Alumni Article – Breast Cancer Awareness Month Edition

Breast Cancer

by dr. Meilania Saraswati Sardjana, Sp. PA (K), MPd.Ked.

dr. Meilania Saraswati Sardjana, Sp. PA (K), MPd.Ked

Educational Background:

  • 2018—Consultant of Pathologists majoring in Renal Pathology and Uropathology
  • August 2013-present: studying in Magister of Medical Education, Faculty of Medicine Universitas Indonesia
  • August 2012—Pathologist (Anatomical Pathology), Faculty of Medicine Universitas Indonesia, Jakarta
  • 2005—Medical Doctor, Faculty of Medicine Universitas Indonesia, Jakarta
    • Graduated as Bachelor of Medicine in 2003
    • Finished Internship on 21 November 2005. The internship was conducted in Cipto Mangunkusumo Central Hospital, Persahabatan Hospital, and Tangerang Hospital.

Working Experience:

  • 2018—Pathologist at Universitas Indonesia Hospital
  • 2016-present—Pathologist at Pondok Indah Hospital
  • 2013-present—Pathologist at Cipto Mangunkusumo Hospital
  • 2013-2016—Pathologist at Pasar Rebo Regional General Hospital

CIMSliography:

  • 2004 – 2005—Member of Supervising Council of CIMSA
  • 2002 – 2003—Vice President for External Affairs of CIMSA
  • 2001 – 2002—National Exchange Officer of SCOPE CIMSA
  • 1999 – 2001—Staff of National Exchange Committee, Standing Committee on Professional Exchange in Indonesia (SCOPE)

 

 

Breast cancer is the common term for malignancy that occur in the breast and also the most frequent cancer occurring in women, with about 1.3 million new cases each year worldwide.  Most of breast cancer originated from the epithelia that lines the duct of mammary glands.  These cells proliferates uncontrollably and have the ability to invade its surroundings.  Hence, the most frequent type of breast cancer was coined as invasive ductal carcinoma, now only referred to as invasive carcinoma, no special type.  There are also other type of carcinoma differentiated by their morphologic appearance under the microscope.  The exact etiology of this type of cancer cannot be determined for certain, but it is known to have association with certain genetic mutation (BRCA1 and BRCA2), hormonal stimulation and environmental factor, such as pollution and smoking.  Women with genetic mutation may develop cancer at a younger age, and it is usually more resistant to chemotherapy.  This mutation may be inherited to the offspring.  Therefore, family history of breast or ovarian cancer in first degree relative should alarm the possibility of inherited gene mutation.

In early cancer, the symptoms may not be obvious, even the lumps can be unseen, however, it is important to find these cancer at the earliest stage possible because the treatment will be much effective and cost efficient.  The easiest way of early detection effort is breast self examination that can be done by all women each month. Several sign or symptoms should alarm women to seek further diagnostic process such as lump in the breast or axilla or skin thickening that lasts through menstruation, redness, or nipple discharge.  Once a year, women above the age of 40 should have mammogram as method of screening.  However, women with higher risk, i.e. those who have first degree relatives with breast cancer, should have yearly mammogram after they turn 30.

When a lump is detected in the breast, it is not necessarily to be cancer.  It may be benign entities such as fibroadenoma or tubular adenoma or even inflammation.  There are several ways to diagnose breast lump.  Firstly, there are several clues that favor malignancy in the mammography, for example sign of calcification, or mass.  Ultrasonography usually complement mammography and pinpointing to direction of diagnosis.  If radiological findings are suspicious, then the next step is usually fine needle aspiration biopsy.  This type of biopsy is less invasive and requires little preparation.  The procedure enables sampling of the cells within the lump to be examined.  Such examination, termed cytopathology examination, will be able to predict whether the lump is benign or malignant.

In order to know the type of cancer, a bigger biopsy of the mass is needed for histopathological examination.  With this type of biopsy, we can examine the cells and its relations to the cells surrounding, for example, to identify invasion, so the diagnosis of cancer can be established.  The basic concept of therapy for breast cancer is to remove the cancer as much as possible, including any possibility of spreading and kill the possible remaining cancer with chemotherapy.  If the biopsy is proven as cancer, or carcinoma, then it will requires further examination using a technique called immunohistochemistry.  This technique enable us to detect proteins expressed by the cancer, some of which are also marker for drugs—or, targeted therapy.  These proteins are estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2).  The presence of these protein will be a target to anti ER/PR and anti-HER2 drug, therefore, the detection of those protein will definitely aid the precise chemotherapy for each patient with breast cancer.  Cytopathology, histopathology, and immunohistochemistry are part of anatomical pathology examinations.  Anti-ER/PR and anti-HER2 drug have improved the survival rate of patients with breast cancer for decades. Unfortunately there is a subset of cancer that do not express ER, PR not HER-2 that is referred as triple negative breast cancer.  Some of these cancer may have BRCA mutation.

As now established that cancer is a product of an accumulation of genetic mutation, then it is important to avoid causes of genetic mutation and acquire materials that help correcting or preventing genetic mutation.  Causes of genetic mutation may include numerous carcinogenic product that can be found in the environment and in food.  And the ones that thought to have effect to counter the effect of carcinogenic product are anti-oxidants. Anti-oxidants may be acquired externally or produced by the body.  There are ways to increase the level of anti-oxidants in the body, for example doing regular exercise.

Breast cancer used to be fatal disease, but nowadays, new therapy brings new hope for most subsets of cancer. Detecting the cancer in earlier stage will enable eradication of more cancer cells hence allowing better control of disease and better prognosis.  Therefore, screening is a must for all women, especially those with high risk trait. Cancer diagnostic is an important part of the management because precise diagnosis will be followed by precise therapy.  Without proper diagnostic process, the patient will not be managed optimally.

 

References:

  1. Tao Z, Shi A, Lu C, Song T, Zhang Z, Zhao J. Breast cancer: epidemiology and etiology. Cell Biochem Biophys. 2015;72:333-8.
  2. https://www.cancercare.org/publications/82-early_detection_and_breast_cancer