YH Loh does an electronic interview with Dr Evelyn Ho, Breast Cancer/Health Awareness Programme Coordinator for the College of Radiology. YH asks questions to help her with an assignment on Breast Cancer Awareness. 18 Oct 2002 The questions and answers are given as follows: Q 1. Who are normally affected by breast cancer? A 1. http://www.radiologymalaysia.org/breasthealth/About/index.htm Both males and females can get breast cancer, although it is far more common in women. In males, the incidence is estimated to be about 1% but in the USA, they already see an increase in this incidence. The older you get, the higher the risk of breast cancer. As to who can get "affected" by breast cancer, anyone can. Almost everyone, your colleague, friend, relative, subordinates etc would have heard of at least someone who has had breast cancer. The closer you are to that person with breast cancer, the more there is psychological impact on you. Q 2. How much at risk are Malaysian women in getting breast cancer? A 2: http://www.radiologymalaysia.org/breasthealth/About/serious.htm When you read this article, you will realise that Malaysia has a paucity of statistics for many reasons. The absence of a National Cancer Registry and the high percentage of deaths that are not medically certified. This means, we do not know the exact number of new cases of breast cancers or relapses throughout the country and in those who die, only 30% are medically certified and the cause of death is known. The estimated risk by International bodies is about 35 per 100,000. Please read to see how this overall risk ranks in the world but keep in mind, the lack of accurate statistics. However, hopefully this will be addressed, as the National Cancer Registry has been revived. Q 3. What are the available treatments (western/ traditional) that are being used to treat breast cancer patients? A 3: http://www.radiologymalaysia.org/breasthealth/Treatment/index.htm This is a very big topic and the article above deals with it briefly and gives you an overview of what is generally done. It is important that the proven treatment be used because that gives the best chance of cure. Any other treatment that is unproven (meaning, you only have the examples of someone testifying to the herb, drug or treatment curing you, without any proof that in the first place, you HAD breast cancer, and then, not knowing if you are really cured off it at all) is dangerous, because if you really are suffering from breast cancer, then, delaying the treatment would mean coming to the doctor at a much later stage of the disease when your chances of cure has diminished considerably. In the cases of claims of healing from dubious treatments, there is no confirmation that the breast lump is a cancer. Remember 90% of any breast lump that is detected by the woman herself are not cancerous and some may spontaneously resolve as it depends on the hormonal changes. Complementary treatment is different. It means the methods used to help you cope better with your chemotherapy or healing from surgery etc. Such cases would be aromatherapy, massage, meditation - anything that will make you feell better and cope better with your treatment. Being able to talk to others who have gone through the same treatment tends to give the patient hope and comfort as well. Q 4: Are Malaysian women aware of this silent killer, especially young Malaysian women? A 4: My comments are anecdotal and comes from seeing the many women who come for breast imaging, finally, after being referred to by their doctors or also from our Breast Health Talkback Q & A section. If you read the Q & A, one even felt foolish about seeing the doctor again, in case what she thought was something in the breasts turns out to be nothing! Basically these are the groups of women/men: 1. Those who know they need to see a doctor when they discover something may be "wrong" with their breasts, even if they are not sure if there is anything at all is wrong 2. Those who ARE NOT breast aware and don't even notice changes until they are very LATE. Then, they hope the lesion will go away or try traditional treatments and finally when they arrive at the doctor, it is very late stage cancer. Fortunately not all large breast lumps that women discover are cancers but to help those with breast cancer lead a normal life and a normal life span, then, these must be picked up early. 3. Those who are preoccupied with their breasts and are overly anxious. This is not healthy and normally arises from absence or inadequate breast care counselling and on how to perform self breast examination properly. 4. Those who basically have a "don't know, don't care" attititude. Probably there are other subgroups but you will find the 2, 3, 4 are more common than group 1. Younger women? I have come across students who are so breast aware, they discover their own breast lumps at the age of 17 years. Then, there will be the group that thinks, they are too young to have breast cancer. Well no age is too young although breast cancers in women less than 30 years are very low, about 2% or thereabouts. Still, they should be aware of their breasts and not be afraid to tell their parents ( at least the mother). Q 5. What are the ways to prevent from getting breast cancer than to cure it? A 5: http://www.radiologymalaysia.org/breasthealth/About/bcriskfactors01.htm http://www.radiologymalaysia.org/breasthealth/About/bcriskfactors02.htm http://www.radiologymalaysia.org/breasthealth/About/diet1.htm http://www.radiologymalaysia.org/breasthealth/About/diet2.htm Basically the best way is not to be a female! Immediately your risks drop. However, the statement I have just said seems "silly"...surely we can't choose our sex? That is basically what I am trying to illustrate... many of the risk factors of breast cancer cannot be controlled. However, when we choose to live a healthy lifestyle - adequate exercise, eat a balanced diet that is not too high in fats, avoid alcohol and definitely no smoking, we will also reduce our risks generally for many diseases. The problem is, there is no one cause that has been 100% identified to be directly causing breast cancer. All we have are facts on risk factors. Please read the topic on Understanding risk factors to get a clearer picture on what this means. Bottomline: Since we cannot identify any one factor as the direct cause of breast cancer, the main thrust of prevention is EARLY DETECTION. Q 6: How does one get breast cancer? Hereditary or lifestyle? A 6: Answers are as in Q 5. The hereditary/Lifestyle question is properly addressed in the Risk Factors 01 and other articles in About Breast Cancer. Q 7: Is technology one of the factors which cause the increasing number of breast cancer patients?