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Doctor On Call (DOC): Dr Radhika – Facts and Myths of Breast Cancer (Part 2)

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Doctor On Call, or DOC for short, is a brand new series brought to you by Medical Channel Asia. This series aims to bring doctors and specialists from various fields to give you an introduction to common health and medical topics that you and the Asian population are interested in. In our 6th DOC, held on 14 Oct (Thursday), from 8pm to 9pm (GMT+8), we have Dr Radhika Lakshmanan, Consultant Breast & General Surgeon at Radhika Breast and General Surgery, to talk to us about Facts and Myths of Breast Cancer.

For Part 1 of the forum, we have Dr Radhika give us a short presentation on the various facts and myths of breast cancer. In Part 2, Dr Radhika answers some of the questions posted by our audience, both collated from the registration process, and also posted LIVE. Read below to find out the answers to some of these questions that may apply to you or your loved ones as well!

Question and Answer – Pre-collated segment

Q1: Is high intensive training (weights/ cardio) suitable for an advanced stage breast cancer survivor?

Dr Radhika: It depends on the definition of advanced stage breast cancer. It can refer to many conditions and situations (e.g. spread to multiple locations, or spread to one location and under control).

If your condition is under control and still under going treatment (not chemotherapy), and you are still physically fit, there are no reasons why you cannot go for such training. However, if your doctor says you are on a oral medication that can make your bones weaker, then perhaps you are not a suitable candidate.

Q2: How accurate is a biopsy result?

Dr Radhika: Biopsy means we are taking a tissue sample from the lump, a very generic term. It depends on what type of biopsy we are doing. Sometimes we do a cytology – we put in a needle and take the tissue sample. The sensitivity is not very high (about 60%), which can result in a false negative.

If we do a core biopsy (i.e. using a big needle to cut part of the tissues out) – this will have a good portion or representation of the lump, and will hence be more accurate.

If the lump is very small (8mm tumours), then we may have to take the whole lump out to test – also called mammotome biopsy.

Sometimes it may not be conclusive as well. It may come back with the result ‘abnormal cells’ instead of cancer cells. This may be due to a small number of cancer cells at the periphery. The doctor will have to make a call base on the imaging, whether the biopsy is representative or not. Hence, we will need to look at the whole picture.

Q3: Does one’s diet play a part in whether you are more likely to get cancer?

Dr Radhika: BMI of more than 25 – definitely a risk of breast cancer. In general obesity is associated with cancer in general. Obesity leads to excessive production of female hormones, that can stimulate cells growth. Obesity can also induce other medical problems such as diabetes and high cholesterol. These medical conditions also decreases your immune status, which also pose as a risk factor of cancer.

Alcohol is also another risk factor. Women are recommended to take only 2 glasses of red wine a week.

There are some patients who also go on the other extreme end of controlling of the diet. Sometimes I feel it is a stress to the patient, by limiting the food choices so much. Try not to focus too much at this. When we talk about healthy living, it is also very much of a healthy mind. We do not want to live in a stressful environment that can actually also drive cancer development.

Question and Answer – LIVE

Q1: If I am young, how often should I go for breast cancer screening?

Dr Radhika: By young I would refer to below 40 years old. Most screening protocols only cater to people above 40 years old. But ironically about 15-20% of breast cancer do occur in young patients. It also depends on other risk factors: such as family history of breast cancer. If family history is present, we may advice screening at 10 years younger than when your relative got the cancer. For e.g. if your mother has breast cancer at 45 years old, the daughter should do it at 35 years old.

There is no benefit of doing mammogram in younger patients due to:

  • Breasts are usually more dense and hence less benefits of doing mammogram
  • We do not want to expose the patients to excessive radiation

Q2: What activities should be avoided for those patients who had done chemotherapy a year ago?

Dr Radhika: It really depends on current fitness levels. Once the chemotherapy is done, they move on with life, when they do not have any crippling side effects. If your current physical state allows you to exercise, you should continue with the exercises, due to the many benefits. Most importantly, ask your specialists.

Q3: Can men get breast cancer?

Dr Radhika: Yes they can, but it is very rare. Only 1% of breast cancers occur in men. Hence, it is not worthwhile to do screening. But if you are a man, you find abnormalities such as lump in the breast or abnormal discharges from the nipple, get it checked. The treatment is also no difference as compared to women.

Q4: When is the best time to assess the breasts? Before or after a menstrual period?

Dr Radhika: The best time would be after a menstrual period. Most women may get engorged breasts before a menstrual period. Everything may feel more swollen. This is likely due to the hormonal changes. We do not want these factors to obstruct the examination. Hence 7 days after the menstrual flow would be a good day to check and assess the breasts.

Q5: Is it normal to feel pain in the breasts before menstrual periods?

Dr Radhika: It is likely hormonal issues acting up, although not all women will get that. Not likely to be harmful, in general.

Q6: I find a lump in my breast which is kind of hard. Is it a sign of breast cancer?

Dr Radhika: It can be a benign lump, but it may also be cancer. Do not wait, get it checked by the right specialist immediately.

Q7: When I sleep, can I lie on the side where mastectomy was done?

