Can superfoods really reduce your risk? If you have bigger breasts, should you worry? asks medical experts to debunk DAVELLE LEE common beliefs about the disease.
DR SEE HUI TI, medical oncologist at Parkway Cancer Centre.
DR EVAN WOO, consultant for breast and plastic surgery at KK Women’s and Children’s Hospital.
DR SAVITHA RAMACHANDRAN, associate consultant for plastic and reconstructive surgery, KK Women’s and Children’s Hospital.
FAHMA SUNARJA, senior dietitian at Parkway Cancer Centre.
In Singapore, one in 16 women will develop breast cancer by age 75, according to a study published in the Japanese Journal of Clinical Oncology in 2013. This means that six per cent of women here will get the dreaded disease in their lifetime. What’s worse is the constant stream of information – or misinformation – we get from friends, family and social media regarding what puts us at greater risk of breast cancer. We asked medical professionals to help us separate fact fromfiction.
MYTH1 “IT DOESN’T AFFECT YOU IF IT HAPPENED ON YOUR DAD’S SIDE.”
It’s wrong to think you only need to be concerned about your mum’s side of the family when it comes to breast cancer. Dr See Hui Ti, medical oncologist at Parkway Cancer Centre, says your genetic predisposition to breast cancer is determined by both maternal and paternal DNA. And your own risk depends on how many members on each side of the family have had the disease.
However, Dr Evan Woo, a consultant for breast and plastic surgery at KK Women’s and Children’s Hospital, says inherited breast cancers are not common. They make up only five to 10 per cent of cancers. If several of your relatives have had breast cancer, you may be carrying one of two abnormal genes
associated with it – BRCA1 or BRCA2. Carriers have an 80 to 90 per cent risk of developing breast cancer at some point in their lives, and a 20 to 40 per cent risk of developing ovarian cancer. Women with a family history and who believe they are at risk can go for genetic counselling at the National Cancer Centre Singapore to determine if they require genetic screening tests. This involves a series of blood tests that costs around $1,500. The amount, however, is not covered by Medisave, so you should discuss your options with the counsellor before taking any action.
MYTH 2“IF YOU HAVE THE GENE FOR BREAST CANCER, REMOVE YOUR BREASTS AND YOU’LL BE OKAY.”
Angelina Jolie famously had a double mastectomy when she found out she had the breast cancer gene. But Dr Savitha Ramachandran, associate consultant for plastic and reconstructive surgery, at KK Women’s and Children’s Hospital, says that as long as you’re vigilant, there’s no need for such a drastic measure.
Consult with your specialist on treatment options, and go for yearly screenings from the time you’ve been identified to carry either the BRCA1 or BRCA2 gene. Detected and treated in its early stages, breast cancer has a very high survival rate, regardless of whether you carry the gene or not. Even if you opt for a double mastectomy like Jolie did, surgery will not eliminate your risk entirely. It can reduce your risk of breast cancer by up to 90 per cent, but there is still a remaining 10 per cent. And you’ll still need to go for regular checks, such as chest X-rays.
MYTH 3“BIG BREASTS, UNDERWIRE BRAS AND IMPLANTS = A BIGGER RISK?
” Does your risk increase with cup size? The experts say no – it’s not how voluptuous you are, but how dense your breasts are. High breast density is associated with higher breast cancer risk, says Dr Savitha. Breast tissue is composed of milk glands, milk ducts and supportive tissue (dense breast tissue), and fatty tissue (non-dense breast tissue).
When viewed on a mammogram, women with dense breasts have more dense tissue than fatty tissue that appears as a solid white area and is hard to see through. Non-dense breast tissue is dark and transparent. However, if you have high breast density and have found a lump, a mammogram may not be enough to determine its nature.
“It may present a false negative result,” says Dr See. In a false negative outcome, the mammogram may look normal even though breast cancer is present. This could lull you and your doctor into a false sense of security, and cause you to delay seeking medical care even though you have the symptoms. For this reason, you may need a breast ultrasound or MRI to determine the nature of the lump.
As for breast implants, they do not increase your risk of developing the disease. But they could obscure the detection of a lump lying beneath them. Patients with implants should opt for magnetic resonance imaging (MRI) scans instead of mammograms. Dr See also dismisses the claim that underwire or tight-fitting bras can cut off lymph drainage and cause toxins to build up, increasing your susceptibility to the cancer. “Not true,” she says. “Nevertheless, if your bra is so tight that it cuts off lymph drainage, it’s the wrong size.”
MYTH 4 “MAMMOGRAMS AND MOBILE PHONES INCREASE YOUR RISK."
” Some people warn that the harmful radiation from mammograms can cause damage to your cells, leading to mutations that can result in cancer. “The level of radiation from a mammogram is the same as you would get from a transatlantic fight,” says Dr See, referring to the ultra-violet and cosmic radiation that airline passengers are exposed to. In other words, the radiation risk is very low.