- With all the radiation and free radicals that comes with technology. A 7: This question is most debatable. No one really knows yet but obviously environmental factors have a role to play. But most important, many times, the incidence increases because of increased awareness. More people are going to see their doctor when there is a breast change. Although the breasts are still a taboo area amongst Asians, at least it is less so now. Even men with breast lumps would be embarrassed to see the doctor and often, by the time, they do, and it turns out to be breast cancer, it is invariably advanced stage. So increased diagnosis will result in an increase in the incidence. The other factor would be a true increase in the incidence. Dr Yip Cheng Har's study in University Hospital shows that from 1993 to 2000 (again these graphs and statistics are in the article on Breast Cancer - a Serious Problem), although the number of breast cancer patients more than doubled, the proportion seeing the doctors in the late stages DID NOT CHANGE. This was attributed to IGNORANCE and FEAR of seeking treatment, and some preferring to seek traditional treatment until that proved a failure. Q 8. What is the total number of breast cancer patients in Malaysia? (Both male and female) A 8: The International Agency for Cancer Research estimated this to be about 3800 in 2000 but this was just the new cases or reported cases. The exact total of new and treated breast cancer patients is not known. Q 9: How come breast cancer attacks mainly women while only 1% of men will get it? A 9: Because of the intrinsic differences between men and women. The breasts are normally just rudimentary in men, compared to women. Men are not exposed to the regular hormonal cycles of women, and specifically, the much higher levels of estrogen that women have. Q 10: Do you think that the media is playing its role rightly in creating breast cancer awareness among Malaysians? A 10: Yes, since I have been involved in raising breast cancer awareness, the media has rallied to help us elevate the level of awareness. However, we understand the media's position in how to present "new angles" to the story. Unfortunately, I can foresee that the public needs repetitive information because it takes more than one reading to actually suddenly absorb that "hey...this could be me"...and that I need to take charge of my breast health. The print media especially newspapers has been one of the most effective means, compared to TV or radio or tabloids/magazines. Still, the attitude in general would be..."nah, this couldn't happen to me"...just to others... Q 11. After going through operations to remove the cancerous cells, is it safe to say that the woman is 100% free from cancer? Will cancerous cells form in other parts of the body? A 11: Well, it is difficult to be 100% sure. There is no 100% in medicine. Cure in the clinical oncology understanding is living beyond 5 years (Cure) but if you live beyond 5 years, your chances of living even longer continue. Remember, even if we could find out that we 'killed" every single breast cancer cell in the body, a person with breast cancer once, has a higher risk of getting breast cancer again, for example in the same breast or in the other breast. Therefore, one has to stay proactive in looking after your breast health throughout your life. The breast cancer cells that have spread to other parts of the body usually do so through the lymphatic or blood stream. For that reason, once you have lymph nodes armpits involved, the higher the chance that cell or two may have escaped into your whole body. That's where chemotherapy comes in. If you are discovered in Stage 1 of breast cancer, your chances of "cure" is as high as 90% compared to Stage 4 where it is 10%. Q12. I read in articles saying that late detection is the main reason why so many women with breast cancer died. What are the ways, would you suggest, to encourage women to perform regular self examination and go for check-ups? A 12: Yes, the only way to prevent breast cancer is through early detection. This is called secondary prevention. This is well discussed in the articles on who’s in charge of your breast health on the website. These principles are for the healthy person without evidence/signs or symptoms of breast problems. Always approach this exercise in a positive manner. You want to stay healthy. Scare tactics may be counterproductive. 1. If you are young, just be breast aware. How? Perform SBE but learn the correct technique. Again this is available on the website in detail. 2. When you are 25-39 or thereabouts, see your health professional every 3 years for a physical examination of the breasts. If the lady gets regular pap smears, that's the time to get the clinical breast examination. 3. When you are 40, consider the mammogram. This is the only technique that can find breast cancer before you can feel it. Even if it is only 80-90% able to pick up breast cancer, this is considered very good and currently is the GOLD standard for early detection. However, if you are ANY age, any gender and find something may be wrong with your breasts, PLEASE See your doctor immediately. Get it checked out and be ready for investigations such as the mammogram - especially if we suspect that "lesion" in your breast could be cancer. At the end of the day, YOU are in charge of your breast health. You are responsible for your own health. Make the right decisions but based on proven facts - not on anecdotes, old wife’s tales or even hearsay. | 