Dr Radhika: If there was no complications such as scarring, it is not a problem to sleep on the side. Of course we are talking about months after the surgery, and not immediately right after the surgery.

Q8: What are the risks for breast cancer for a single lady?

Dr Radhika: Incidence or life time risks in Asia is about 1 in 14 women about 5 years ago, from the age of 40 to 75 years old. This has risen to about 1 in 11 women now. This increase in incidence could have been due to the increase in awareness of the screening of breast cancer, as compared to many years ago.

Another reason could be due to a more sedentary lifestyle. Exercising definitely helps reduce the risks of cancer. Other mitigating factors may include a stressful lifestyle as well.

Q9: I have breast pain for about 2 weeks. Upon ultrasound, the sonologist informed me about breast cysts. Are these causing the pain, and how can it be alleviated?

Dr Radhika: This is a very common presentation in the breast clinic. Naturally you will be distressed about the pain. The pain is usually due to the female hormones acting up, which may or may not be due to menstrual cycle.

Usually very tiny cysts do not cause pain. Pre-menstrual swelling may exacerbate the pain. Removing the cysts is not likely to get rid of the pain, as the underlying cause of the pain is likely due to the hormones.

Q10: Is breast ultrasound necessary apart from a mammogram?

Dr Radhika: It depends on the context. If we are talking about breast screening in general (i.e. general population without any symptoms), then mammogram is adequate.

Once you have a symptom (i.e. lump, pain, nipple discharge), then using a mammogram may not be adequate. We are likely to be dealing with a problem. Mammogram can miss 8 to 10% of cancers. Hence, when you have a problem, do not simply go to the screening centre to get a mammogram. The mammogram may come back normal and lead you to think that there is no problem. You should go and see a specialist who can then further direct you to the right evaluation methods (e.g. MRI, ultrasound).

Basic screening: a mammogram is adequate. If the breast tissues are very dense upon screening (i.e. physical characteristic on mammogram), we cannot see things beyond the opacity. The specialists will then advice an ultrasound.

Q11: Can someone with stage 2 breast cancer undergoing treatment, suddenly advance to breast cancer stage 4?

Dr Radhika: It depends on whether she was fully evaluated before treatment was initiated. Some centres do not do staging scans before treatment was initiated (for some reasons or another). In such cases you may be led to think that the tumour was very small but in actual fact it was already there.

Another reason could be due to issues with the treatment. Otherwise it is a bit unusual.

Q12: Are breast lumps possible to be treated to taking oral pills?

Dr Radhika: No unfortunately not! No oral pills currently available to treat the lumps, and hence you need to see the breast surgeons!

Q13: I have no lumps, but I feel pain underneath the breast which connects to my back. It also feels hot whenever it occurs. What could the reason be?

Dr Radhika: I think generally this occurs in heavily breasted women. The weight of the breast can cause skin problems beneath the breast due to trapping of the moisture. The weight can also cause back pain. It is one of the physical possibility.

If you do not fall within this category, it could be due to stress, or a potential muscle or skin issue.

Q14: I am 56 years old, and had both benign breast lumps removed 20 years ago. 3 years ago, they found calcium deposits in my breasts. How often should I go for check up?

Dr Radhika: It depends on what kind of calcifications are found in the breast. The calcifications found on mammogram are usually benign (80%). We then follow up with the patient on a yearly basis to see the progress or pattern of the calcifications. If we follow up for about 1 to 2 years and found out there are no change and stable, it is probably normal. However it is still dependent on the type of calcifications present.

Also, the advisory on frequency of doing mammogram for a woman above 50 years old is every 2 years. I would suggest you to go for a mammogram screening, since it has already been 3 years! If it is stable, then the specialists will give you a more personal advice.

Q15: Is pain in the bone under the breast a sign of breast cancer?

Dr Radhika: Usually not. If you get tenderness and soreness when you press deep in, this is usually what we call costochondritis (i.e. inflammation of the rib bone). But this should resolve on its own. Generally it takes about a month or 2 to settle down. If it does not, then you need to get it checked.

Q16: If the breast discharges whitish and bloody fluid, what does it mean?

Dr Radhika: Oh, it means you have to get it checked! It is not safe to leave it alone, you need to get it accessed! Please see a breast surgeon and get it accessed, instead of simply going to the screening centre and getting a mammogram.

What’s next in store?

  • Click here to see Dr Radhika’s presentation in Part 1 if you have missed it!
  • If you have missed our previous DOC webinars, visit our Medical Channel Asia’s YouTube page, or you can also read the articles:
    • Doctor On Call (DOC): Dr Sean Leo – Common Sports Injuries Part 1, Part 2
    • Doctor On Call (DOC): Dr Lee Fang Jann – Men’s Health Part 1, Part 2
    • Doctor On Call (DOC): Dr Felix Li – Medical Aesthetics Part 1, Part 2
    • Doctor On Call (DOC): Dr Michael MacDonald – The Silent Killer Part 1, Part 2
    • Doctor On Call (DOC): Dr Jade Kua – DARE to Save a Heart Part 1, Part 2

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