Monday, October 17

Facts and Myths About Breast Cancer That Every Filipina Should Know

Two months ago, Asian Hospital and Medical Center (AHMC) in Muntinlupa City opened the biggest (685 sqm.) and most complete Breast Center in the country. According to Dr. Aldine Basa, breast surgeon and the center's head, they can do consultations, mammogram, ultrasound, biopsies, chemotherapy, and many other procedures all in one place. The center's patient population is composed of women from the south of Metro Manila including those who live in Cavite, Batangas, and Laguna.

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In honor of Breast Cancer Month this October; Dr. Basa reiterates the importance of early screening and detection for breast cancer as it has already overtaken lung cancer as the number one killer of Filipino women.

According to her, although survival rates are good for those who get diagnosed early, the Philippines has a high mortality rate for breast cancer because majority of women only consult a doctor when it's too late and they are already in the advanced stages. In first world countries, despite the high incidence of breast cancer, they have very good survival rates because women get detected early.

"We have everything here that America has for treatment. But we don't have a very open attitude of wanting to know what is wrong. We'd rather not know, thinking that is better. But that just makes everything worse," explains Dr. Basa. "What happens a lot of times is, women don't do anything because they don't want to burden their family."

But when the lump becomes very big, pus develops, and the breast starts to stink, that's the only time women are finally forced to see the doctor. "The whole family is shocked that it has reached this stage and try to pull resources. But they end up spending even more for consulting at this late stage when the outcome is already poor."

Dr. Aldine Basa
Here, Dr. Basa answers questions that may help women understand why it is very important to get screened for breast cancer as soon as they hit 40 years old.

What do you advise women who are experiencing pain or can feel a lump?

Remember, 80 to 90 percent of complaints about the breast, whether it's pain or a lump, are benign. So majority is not cancer. That's what people should remember. Because they think when there's pain, they might already have cancer when it's the other way around.

When there's a lump, is surgery always the answer?

Cysts don't need surgery. They're really related to hormonal changes because of menstruation. They are painful especially during the monthly period. In medicine, a cyst, or fibroadenoma, means a lump filled with fluid. It is the most common lump in the breast. So those actually resolve spontaneously. What we do operate on is something solid. And you can see the difference on ultrasound.

So which diagnostic procedure is more accurate?

Actually, they see different things; you cannot compare. The mammogram sees what the ultrasound cannot see and vice versa. You can't say, "I'll have ultrasound instead of a mammogram" because you'll be missing out on something. You need to undergo both, ideally and these procedures should be done, ideally, on the 7th to 10th day after the first day of menstruation.

In a mammogram, what we look for are micro calcifications, which are calcium deposits in the breast. Sometimes, there are certain configurations that are alarming and look suspicious. At that point, once we've biopsied it, it's very early stage cancer, as in stage zero. That's why we recommend mammograms yearly starting at age 40 because it can catch cancer at this early stage.

An ultrasound, on the other hand, can see a lump. It can tell you whether this lump is solid or filled with fluid. With the mammogram, even without a lump, it can already detect calcium deposits.

AHMC's Breast Center
Once diagnosed with breast cancer, what happens then?

Standard therapy is recommended. Definitely, anybody who has cancer has to undergo surgery. That's the first step. We have to remove the cancer from the body. And there are always two options. You can have your breast conserved or the breast removed (mastectomy). For those who had mastectomy, they have the option for immediate breast reconstruction.

After surgery, the tumor is examined and then we do tests to find out whether it's aggressive or not. Based on these tests, it will tell us if the patient needs chemotherapy or radiotherapy or hormonal therapy. All of that comes after surgery. And that's dependent on the results of the biopsy.

One misconception is that a lot of women believe that if you had the breast removed, then they are cured and the cancer will not come back because the breast is out. But that's not true. Because it depends on the nature of the cancer whether it's aggressive or not. Even if you remove your breast, if you don't have the recommended treatment, it can come back in that area or your other organs.

What's the difference between chemotherapy and radiation?

Chemo's effect is systemic. It acts throughout your whole body because it's given intravenously. It tries to kill any cancer cells that were able to escape into your bloodstream. Radiotherapy has a local effect; it's localized and administered on your breast. It just prevents the cancer from coming back in your breast, not in other parts of your body. So you can't say, "I want radiotherapy rather than chemo" because the effects are totally different.

Why should women with breast cancer avoid comparing treatments?

There are many forms of breast cancer that's why you cannot compare your condition with your friend's condition. That happens a lot. Aside from different types of cancer, we do tests to find out the aggressiveness of cancer, which is different per person. There are many factors that contribute to its behavior so you really cannot compare. This is a big mistake women do. They compare and question their treatment and then they don't go through the recommended treatment for them because they're saying, "How come my cousin has something else?" You can't do that because everybody's situation is different. You cannot say what worked for one woman would work for you.

one of the treatment rooms
What are the chances of survival once a woman gets diagnosed with breast cancer?

Stage one, 90 percent; stage two, about 80 percent; stage three is about 60-70 percent; stage 4, around 20 percent.

Can breast cancer be prevented?

With cancer, there is no prevention. There's nothing that you can do unless you have your breasts removed like what Angelina Jolie did. Having a healthy lifestyle doesn't mean you won't get it. It hasn't been established that there's a relationship between food or lifestyle and breast cancer. I have a patient who is a vegetarian and does yoga and she got cancer. So you cannot blame lifestyle and diet.

Are there risk factors?

As we grow older, our chances of getting breast cancer increases. If you had breast cancer or uterine cancer or ovarian cancer before, your risk of getting breast cancer again is higher. If you have a first degree relative with breast cancer, your risk of getting it is higher compared to somebody who does not have a family history. But that doesn't mean you will definitely get it.

We know that 60 percent of cancers are stimulated by estrogen. So if you had your first menstruation before you were 12 or you had menopause after 55, those are risk factors because you have been exposed to estrogen for a long time.

If you've never been pregnant, if you had your first pregnancy after 30, if you've never breastfed, if you're overweight, or if you drink a lot of alcohol, those are also risk factors. Also, if you have taken contraceptive pills or hormonal replacement therapy for two years or more straight, you are also at risk. If you take pills intermittently, it's okay. So take them for six months then stop for a month, then take them for six months again. Don't do it continuously.

If you're pregnant, your estrogen levels are low because you're not menstruating. So having multiple pregnancies is actually protective because your estrogen is low during those times.

There are many risk factors but there are women who have a lot of those, who don't get breast cancer. And there are women with no risk factors, who are completely healthy, and still get it. So we still don't know the cause up to now.

walls lined with paintings by breast cancer patients 
What are the myths about breast cancer?

It is not true that when your baby kicked your breast, you wear an underwire bra, you use deodorant, or you take supplements that are supposed to prevent breast cancer, you will get breast cancer. It is not true that having a benign lump removed will increase your chances of getting cancer. Likewise, it is not true that if you had an abortion or miscarriage, you are going to get cancer.

* AHMC's Breast Center offers various breast care services. For consultation and further inquiries, visit AHMC's Breast Center located on the 4th Floor, Tower 2 of Asian Hospital and Medical Center 2205 Civic Drive, Filinvest Corporate City, Alabang, Muntinlupa City.

(Note: this article was originally printed in Manila Bulletin's Wellness section on October 2013)
© Ruth Manimtim-Floresca

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