Worldwide, it affects millions of women: It killed 385,000 women globally in 1997 and one in nine American women will have it by the age of 85. But there is some good news on breast cancer: with an increasing awareness of the disease, and more sophisticated technology, the early detection and treatment of breast cancer is becoming easier and is improving women’s chances of survival.
In Thailand, the statistics on the number of women diagnosed are difficult to pin down. For Bangkok, it’s estimated that just over 20 women in every 100,000 will be diagnosed with breast cancer – a rate higher than the rest of the country, but similar to rates in developed countries.
Dr Narongsak Kiatikajornthada, an oncologist at Samitivej Hospital, says that people are more aware of breast cancer than ever before. "And the incidence of breast cancer is now higher partly because we can detect it more easily. [At Samitivej] we see more breast cancer than cervical – but if you look at the national figures, cancer of the cervix is number one."
This, he says, is probably because the hospital’s patients tend to come from a higher socio-economic group among whom there’s a higher awareness – and fear – of the disease. There’s also a possible link between the diet of this group compared to others.
"There are now facilities all over the country, and we have the technology to detect breast cancer in its early stages. The problem is getting people to go and be examined," says Dr Sankiat Vayakornvichit, a gynaecologist at the same hospital.
Regular breast examinations and mammograms (breast x-rays) have a vital role to play in the early detection of breast cancer, when treatment has a much higher rate of success. At Samitivej, doctors recommend that women start to regularly self-examine with the onset of puberty, but they note that there are some cultural barriers to overcome for Thai women to do this. "The culture of Thai women means they are usually not keen on doing breast examinations," says Dr Pornthep Pramyothin, a surgeon on the Samitivej team.
But self-examinations alone are not enough – they are a necessary complement to regular mammograms. "If you can feel a lump in your breast, there’s a fifty per cent chance that it may spread through your system," says Dr Pornthep. Mammograms, on the other hand, can detect lumps that you can’t yet feel yourself.
"Guidelines for when to start screening for breast cancer vary between different national cancer bodies around the world, and between hospitals," says Connie Larkin, founder and co-ordinator of the Bangkok Breast Cancer Support Group. "We tend to promote the American Cancer Society’s guidelines because they are the most conservative."
These guidelines recommend that self-examinations should be done monthly from the age of 20, a clinical breast exam should be done every three years for women aged 20 to 39, and women aged over 40 should have a mammogram and a clinical exam every year.
When a lump is found a biopsy is required to find out whether it is cancerous. If cancer is detected, the course and combination of treatments followed will depend on the individual woman’s risk factors, her genetic disposition and the characteristics of the cancer."There is some choice," says Dr Pornthep. "The main objective is to control the disease. We need to consider the pros and cons of different treatments, explain the options to the patient and make a recommendation."
Dr Sankiat strongly encourages women to see their gynaecologist annually. "Please have a physical exam once a year – not just for a pap smear, but for a breast exam. It’s an integral part of a woman’s check up. And see a gynaecologist directly – we have more expertise in this area, it’s what we do. We want to see patients before they have a lump, rather than at a late stage, because with early detection, patients have a better prognosis."
The median age for women with breast cancer is 50 years old – that is, in a group of 100 women with breast cancer, around half will be aged close to 50. "If you are young and you find a lump, it’s probably fibrocystic disease, which is benign," adds Dr Narongsak. "I’ve seen many young women who have not been able to sleep because they have found a lump. They need to know that they are not in a high risk group, but they should still seek medical advice."