Breast cancer is the commonest in the UK and Philippines. Most ( 4/5 ) are over the age of 50. As at least 1/9 women will develop the cancer at some stage in their life, it’s likely we all have experience of it, directly or indirectly ( and it does occasionally affect men ).


There are several different types – either non-invasive or invasive. It’s the ability to invade breast tissues and beyond – either directly or through lymphatics / blood vessels - which determines the outlook.


If there are symptoms, the first to be noticed is usually a lump. Remember that most lumps are NOT cancer, especially in younger women.


There are risk factors – but none of these are certainties and there’s an element of luck. Family history may be the result of chance, or ( in up to 10% ) be due to “ faulty “ genes – such as BRCA1 ( Angelina Jolie has this ) or BRCA2. Others include some benign lumps, dense breast tissue, hormones ( especially oestrogen levels ), obesity, and alcohol. Cosmetic implants may delay diagnosis ( but not cause cancer ).


Apart from breast self examination, diagnosis may be made by clinical breast examination, mammogram, ultrasound, and biopsy ( a “ needle core “ of tissue examined by microscopy ).


We often talk about “ survival “ rates for cancers – not necessarily the same as “ cure “. In the UK survival rates have been improving for three decades and are now over 80% at 5 years, compared to 75% for Filipinos. About 2/3 survive 20 years in the UK, whereas a smaller number even survive 10 years in the Philippines ( overall perhaps only 40% ).


The outlook for breast cancer depends on how early or advanced it is ( stage ) at diagnosis, and also microscopic type. Early diagnosis is vital ! In the UK there is an established breast screening programme for women aged 50-70 years ( 47-73 by 2016 ). The system is not perfect – there is concern about over-diagnosis ( non life-threatening cancers ), and of course its cost ( about £ 100 million / year ). Screening simply isn’t widely available in the Philippines, although awareness has recently improved with at least some treatment benefits payable by PhilHealth. Late diagnosis and cost of effective ( not “ alternative “ ) treatment are major reasons for less good survival.


Genetic testing provides an estimate of risk – not diagnosis of existing – breast cancer. In the UK there are 35 testing centres, and it’s expected that women will be offered testing if, depending on factors such as family history, they are thought to have a 10% probability of carrying faulty ( BRCA1 or 2 ) genes. The centres may become overwhelmed by increasing demand … but such testing is in any case beyond reach of the vast majority in the Philippines.


The option of removal of both breasts ( and possibly also ovaries ) is not the only one. Even with a family history, “ faulty genes “ may not be present and each woman needs medical appraisal and counselling BEFORE testing. There are other, less drastic options. These include more frequent screening ( mammography and MRI or magnetic resonance imaging ). A recent study published in the Lancet suggests that drugs such as “ Tamoxifen “ ( a “ selective oestrogen receptor modulator ) could be helpful in preventing breast cancer in women thought to be at increased risk. A decision is expected this year whether this should be available on the NHS.


ALL patients referred to hospital breast cancer units in the UK are discussed – confidentially – in multidisciplinary team meetings. This provides the best treatment for each individual, including choice of drugs, surgery, and radiotherapy. Risk assessment and “ survival statistics “ are not absolute. Just as there are different types of breast cancer, so also each patient is unique and deserves respect .


http://www.nhs.uk/Conditions/Cancer-...roduction.aspx

http://www.philstar.com/health-and-f...-breast-cancer

http://www.abante.com.ph/issue/oct18...m#.UZOSjrWG1FY

http://opinion.inquirer.net/37470/curing-breast-cancer