8 Common Questions on Breast Cancer, Answered by an Oncologist

Last updated on November 10, 2021.

Were you aware that breast cancer is the most common cancer among women in Hong Kong? 1 out of 14 Hong Kong women will be diagnosed with breast cancer. October is Breast Cancer Awareness Month, people around the world show their support to raise awareness about the impact of breast cancer, so do we! 

As a health and medical community, we wish to educate people and correct misconceptions about breast cancer. We have partnered up with Dr. Alice Ng, Clinical Oncologist from ICON Cancer Centre, to answer 8 common — and important — questions people often think about.

1. Is breast cancer lump painful? 

Every individual with breast cancer may have different symptoms. The most common one is breast mass. Unlike what most people think, cancerous breast mass is often painless. However, some people might experience pain, tenderness or burning sensation in the breast due to skin changes. It is important not to ignore any signs and symptoms our body flagged up. If you have any other concerns, be sure to check with your doctor right away. 

Some warning signs of breast cancer:

  • New lump or thickened area in the breast or underarm (armpit)
  • Change in breast size, shape and curve
  • Pulling in of the nipple 
  • Redness, scaly or pain in the nipple area or the breast 
  • Unusual nipple discharge, including blood
  • Skin changes including thickening or swelling of the breast 

Knowing your breasts is crucial to help you detect any early signs of breast cancer. Women of all ages are recommended to perform a breast self-examination at least once a month. 

How to do a breast self-examination

Step 1: Inspect your breasts with arms on your hips: 

  • Check for changes in shape, size and color of the breast;
  • Dimpling or swelling of the skin;
  • Redness, rash or inverted nipples or any signs of unusual fluid coming out of both nipples

Step 2: Raise your arms high overhead and look for the same changes.

Step 3: Feel your breast while lying down:

  • Use your right hand to feel your left breast and your left hand to feel your right breast;
  • Keeping the fingers flat, feel your breast with a firm and smooth touch in a circular motion;
  • Follow a pattern to ensure that you cover the whole breast. You may begin at the nipple, moving in larger circles until you reach the outer edge of the breast;
  • Feel for the deep tissue and any new lumps

Step 4: Finally, feel your breast while standing or sitting up:

  • You can do this in the shower so that your breast is wet and slippery;
  • Repeat the inspection using the same hand movements described in step 3.

2. What is a mammogram?

Doctors commonly use a mammogram (MMG) to look for early signs of breast cancer. A mammogram is a detailed X-ray of the breast, during which a technologist will place your breast on a plastic plate, with another plate firmly pressing your breast from above. You might feel some pressure or slight discomfort. Performing a mammogram is quick and non-invasive. 

Positive findings on a mammogram can be distressing, but it does not necessarily mean that cancer is present. Many find lumps that are non-cancerous, and most positive mammograms require further diagnostic tests to confirm a diagnosis. These can include:

  • Ultrasound
  • Magnetic resonance imaging (MRI) 
  • Breast biopsy

3. Can breast cancer be diagnosed without a biopsy? 

A biopsy is where a sample of cells is taken from your breast and examined under a microscope to see if it’s cancerous. Your doctor would recommend a biopsy should there be any concerns on clinical findings and suspicious findings on your mammogram, ultrasound or MRI. Other diagnostic tests can suggest the presence of cancer, but biopsy is the only sure way for the doctor to know if an area of the body has cancer.

Different methods might be used to obtain tissues depending on what your doctor knows about your conditions. 

  • Fine needle aspiration
    – Your doctor will use a small needle to extract a sample of cells, without removing any tissue.
    – A local anesthetic is not routinely required.
    – This can also be used to drain a small fluid-filled lump (benign cyst).
  • Core needle biopsy
    – This is the most common type of biopsy, in which your doctor will take a sample of tissue from a lump in your breast using a large needle.
    – You may have a local anesthetic, meaning that you will be awake during the procedure, but an area of your breast will be numb.
    – This may be done with guidance (usually ultrasound or X-ray, sometimes even MRI), to obtain a more precise sample for the diagnosis of cancer.
  • Vacuum assisted biopsy
    – If a previous biopsy fails to provide definite results, or if the area of concern is difficult to target, a vacuum assisted biopsy might be needed.
    – After a local anesthetic, a small cut is made in the skin. A probe connected to a vacuum device will be placed through the cut to obtain a tissue sample using mammograms or ultrasounds as a guide.
  • Excisional biopsy
    – The surgeon will make an incision in the skin and remove the entire breast mass concerned for examination.
    – More commonly used in tissues suspected to be cancerous. 

4. What treatment options are available for breast cancer?

After a diagnosis, your doctor may develop a treatment plan to remove the cancer, to lower the odds for it to come back and to reduce the chance of the cancerous cell spreading to other organs (i.e. metastasis). 

Your treatment depends on the size and location, the type of cancer cells and the stage of the disease. Your doctor would consider your age, general health and your opinion to make a joint decision.

