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Information about Breast Cancer provided by HKIOC

Breast cancer is the second leading cause of cancer death in women after lung cancer. Breast cancer can occur in both men and women, but it’s far more common in women. Breast cancer is a common cancer in Hong Kong and around the world. In 2016, there were more than 4,100 cases diagnosed in Hong Kong, and the incidence rate is on the rise. Female breast cancer cases diagnosed in Hong Kong has increased by 3.5 times from 1,152 in 1993 to 4,123 in 2016. There are about 11 women diagnosed with breast cancer every day.

Signs and Symptoms

1. A breast lump or thickening that feels different from the surrounding tissue
2. Change in the size, shape or appearance of a breast
3. Changes to the skin over the breast, such as dimpling
4. A newly inverted nipple
5. Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
6. Redness or pitting of the skin over your breast, like the skin of an orange
7. An enlarged of underarm lymph node

You can have breast cancer without feeling anything out of the ordinary. However, please consult a doctor if you have developed above symptoms that last for more than a few days.

Screening and Diagnosis

- Imaging test such as mammogram, X-ray and ultrasound to examine the breast tissue for any suspicious areas.
- Biopsy is a test that removes tissue or sometimes fluid from the suspicious area. The removed cells are examined under a microscope and further tested to check for the presence of breast cancer.

Treatment According to Stages


Stage 0

It is called pre-cancer, this is the earliest stage of breast cancer. It involves abnormal cells that have not spread into breast tissue from the ducts or lobules where they began. Stage 0 breast cancer also has not spread to lymph nodes or other parts of the body. Stage 0 breast cancer is non-invasive, like ductal carcinoma in situ (DCIS).

Stage 1

It is an invasive cancer, meaning it is invading healthy breast tissue, but it has not spread outside the breast. This stage also has two categories, 1A and 1B, based on whether there is any evidence of small clusters of breast cancer cells in nearby lymph nodes.

Surgery is the main treatment for stage I breast cancer. These cancers can be treated with either breast-conserving surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. The nearby lymph nodes will also need to be checked, either with a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND).

In some cases, breast reconstruction can be done at the same time as the surgery to remove the cancer. But if you will need radiation therapy after surgery, it is better to wait to get reconstruction until after the radiation is complete.

Radiation therapy is usually given after surgery to lower the chance of the cancer coming back in the breast and to also help people live longer.

Chemotherapy: If the tumor is larger than 1 cm (about 1/2 inch) across, adjuvant chemotherapy (chemo) is sometimes recommended. For women who have a hormone receptor-positive (ER-positive or PR-positive) breast cancer, most doctors will recommend hormone therapy (tamoxifen or an aromatase inhibitor, or one followed by the other) as an adjuvant (additional) treatment, no matter how small the tumor is.

Stage II

Breast cancer is growing but is only in the breast or nearby lymph nodes. This stage has two categories, 2A and 2B, based on how large the tumor is and whether or not it has spread to nearby lymph nodes.

Stage II cancers are treated with either breast-conserving surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. The nearby lymph nodes will also need to be checked, either with a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND).

Women who have BCS are treated with radiation therapy after surgery. Women who have a mastectomy are typically treated with radiation if the cancer is found in the lymph nodes. Some patients who have a SLNB that shows cancer in a few lymph nodes may not have the rest of their lymph nodes removed (ALND) to check for more cancer. In these patients, radiation may be discussed as a treatment option after mastectomy.

Systemic therapy is recommended for women with stage II breast cancer. Some systemic therapies are given before surgery (neoadjuvant therapy), and others are given after surgery (adjuvant therapy).

Stage III

Breast cancer is an advanced cancer. It’s in the lymph nodes but has not spread to other organs. This stage is divided into three categories, 3A, 3B and 3C, based on the size of the tumor and how many and which lymph nodes are involved.

Stage III cancers is treatment with surgery first. Because these tumors are fairly large and/or have grown into nearby tissues, this usually means getting a mastectomy. For women with fairly large breasts, BCS may be an option if the cancer hasn’t grown into nearby tissues. SLNB may be an option for some patients, but most will need an ALND. Surgery is usually followed by adjuvant chemotherapy, and/or hormone therapy, and/or trastuzumab. Radiation is recommended after surgery.

Stage IV

Breast cancer has traveled to distant sites in the body, often the bones, liver, brain, or lungs. This is called metastatic breast cancer. Although this stage is considered incurable, new treatments allow patients to live longer with their disease.

Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs. Treatment may include hormone therapy, chemotherapy, targeted therapy, or some combination of these. Local treatments such as surgery or radiation might also be used to help prevent or treat symptoms.

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Risk Factor

  • Age: As with many other diseases, your risk of breast cancer goes up as you get older. About two out of three invasive breast cancers are found in women 55 or older.
  • Family history: Women with close relatives who’ve been diagnosed with breast cancer have a higher risk of developing the disease. If you’ve had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled.
  • Genetic: About 5% to 10% of breast cancers are thought to be hereditary, caused by abnormal genes passed from parent to child.
  • Personal history of breast cancer: If you’ve been diagnosed with breast cancer, you’re 3 to 4 times more likely to develop a new cancer in the other breast or a different part of the same breast. This risk is different from the risk of the original cancer coming back (called risk of recurrence).
  • Race/ Ethnicity: White women are slightly more likely to develop breast cancer than African American, Hispanic, and Asian women. But African American women are more likely to develop more aggressive, more advanced-stage breast cancer that is diagnosed at a young age.
  • Being overweight: Overweight and obese women have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause. Being overweight also can increase the risk of the breast cancer coming back (recurrence) in women who have had the disease.
  • Pregnancy history: Women who haven’t had a full-term pregnancy or have their first child after age 30 have a higher risk of breast cancer compared to women who gave birth before age 30.
  • Breastfeeding history: Breastfeeding can lower breast cancer risk, especially if a woman breastfeeds for longer than 1 year.
  • Menstrual history: Women who started menstruating (having periods) younger than age 12 have a higher risk of breast cancer later in life. The same is true for women who go through menopause when they’re older than 55.
  • Using Hormone Replacement Therapy: Current or recent past users of HRT have a higher risk of being diagnosed with breast cancer. Since 2002 when research linked HRT and risk, the number of women taking HRT has dropped dramatically.
  • Alcohol: Research consistently shows that drinking alcoholic beverages — beer, wine, and liquor — increases a woman’s risk of hormone-receptor-positive breast cancer.
  • Dense breast: Research has shown that dense breasts can be 6 times more likely to develop cancer and can make it harder for mammograms to detect breast cancer.
  • Lack of exercise: Research shows a link between exercising regularly at a moderate or intense level for 4 to 7 hours per week and a lower risk of breast cancer.
  • Smoking: Smoking causes a number of diseases and is linked to a higher risk of breast cancer in younger, premenopausal women. Research also has shown that there may be link between very heavy second-hand smoke exposure and breast cancer risk in postmenopausal women.
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Prevention

  • Keep weight check
  • Be physically active
  • Eat more fruits and vegetable
  • Avoid smoking and alcohol
  • Breastfeed if possible
  • Avoid birth control pills
  • Regular breast screening begin at age of 40

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