Breast Cancer Stages, Associated Risks and Treatment Options

Stage 0 breast cancer usually refers to a condition known as ductal carcinoma-in-situ (DCIS). This is a precancerous condition. Given time, this condition if untreated may progress to form a frankly cancerous tumour which is described as invasive breast cancer. With the further passage of time, it will progress from a small cancer (stage 1) to a larger cancer with spread to the surrounding lymph nodes (stage 2 and 3) and eventually spread to other organs such as the lungs, liver, bones and brain through the blood stream (stage 4).


All stages of invasive breast cancer, from stage 1 to 4, has the ability to travel to other parts of the body outside the confines of the breast, take root and lie dormant, eventually to reactivate and grow in those areas causing a relapse. That is why in most cases of breast cancer relapse, the disease does not recur in the breast but in other organs. In such situations, the cancer is considered advanced and incurable.

 

Fortunately, in the pre-cancerous stage of DCIS (as is the case under consideration), the tumour cells have yet to acquire the ability to travel and spread through the blood stream. Thus, there is no possibility of the disease relapsing in other organs in future causing death. In other words, the long term survival form DCIS (stage 0 breast cancer) is practically 100%. The long term outlook of your relative is therefore very optimistic.


While the risk of the disease spreading and causing a relapse in other organs is absent, there is still a significant risk of a new breast cancer developing in the opposite breast. A new breast cancer, if it does form, may either be of the same stage 0 or it could develop as a higher stage cancer. This is particularly true of your relative who has both a personal as well as a family history of breast cancer.


Women are at much higher risk of developing breast cancer compared with men because the female hormones in women has a stimulatory effect on the transformation of normal breast cells into breast cancer cells. This may potentially be the underlying cause of breast cancer development in your relative. A laboratory test may be performed on the breast cancer tissue that was removed 3 years ago to see if the cancer cells respond to the stimulation of female hormones. This test may still be performed even though the surgery was performed 3 years ago as local hospitals have a practice of preserving and storing all tumour tissue removed during surgery for 5 or more years.


If the test shows that the cancer cells are responsive to female hormones, you relative may consider taking an anti-hormonal treatment to reduce the stimulatory effect of the body's female hormone on the opposite breast thereby reducing the risk of a new cancer forming in that breast. Studies have shown that such a proactive treatment may reduce the risk of a future breast cancer by 50-70%.


If your relative has any female siblings, they are at high risk of developing breast cancer as they now have 2 first degree relatives (mother and sister) with breast cancer. They should consider consulting an oncologist to discuss preventive treatment as I have described.


An active lifestyle with regular exercise and a healthy diet may reduce the risk of future breast cancer relapse. The probable explanation is that such a lifestyle is associated with a lower rate of obesity. As the fat tissue in a woman's body is capable of converting substances in the blood into female hormones, this may lead to a greater stimulatory effect on the transformation of normal breast tissue into breast cancer. Avoiding obesity, in this case, is therefore particularly important.


Surgical removal of a cancerous breast lump while conserving the breast is usually the preferred treatment if such a surgery can be performed with a reasonable cosmetic outcome. Such a breast conserving surgery is usually followed by radiotherapy to the affected breast. The long term survival from breast cancer in such an approach is similar to total removal of the breast (mastectomy) and is better for the patient's self-image and psychological health.

This article was contributed to Tab A Doctor by,

By Dr Wong Seng Weng, Medical Director, The Cancer Centre, a subsidiary of the Singapore Medical Group

Providing Support to a Family or Friend Diagnosed with Breast Cancer

There will always be an initial state of shock for most patients. Some may feel a sense of anger of what has happened. The most worrying state to be in is to be in the state of denial, where patients may refuse treatment. But generally, most will come to an acceptance of the illness and accept appropriate treatment.

After diagnosis, a comprehensive discussion of the treatment plan needs to be discussed with the patient. First of all, we need to stage the patient, that is, we need to do some imaging to ascertain if the disease has spread to other parts of the body. Following this, we need to decide if the patient should go for upfront surgery to remove the breast, or if the patient need some treatment, such as chemotherapy and targeted therapy to optimise the condition prior to surgery. 

With modern surgical techniques, surgery is not disfiguring as one would imagine. Depending on the type of surgery, there may also be an option for breast reconstruction which can produce good results. When a patient is undergoing chemotherapy, there may be a possibility of hair loss but this is only temporary.

The diagnosis of cancer and the treatment that one has to undergo is often a daunting experience for many. As a family or friend, it is important to provide emotional and moral support for the patient. I would try to avoid offering medical advice as this may confuse the patients. If the relative or friend is keen to know more, it is best to accompany patient to the treating physician and discuss. With the availability the internet, patients and relatives have easy access to information about medical conditions but often these information are misinterpretated or misconstrued. Hence, my advice is just to be sensitive to the patient’s feelings and needs, lend them a shoulder to cry on, and offer a listening ear if necessary.

The diagnosis and treatment of breast cancer have evolved to offer treatment with lesser side effects and minimal disruption to patients’ lifestyle. When the patient undergoes surgery or chemotherapy, they may feel slightly more lethargic than usual, limiting their activities but this is a temporary problem. One’s appetite may be affected during chemotherapy and therefore we encourage food with more nutritional value. We advise everyone, not only breast cancer patients to maintain a healthy lifestyle of exercise, food consisting of more fruits and vegetables and abstain from alcohol and smoking.

Common Myths about Breast Cancer

Myth 1: All breast lumps are cancerous.

This is not true. About 80% of breast lumps are usually benign (non-cancerous). The important thing is to get it evaluated, and catch it early if it is truly something serious. It is also important to note that sometimes breast cancer may manifest as skin changes such as skin irritation, redness or dimpling, breast pain, nipple retraction (turning inward) and nipple discharge

Myth 2: Annual mammogram exposes one to too much radiation.

The radiation used in mammogram is very small. Any associated risks are minimal compared to the potential benefits that it can offer to detect breast cancer. Mammograms can detect lumps before they can be felt or noticed and the earlier cancer is detected, the better the chance of survival. All women should undergo a screening mammogram every year, starting from age 40.

This article was contributed to Tab A Doctor by,
By Dr Wong Chiung Ing, Medical Oncologist, The Cancer Centre, a subsidiary of the Singapore Medical Group