Besides, says Dr Woo, even if a radiation risk for mammograms can be proven, it would be insignificant – a one per cent association with breast cancer, as compared to the benefit of early detection, which can point to a 90 per cent recovery rate. As for mobile phone radiation, the jury is still out. There isn’t enough scientific evidence to suggest a clear link.
MYTH 5 “BREAST SELFEXAMS ARE GOOD ENOUGH.”
These are a good practice, but should not be used as a substitute for mammograms, cautions Dr Woo. “In order to detect a cancerous lump in your breast, it must already be signficantly large,” he says. Relying on selfexaminations alone can delay the diagnosis.
Dr See says mammograms are much more effective because they can spot micro-calcifications, or small calcium deposits in breast tissue, that could indicate the presence of cancer and could be easily missed in a self-exam. Her advice: do a monthly selfexam a week after your period, and still go for yearly mammograms, so that any potentially malignant calcifications do not slip under the radar. During your selfexam, feel for any firm or solid lumps.
If you have lumpy breasts, look for any changes or new lumps. You should look out for bloody, milky or clear nipple discharge, nipple retraction, skin dimpling or persistent eczema in or around the nipple, too. If any of these symptoms for emerge, see your doctor as soon as possible.
The level of radiation from a mammogram is the same as you would get from a transatlantic flight.
MYTH 6 “ORAL CONTRACEPTIVES AND FERTILITY TREATMENT CAN GIVE YOU BREAST CANCER.”
The medical community is divided on this one. There is no evidence that links oral contraceptives or fertility treatments to a risk of breast cancer. But studies have shown that hormone replacement therapy (HRT), used to treat menopause symptoms such as hot flashes, can increase your risk. Both Dr Savitha and Dr Woo agree that you should speak to your doctor before deciding whether or not to undergo HRT. It’s a personal choice and depends on whether you feel your menopausal grievances outweigh the cancer risk.
MYTH 7 “WOMEN WITH FIBROCYSTIC OR LUMPY BREASTS ARE AT A HIGHER RISK OF BREAST CANCER.”
Here’s good news for women who have naturally lumpy breasts. Dr See says pre-existing lumps do not put you at a greater risk. But you should remain vigilant and monitor your breasts for any changes or new lumps.
MYTH 8 “SUPERFOODS, LIKE TURMERIC BLUEBERRIES, AND BROCCOLI, CAN PREVENT IT.”
No superfood has been proven to fight cancer. Fahma Sunarja, senior dietitian at Parkway Cancer Centre, says: “The likes of blueberries, turmeric, walnuts, garlic and broccoli contain phytonutrients, antioxidants and vitamins that are good for your health and should be included in your diet, but they do not provide targeted protection against any form of cancer.”
What does put you at greater risk is body weight. The higher your body mass index (BMI), the higher your chances of getting breast cancer, warns Fahma. You can prevent this with regular exercise and a healthy diet. You should also avoid drinking alcohol. When it is broken down in the body, a toxic chemical called acetaldehyde is produced, which can damage DNA and proteins.
Alcohol also reduces the absorption of nutrients, like folate, carotenoids and various vitamins, that can help decrease the risk of cancer. It increases the level of oestrogen in the blood. This sex hormone has been linked to a higher risk of breast cancer. Fahma also recommends eating less red meat and processed food, which have also been associated with an increased risk of cancer.
Alcohol also reduces the absorption of nutrients like folate, carotenoids and various vitamins, that can help lower your cancer risk.
GOING UNDER THE KNIFE
Dr Evan Woo, also president of Breast Reconstruction Awareness Singapore (BRAS), explains the surgical options available if you have been diagnosed with breast cancer. A non-profit organisation, BRAS provides support and resources related to breast reconstruction for women here. Mastectomy The entire breast with the cancerous tumour is removed.
Depending on its stage, further treatment, such as chemotherapy, may be needed. Breast Conservation Surgery Or Lumpectomy Less widely known, this removes only the diseased part of a breast. It’s usually offered to patients in the early stages of cancer, where the size of the tumour is small in relation to the breast. Otherwise, there is a risk of deformity. After the lumpectomy, patients must still undergo daily radiotherapy for four to six weeks.
Breast Reconstruction Women who’ve had one of the above surgeries can also opt for breast reconstruction, which may include implants and grafting of your own tissue. Dr Woo explains: “In addition to the anxiety associated with surgery and chemotherapy, breast cancer treatment can affect a patient’s self-esteem when it comes to body image.
“Breast reconstruction helps women avoid anxiety of this nature as the patient knows that after surgery, she will look the same as before.” He also assures patients not to worry about the cost of breast reconstruction, as it is usually covered by Medisave and insurance provided the surgery is performed at the same time as when the cancerous tissue is removed. The members of BRAS include plastic surgeons, breast care specialist nurses and patients who have previously undergone breast reconstruction. Visit www.bras.org.sg to learn more.