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BREAST SCREENING
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October14
3 Mount Elizabeth, #11-09 Mount Elizabeth Medical Centre
6836 5167 | georgettechan.com.sg
SURGICAL TREATMENTS FOR BREAST CANCER
According to Dr Chan, most patients begin their
treatment with surgery. “The goal is to remove
the cancer and check the lymph node status
in the axilla, or armpit,” she says. “The tumour
profile needs to be studied to individualise other
therapies that may be required following surgery.
The type of surgery really depends on the size
and the position of the tumour.”
For small tumours, a wide excision of the tumour
– known as
breast-conserving surgery
– can be done,
followed by several weeks of radiation treatment. “The advantage here is that
the majority of the normal remaining breast can be preserved,” says Dr Chan.
For larger tumours, on the other hand, or those involving the nipple,
conserving the breast may not always be possible. In this case, a
mastectomy
(breast removal) may be a safer bet. “Usually, patients who have undergone a
mastectomy do not require further radiation therapy,” she says.
RECONSTRUCTIVE SURGERY
For patients who need a mastectomy, Dr Chan says she usually offers
breast reconstruction surgery, which aims to rebuild the breast mound. In
fact, she says, 80 to 90 percent of her mastectomy patients opt for breast
reconstruction, which can be done either at the time of the mastectomy or
a few months after chemotherapy or radiation therapy has been completed.
“Reconstruction not only physically rebuilds the breast mound – making
it easier for the patient to wear her clothes and even a swimsuit – but it
also rebuilds her self-confidence and does wonders for her self-image,”
says Dr Chan.
False positives
Some medical experts and patients
feel that, when taking into account the
frequency of false positives – when
mammogram findings that look like
cancer turn out to be benign – and
the potential for causing unnecessary
distress, the risks of mammography
offset the benefits. This is because
many women who receive false positive
results become upset and fearful about
the possibility of having breast cancer,
and must return for anxiety-inducing
follow-ups and testing.
On the other hand, this may be
outweighed by the possibility of detecting
cancer in its early stages. According
to Cancer Research UK, many women
understand that mammography is likely
to pick up cancers at an early stage
when treatments work best, and they find
having regular screenings reassuring.
In addition, many experts note that,
while mammography may not be
perfect, MRI is not a perfect tool either.
According to Dr Chan, MRI scans
create more false positive results than
mammograms do, because the scans
are more detailed. “There is a lot of
overlap between normal and abnormal
tissue,” she says. “Even the timing of the
scan in relation to the menstrual cycle
can make a difference because of the
hormonal influence. More false-positive
results may mean more unnecessary
biopsies and patient anxiety.”
Over-diagnosis
Also central to the debate is the concern
of over-diagnosing early cancers and
unnecessarily treating tumours that
wouldn’t have affected a woman’s health
during her lifetime. Since there’s no way
to tell which cases of cancer will go on to
become invasive breast cancer, causing
illness or death, almost all cancers are
treated, which means some women are
unnecessarily treated, or “over-treated”,
with radiation and invasive procedures.
Radiation
Like normal x-rays, mammography uses
ionising radiation to create images that
are then analysed for any abnormalities.
According to the US-based Susan
G. Komen cancer organisation,
while the radiation exposure during
mammography can increase the risk of
breast cancer over time, this increase
in risk is very small. Nevertheless, the
concern over exposure to small doses
remains, and it’s up to the individual to
make that choice for herself.
Other considerations
Many women refuse an MRI based
on the claustrophobic sensation, and
the length of time the procedure takes.
According to Dr Chan, MRI scans are
more uncomfortable, as the patient must
lie on her belly for 30 to 45 minutes, as
opposed to a few minutes of discomfort
duringamammogram. Shealsonotes that
MRI requires an intravenous injection of a
dye via IV for better visualisation, making it
more of an invasive procedure. However,
some feel that MRI is less uncomfortable
than mammography – it really depends
on one’s own comfort level.
To each her own
The verdict? It’s still complicated. It’s
true that there is growing evidence
that breast MRI in combination with
mammography, compared with
mammography alone, can increase
detection of breast cancer in certain
women at high risk; and although
there are some risks involved with
mammography, forgoing mammograms
altogether can be risky. In the end,
however, it really comes down to each
individual speaking with her doctor and
weighing the benefits and risks based
on her specific circumstances, including
her genetic risk of cancer and her breast
density, among other factors.
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