Do you know that October is International Breast Cancer Awareness Month? It’s an annual, international campaign to increase attention and support of breast cancer awareness, early detection, and treatment, as well as palliative care for this disease.
According to the World Health Organisation (WHO), there are approximately 1.38 million new cases of and 458,000 deaths from breast cancer each year. Breast cancer is by far the most common cancer in women worldwide, both in developed and developing countries.
In Indonesia, the number of new cases is the highest: there are 58,256 cases out of a total of 348,809 cancer cases. Moreover, the data from the Ministry of Health of the Republic of Indonesia shows that as of January 31, 2019, the average death rate from this cancer is 17 people per 100,000 population. Lack of awareness about early detection and barriers to health service are the main causes of the high number of deaths.
Many people may lack information about this dangerous disease. Dr. Andy Achmad Suanda, Sp.B (K) Onk., a medical doctor specialising in surgical oncology in Rumah Sakit Umum Daerah (RSUD). Dr. M. Soewandhie Surabaya stated that the main cause of breast cancer remains unknown. “Only 10 percent of the causes of breast cancer are known, that is hereditary or passed down from the parents’ genes. The other 90 percent are sporadic, meaning that the disease occurs suddenly. This can result in the modification of the body’s cells where the cells begin to divide without stopping and spread into surrounding tissues. That is called cancer,” said Dr. Andy Sp.B (K) Onk.
Furthermore, he explained that there are several risk factors for breast cancer, such as women who have not been pregnant and breastfed, as well as women who have early menarche, late menopause, and use birth control for more than five years as breast cancer is also driven by an excess of oestrogen hormones. Although it seems like women are more susceptible to breast cancer, it does not mean that men cannot be affected too. Dr. Andy, Sp.B (K) Onk. says that around five men in 100 are susceptible to this disease as men also have breast tissue, even though smaller than women.
There are several things one can do to try to prevent breast cancer, for instance, manage a healthy lifestyle and environment, such as eating healthy foods, stay hydrated, no smoking, and exercising regularly; know our traits, for instance, see if there are other family members who have suffered from breast cancer, colon cancer, or endometrial cancer; and most importantly, seeking an early detection of breast cancer as the early symptoms may not be apparent.
There are simple steps to follow, according to Dr. Andy, Sp.B (K) Onk. First of all, every 10th to 12th day of your menstrual cycle, when the breasts are considered more tender, look at both breasts in front of a mirror. Examine if there is any difference in shape, nipple discharge other than breast milk, skin swelling or redness, pain, and skin flaking or dimpling. For women above 40 years old, it is suggested to do a breast cancer screening annually through mammography, a process of using low-energy X-rays to examine for any abnormality of the breasts. Moreover, to supplement the screening, breast ultrasound and magnetic resonance imaging (MRI) may be necessary.
Early detection and regular screening for breast cancer can contribute to saving more lives because the earlier it gets diagnosed, the quicker it will be treated. Most fatal cases are caused by late diagnosis of breast cancer, especially as most of the early occurrences of breast cancer do not hurt at all.
Dr. Andy, Sp.B (K) Onk. asserted that the cure for breast cancer is different for each person. Some people may need a mastectomy or the removal of the whole breasts, while some others only need chemotherapy. “Breast cancer is unique because it is the only type of cancer that has multiple sub-types. Therefore, each patient should be treated accordingly with their conditions,” said Dr. Andy, Sp.B (K) Onk.
In terms of surgery, Dr. Andy, Sp.B (K) Onk., emphasises that he is fully aware that most women do not want their breasts to be removed as they are considered a symbol of femininity. Therefore, he also discusses breast-conserving surgery or an operation that aims to remove breast cancer while avoiding a mastectomy. “While also doing the breast-conserving surgery, we usually put some other normal tissues from the back or stomach to reconstruct the breast,” he added. However, women above 60 years old often do not want any breast reconstruction surgery.
After the surgery is done, regular chemotherapy is undertaken to get rid of the remaining cancer cells and prevent them from spreading to other tissues. Palliative care is also needed to improve patients’ quality of life. Not only to help prevent as well as relieve symptoms and side-effects related to breast cancer and treatment, palliative care is also important to increase the patient’s confidence even after having undergone a mastectomy.
By doing palliative care, the oncology team collaborates with the patients’ family members and relatives to help the patient address spiritual and emotional issues, getting support for making decisions about treatments and other care, and accessing grief counselling. Palliative care is very important for the patients of breast cancer to restore their state of mind so that they can recover faster and with less pain.
Although the total cost for curing the disease is very expensive, the Indonesian national insurance company, Badan Penyelenggara Jaminan Sosial (BPJS) covers all of the expenses until the patient is fully recovered. So, it is now very easy and cheap to be aware of your breast health. Start examining yourself and see the oncologist if you feel any difference in your breasts. The earlier you are aware, the quicker you will heal!