BREAST CANCER

You can beat breast cancer, by empowering yourself with information.

By Cathy Babao Guballa

Kara Magsanoc Alikpala is a survivor. Specifically, a breast cancer survivor. In her early thirties, she had the world at her feet.’ One day, during a routine examination, she felt a lump in her breast. After a check­up, it was decided that she would undergo a biopsy, which she thought was going to be routine. “My doctor really did not think there was going to be a problem.” An hour after surgery, it was found out that she had breast cancer. Months later, she and her family went to the U.S. for further tests and treatment. A journalist by profession, Kara learned to become an active participant in her war against breast cancer. It has been a most interesting journey for this young woman who has now been cured of a disease that was once commonly thought of as a “death sentence” .After being declared free from the disease, Kara married her long-time boy- friend and, last year, wrote a book “I Can Serve”, a source book of people, places, and services for the Philippine breast cancer community. Today, through her doctor’s help and by God’s grace, she is living what she calls a second lease on life and expecting her first child in the summer. In the foreword of her book Kara says, “Every person will have that crisis in his lifetime that would define and change him forever. Mine was cancer. The least I can do is to give back the grace that has been given me. Women need to empower themselves with information. It’s the first line of defense and the best we can do for ourselves and the people we love best’

BREAST BASICS: Breast cancer is the second most common cause of cancer death in the U.S. In Asia, the Philippines has the highest incidence of breast cancer; the disease is one of the leading causes of death among Filipino women. Breast cancer can be stow or fast growing. Cancer cells are microscopic; it may take one to five years before the cancerous area grows large enough to be felt as a mass or tumor.

Seventy to 80 percent of all breast cancer develops in the ducts of the mammary glands. It is best to discover cancer while it’s still growing in the ducts, before the cells have spread outside the duct lining and potentially throughout the body. Although breast cancer may strike close to a hundred thousand women all over Asia each year, this is not the end of the road for these women many times, not even the loss of a breast.

These days, more and more women are opting for lump ectomies and radiation rather than mastectomy. Lumpectomy involves the (erioval of the tissue around the lump only, rather than the whole breast (mastectomy). In’ addition, mammography and monthly breast self exams give women the chance to catch cancer early. According to experts, there can be a 95 percent survival rate if cancer is detected early.

PREPARING FOR AN EXAM: The causes of breast cancer remain unknown. However, what we have learned so far has been enough to contribute to the survival of thousands of women and men (yes, men can and do get breast cancer). The following are symptoms of’ breast cancer:

• A lump or thickening in your breast or under your arm

• Any change in the size or shape of your breast

• Any bloody or unusual discharge from your nipple

• Changes in color or texture of the skin of your breast, such as dimpling, puckering, or-developing a rash

• Swelling, redness, feeling sensation of heat in your breast

• Inverted nipple in a breast where the nipple previously was not inverted

If you notice any of these symptoms, call or see your physician right away. At the doctor’s office you should be able to answer when you noticed the lump, discharge, or change in the appearance of your breast; at what point in your menstrual cycle were the changes visible and whether it has changed since then. How was it found? Was it by accident, by someone else, or during a breast self-exam (BSE)? Are there any other symptoms or incidents that accompanied the lump-pain, itching, or something striking your breast? Were there previous breast symptoms? Be prepared to relate your medical history-all medications taken including hormones and over the counter remedies, your reproductive history, previous cancers, and even conditions that may seem unrelated. A background check of your family history is also included during a doctor’s visit. To better understand breast cancer, you will no doubt have many questions. If you are unfamiliar with something-a new word or medical procedure do not be afraid to ask about it. The following suggestions can assist you in having an informative discussion with your physical or health care provider:

• Think about how you best learn information. Is it from books? People? On-line? Use these sources to get the information you need. As you think of questions, write them down. Keep a notepad at your bedside, in your purse, in the car, etc. Ask your doctor these questions and remember: all questions are good questions.

• Every individual is allowed to have a copy of his/her records. If there are any questions or concerns about any mammogram, pathology, diagnosis, or treatment option, consider a second opinion. It is best to go to a different hospital or clinic for a second opinion. When you make treatment decisions, consider also ongoing clinical trials and ask how these might affect you.

• For emotional support, ask about individual counseling or support groups near you. Although it is often helpful to seek opinions and advice from others, always remember that the decisions you make should be based on your unique medical circumstances, value systems, and beliefs.

TESTS & SECOND OPINIONS

Breast self examinations (BSEs) make you more aware of changes in your breast. It gives you the opportunity to know what’s usual or unusual about the shape, appearance, and feel of your breasts so that you are likely to notice any changes. A BSE only takes a few minutes, just once a month. It is best done five to seven days after the start of your period. If you are postmenopausal, select a particular day like the first or last day of the month.

Regular clinical check-ups by a health care professional skilled in breast examination should be performed at least once a year. Mammograms are an important screening technique and can usually detect breast cancer before any noticeable symptoms occur. However, screening mammograms miss at least 20 percent of all tumors, so you need to be aware of what mammography can and cannot do for you. According to Etta Pisano, M.D., a professor of radiology and chief of breast imaging at the University of North Carolina, about 10 percent of mammograms reveal an abnormality, but many of these turn out to be false positives. Several other new techniques are gaining support such as magnetic resonance imaging (MRI) which is often better than mammography at spotting possible cancers in women with dense breasts, scarring from previous surgery, or breast implants, and may eventually be better at detecting early cancers. Another promising but high- priced technology is digital mammography. Like regular mammography, it x-rays the breast, except that the images are captured electronically and viewed on a computer monitor instead of on film. “Diagnosing breast cancer is like looking for a baseball in a forest,” explains Pisano. “Digital mammography allows us to cut down some of the trees for a better view.” Currently the technique is being tested in clinical trials around the U.S.

Until recently, most women whose mammograms were questionable had no choice but to undergo a surgical biopsy in which the doctor anesthetizes

the patient and removes a piece of tissue from the breast for evaluation. This procedure leaves a noticeable scar. Only a fifth of these biopsies turn up a Diagnosis of cancer meaning the scarring and post­operative pan of the procedure were often unnecessary. As an alternative, the core needle biopsy became widely accepted in the early “90s. The procedure allows physicians, guided by either ultrasound or mammography, to extract a tiny piece of tissue from a woman’s breast using a hollow needle. “Core needle biopsy is a wonderful, minimally invasive technique for making a diagnosis of abnormalities in the breast,” says Laura Lieberman, M.D., an associate attending radiologist at MemorialSloan-KetteringCancerCenter in New York City. “When done correctly, its accuracy is comparable to that of surgical biopsy.” What’s more, the technique leaves little or no scarring and costs less than going under the knife.

Remember, YOU are the owner of your body. You have choices. You have the power to make Ihe decisions that affect your body. Breast cancer patients have often found it helpful to take a friend with them to medical appointments. Because there is so much information to remember, it may be helpful to bring a tape recorder as well.