Available treatment options include:

  • Surgery
    • Lumpectomy – removal of the lump within the breast
    • Mastectomy – removal of the entire breast
  • Systemic treatments:
    • Chemotherapy – use of anti-cancer drugs most commonly being injected to the body through a vessel
    • Hormone therapy – target cancer cells through interfering with normal female hormones
    • Targeted therapy attack specific growth signals that tell the cells to grow and spread, and block the abnormal growth of cells that causes the cancer
    • Radiation therapy – use of ionizing radiation to damage cancer cell at DNA level and thence stop cells from reproducing

Visit Icon Cancer treatments page for more detailed information about the range of treatments.

5. Do I need another treatment after my surgery? 

Depending on your cancer, your doctor may recommend other cancer treatments as mentioned to be used as adjuvant after the surgery, in order to lower the risk of recurrence; to reduce the chance of the cancerous cell moving to other organs and hence increasing the chance of cure.

6. What are the risk factors of breast cancer and how to prevent it? 

Breast cancer risk is often related to factors that you have no control of, like your age, race and genes, as well as some factors you can change by choosing a healthy lifestyle. 

The School of Public Health of the University of Hong Kong conducted the Hong Kong Breast Cancer Study and developed an Online Breast Cancer Risk Assessment Tool that is validated for Hong Kong Chinese female population aged 44-69.

Click here to start the online assessment after reading the preamble and disclaimer.

Minimize Modifiable risk factors (life habits you can control)

  • Limit alcohol use 
  • Maintain a healthy body weight 
  • Exercise regularly
  • Avoid smoking
  • Manage and reduce stress 
  • Breastfeed can lower breast cancer risks 
  • Minimize hormone intake (oral contraceptives, birth control implants, intrauterine devices (IUDs), birth control skin patches, vaginal rings, combined hormone therapy post menopause) 
  • Have a balanced diet
    • Reduce consumption of dairy products and saturated animal fat (such as red meat)
    • Eat 5 or more portions of vegetables and fruits every day 
    • Introduce cruciferous vegetables (broccoli, cauliflower and kale), which can lower estrogen level and reduce risk of breast cancer 

Non-modifiable risk factors (factors you can’t control)

  • Advancing age 
  • Family history 
  • Genes 
  • Reproductive history 
  • Early menstruation (first period before 12 years old)
  • Late menopause (after 55 years old)

Age-appropriate screening is crucial to detect breast cancer early. The Hong Kong Breast Cancer Foundation recommended women aged 40+ to have regular mammography at least once every 2 years. 

Mammography screening can be accessed in both public and private hospitals in Hong Kong. There are also dedicated government-authorized non-profit organizations in Hong Kong that provide breast health assessments, such as Hong Kong Breast Cancer Foundation (HKBCF), Hospital Authority and Family Health Service.

7. Is breast cancer mainly caused by genetic factors or family history? 

Breast cancer is often the result of a combination of factors, including but not limited to genes and family history. 

About 5-10% of breast cancer cases are found to be hereditary, meaning they happen as a direct result of genetic changes (mutation) being passed on from a parent. 

BRCA1 and BRCA2 genes are the most common cause of hereditary breast cancer. Women with one of these mutations have a higher chance to develop breast cancer in their lifetime, besides having a higher risk of ovarian and some other cancers.

8. Is breast cancer curable? 

Breast cancer is curable. 

Almost 80% of local breast cancer cases were incidental findings detected by the patients themselves. For stage I breast cancer, treatment can be highly effective and the 5-year survival rate could reach over 90%

Screening is key to early detection of breast cancer. Take good care of yourself and do a regular self-examination from now on (if you haven’t started doing so)! If you have any further questions around breast cancer or cancer in general, please contact Icon Cancer Centre who will happily answer any questions that you might have.

Reference:

  1. What Are the Symptoms of Breast Cancer? | CDC [Internet]. Available from: https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm
  2. Breast Self-Exam – National Breast Cancer Foundation [Internet]. Available from: https://www.nationalbreastcancer.org/breast-self-exam
  3. Screening Tests and Early Detection [Internet]. Avaliable from: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/breast-biopsy.html
  4. Breast Cancer Treatment [Internet]. Avaliable from: https://iconcancercentre.hk/en/treatment/breast-cancer/
  5. Breast Cancer | Hong Kong Breast Cancer Foundation – Surgical Treatment [Internet]. Available from: https://www.hkbcf.org/en/breast_cancer/main/93/
  6. Cancer Online Resource Hub – Breast Cancer Risk Assessment Tool [Internet]. Available from: https://www.cancer.gov.hk/en/bctool/index.html
  7. HKBCR Bulletin [PDF]. Available from: https://www.hkbcf.org/zh/our_research/main/424/upload/category/424/self/5ba4bc8c09c2f.pdf
  8. Kwong A, Shin VY, Au CH, et al. Detection of germline mutation in hereditary breast and/or ovarian cancers by next-generation sequencing on a four-gene panel. J Mol Diagn 2016;18:580-94
  9. Breast Cancer | Hong Kong Breast Cancer Foundation – Early Detection Saves Lives [Internet]. Available from: https://www.hkbcf.org/en/breast_cancer/main/16/

This article is brought to you in partnership with Icon Cancer Centre. It is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.