BREAST CANCER AND US

WELCOME OCTOBER! 

October is a Breast Cancer Awareness Month! It is a worldwide annual campaign, involving thousands of organisations including SCORA CIMSA, to highlight the importance of breast awareness, education, and research. 

Why is Breast Cancer Awareness Month important?

Breast cancer awareness is important because there is a need to explain the importance of detecting an abnormalities in your breast as early as possible and increasing the chances of successfully managing and treating the disease. So now let’s talk about breast cancer.

What is Breast Cancer?

Breast cancer is a cancer that forms in the tissues of the breast – usually in the ducts (tubes that carry milk to the nipple) or lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

How Common is Breast Cancer?

Breast cancer is a leading cause of cancer-related deaths in women, with almost 1.7 million cases diagnosed per year and more than half a million deaths every year (Ferlay et al. 2013). In developed countries, 1 in every 8 women will develop breast cancer in their lifetime.

What Causes Breast Cancer?

The precise cause of breast cancer is unknown, but several risk factors for developing the disease have been identified. It is important to remember that having a risk factor increases the risk of cancer developing but it does not mean that you will definitely get cancer. Likewise, not having a risk factor does not mean that you definitely won’t get cancer. Most important risk factors are :

  • Female gender 
  • Exposure to ionising radiation
  • Increasing age 
  • Having fewer children
  • Genetic predisposition (family history or mutations in certain genes)
  • History of atypical hyperplasia
  • Obesity 
  • Exposure to estrogens
  • Alcohol

What is Breast Cancer Screening?

  • Mammography is a low-dose x-ray procedure that allows visualization of the internal structure of the breast.
  • Magnetic resonance imaging (MRI)
  • Breast ultrasound is sometimes used to evaluate abnormal findings from a mammogram or physical exam. 
  • Clinical breast examination (CBE)
  • Breast self-awareness, experts have concluded that self-awareness seems to be at least as effective for detecting breast cancer as structured BSE.

How should I Check My Breast?

There’s no right or wrong way to check your breasts. But it is important to know how your breasts usually look and feel. 

  • A change in size or shape
  • A lump or area that feels thicker than the rest of the breast
  • A change in skin texture such as puckering or dimpling (like the skin of an orange (Peau D’Orange))
  • Redness or a rash on the skin and/or around the nipple
  • Your nipple has become pulled in or looks different, for example a change in its position or shape
  • Liquidthat comes from the nipple without squeezing
  • Painin your breast or your armpit that’s there all or almost all of the time
  • Aswellingin your armpit or around your collarbone

What is the Breast Cancer Survival Rate? 

Relative survival rates are an estimate of the percentage of patients who will survive for a given period of time after a cancer diagnosis, accounting for normal life expectancy. Survival among cancer patients is compared to survival among people of the same age and race who have not been diagnosed with cancer. Based on the most recent data, relative survival rates for women diagnosed with breast cancer are: 

  • 91% at 5 years after diagnosis 
  • 86% after 10 years 
  • 80% after 15 years

Relative survival rates should be interpreted with caution. First, they are based on the average experience of all women and do not predict individual prognosis because many patient and tumor characteristics that influence breast cancer survival are not taken into account. Second, long-term survival rates are based on the experience of women diagnosed and treated many years ago and do not reflect the most recent improvements in early detection and treatment.

Be breast aware.

Sources :

  1. Breast Cancer Awareness Month. https://www.wearitpink.org/about/breast-cancer-awareness-month. Access on October 5th, 2019.
  2. European Society For Medical Oncology. 2018. Breast Cancer Guide for Patients. Switzerland : ESMO.
  3. American Cancer Society. 2018. Breast Cancer Facts & Figures 2017-2018. cancer.org.
  4. Kumar V, Abbas A, Robbins SL. 2018. Buku Ajar Patologi Robbins. Edisi ke 9. Singapore : ELSEVIER.

Di Indonesia, kanker serviks menjadi penyakit kanker pada wanita dengan jumlah penderita terbesar setelah kanker payudara. Pada tahun 2018, diperkirakan 570.000 wanita didiagnosis menderita kanker serviks di seluruh dunia dan sekitar 311.000 wanita meninggal karena penyakit tersebut. Berdasarkan data Kemkes tahun 2019, di Indonesia kanker serviks didapatkan pada 23,4 per 100.000 penduduk, dengan rata-rata kematian 13,9 per 100.000 penduduk. Kanker serviks adalah kanker yang ditemukan di mulut rahim, yaitu bagian antara vagina dan rahim. Hampir semua kasus kanker serviks (99%) terkait dengan infeksi human papillomavirus (HPV) risiko tinggi, virus yang sangat umum ditularkan melalui kontak seksual. Saat terpapar HPV, sistem kekebalan tubuh biasanya mencegah virus melakukan kerusakan. Namun, pada sebagian kecil orang, virus bertahan selama bertahun-tahun, berkontribusi pada proses yang menyebabkan beberapa sel serviks menjadi sel kanker.  

Penyakit ini bisa dicegah dengan melakukan tes skrining yaitu dengan pemeriksaan serviks, yang bertujuan untuk menemukan dan mengobati perubahan pada sel sebelum berubah menjadi kanker. Kanker serviks biasanya tumbuh sangat lambat, sehingga bila dilakukan skrining yang teratur penyakit ini bisa dicegah. Diawali dengan perubahan serviks normal menjadi lesi prakanker, Lesi prakanker pada serviks adalah perubahan pada sel serviks yang membuatnya lebih mungkin berkembang menjadi kanker.

 Pendekatan pencegahan primer (dengan vaksinasi HPV) dan pencegahan sekunder yang efektif (penyaringan/tes skrining dan pengobatan lesi prakanker) adalah bagian dari upada pencegahan kanker serviks. Di Indonesia, prevalensi dan determinan dari lesi prakanker serviks di kalangan wanita membantu untuk mengambil tindakan seperti program vaksinasi pada anak usia 12-13 tahun, meningkatkan cakupan skrining bagi semua wanita antara usia 25 dan 65 tahun, dan manajemen yang ketat dan tindak lanjut yang dapat menurunkan morbiditas dan mortalitas yang disebabkan oleh kanker serviksIni membantu melindungi terhadap semua kanker yang disebabkan oleh HPV, serta kutil kelamin. Skrining serviks secara teratur adalah perlindungan terbaik terhadap kanker serviks. Wanita berusia 25-65 tahun dan memiliki serviks serta pernah aktif secara seksual memerlukan tes skrining serviks. Skrining kanker serviks dengan tes HPV saja atau tes HPV sekaligus Pap smear dapat dilakukan setiap 5 tahun sekali, atau tes Pap smear (sitologi) setiap 3 tahun sekali. Pada usia di atas 65 tahun dengan hasil skrining sebelumnya normal tidak perlu lagi melakukan tes skrining.

Referensi:

– The American College of Obstetrician ang Gynecologist Update Cervical Cancer Screening Guideline 2021
– WHO Guideline for screening and treatment of cervical pre cancer lesions for cervical cancer prevention 2021

Artikel dibuat oleh: dr. Hartatiek Nila Karmila, Sp.OG

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