination using medical dyes or radioactive substances. Complete axillary lymph node dissection is only done if cancer has spread to lymph nodes, significantly reducing the risk of arm swelling and shoulder stiffness.
Assoc. Prof. Dr. Kamonrat Piboon
Specialist in Breast Surgical Oncology
Rak Breast Center, Phyathai 1 Hospital
