heal-white-logo-en

Know yourself, know your enemy, and you will never be defeated

Understanding Breast Cancer

Breast cancer remains the most common cancer among women in Hong Kong and worldwide. Who is at higher risk? What are the symptoms? And how should it be treated?

The TVB drama “Come Home Love: Lo and Behold” is popular evening entertainment for many Hong Kong viewers. The character “Big Miss” became widely beloved, ultimately propelling actress Mandy Lam, who portrays the role, to win the “Best Supporting Actress” award last year. However, Mandy Lam’s path from her Miss Hong Kong pageant debut 19 years ago to her current acting fame has been challenging. After spending her early career without landing lead roles, she was diagnosed with stage II breast cancer in 2010. She has openly shared the difficulties of her cancer battle, including experiencing severe hair loss as a side effect of chemotherapy and targeted therapy treatments.

In this article:

Incidence and Mortality Statistics
Common Symptoms
Risk Factors
Diagnostic Methods
Treatment Methods
Personal Care

Prevalence of Breast Cancer in Hong Kong

Is Breast Cancer The Leading Women's Cancer? Incidence And Mortality Rates Of Breast Cancer In Hong Kong

Breast cancer is the most common cancer of women in Hong Kong. In 2022, there were 5 182 new cases of breast cancer, accounting for 28.6% of all new cancer cases in women in Hong Kong. The median age at diagnosis was 58 years. The crude annual incidence rate per 100 000 women was 130. Breast cancer was the third leading cause of cancer deaths among females in Hong Kong. In 2022, a total of 792 women died from this cancer, accounting for 12.5% of all cancer deaths in women.

With medical advances, the cure rate of breast cancer has been improving in the last decade. Still, early detection and treatment are critical for improving the survival rate of patients. According to the Cancer Registry statistics, the overall five-year relative survival rate of patients with breast cancer was 84%. Stage I breast cancer had a five-year relative survival rate of 99.3%, which means that these individuals had almost the same chance of surviving more than five years as the general population. The five-year survival rate for stage II was 94.6%, and that for stage III was 76.2%. Stage IV breast cancer still had a five-year relative survival rate of about 30%.

Three Major Breast Symptoms

What Are The Common Symptoms Of Breast Cancer?

Symptoms related to breast conditions can generally be categorised into three areas:

  • Breast
    • Presence of a lump; changes in shape or size; dimpling or puckering of the skin; thickening, scaling, or an orange-peel-like appearance of the skin.
  • Nipple
    • Retraction or inversion; changes in shape; lumps or thickening; spontaneous discharge, including bleeding.
  • Underarm
    • Swelling or enlarged lymph nodes.
It is important to note that many women occasionally experience breast tenderness or feel lumps around the nipple area. These symptoms are often caused by hormonal changes during menstrual cycles or early pregnancy, representing normal physiological responses that shouldn’t cause undue concern. However, breast cancer patients may not experience any noticeable symptoms until tumours have already formed or grown significantly. If abnormalities are detected, immediate medical consultation is recommended to determine whether the tumour is benign or malignant. Most breast lumps are benign conditions like cysts or fibroadenomas, which pose no health risks.

Causes of Breast Cancer and Self-Examination

What Are The Causes Of Breast Cancer?

Breast cancer develops when breast cells grow and divide uncontrollably, forming a tumour. If the tumour is malignant, it becomes breast cancer. The exact cause of this process remains undetermined in the medical field. However, the following are generally recognised as high-risk factors for breast cancer:

  • Early menstruation (before age 12) or late menopause (after age 55)
  • Long-term consumption of high-fat foods
  • Sedentary lifestyle, smoking, or excessive alcohol consumption
  • Never having given birth or having a first pregnancy after age 35
  • Long-term use of oral contraceptives or hormone replacement therapy for more than five years
  • Previous benign breast conditions, such as atypical hyperplasia, lobular carcinoma in situ, ovarian cancer, or endometrial cancer
  • History of other cancers, including Hodgkin’s lymphoma, lung adenocarcinoma, or colorectal cancer
  • Prolonged exposure to radiation
  • Having a first-degree relative (mother, sister, or daughter) diagnosed with breast or ovarian cancer before age 50
Individuals who meet any of these conditions have a higher risk of developing breast cancer. If suspicious symptoms appear, early medical examination is strongly recommended.

To reduce the risk of breast cancer, maintaining healthy lifestyle habits is essential. This includes regular exercise, limiting fat intake, eating fresh fruits and vegetables, and avoiding smoking and alcohol. Additionally, since early-stage breast cancer has a high cure rate, women should remain vigilant by performing regular breast self-examinations to check for any suspicious symptoms.

Doctors recommend performing self-examinations monthly. For women who have not reached menopause, the best time is between the 7th and 10th day after the start of their menstrual cycle. Postmenopausal women should examine themselves on the same day each month. The self-examination process consists of three steps:

  • Visual Inspection
    • Stand in front of a mirror with your arms raised overhead. Observe the breast skin for wrinkles, dimpling, redness, or unusual discolouration. Check the nipples for crusting, changes in shape, redness, bleeding, or abnormal discharge.
  • Physical Examination
    • Place your right hand behind your head while showering or lying flat on your back. Using the pads of your left index, middle, and ring fingers, gently massage your right breast in circular motions, moving from the outer armpit area toward the nipple. Gently squeeze the nipple to check for pain or discharge. Repeat the process on your left breast using your right hand, including examination of the left armpit area.
  • Comparison

Compare your current breast condition with previous observations, noting any unusual changes in size or shape. Also, compare both breasts to identify any asymmetrical changes or abnormalities between them.

How Do Doctors Diagnose Breast Cancer?

What Are The Diagnostic Methods For Breast Cancer?

If you notice potential symptoms of breast cancer, you should consult a doctor for examination. After reviewing your medical history, the doctor will first examine your breasts, armpits, and neck lymph nodes to check for any swelling, pain, or other abnormalities. Following this initial assessment, a series of tests will be conducted.

  • Initial Examinations
    • Blood tests
      • If the blood contains certain chemicals that cancer cells depend on for growth, it may indicate the presence of cancer in the body.
    • Mammogram
      • The breast is placed on an imaging device and compressed for about 10 to 15 seconds. The resulting image reveals the breast structure and glandular tissue, including fluid-filled cysts commonly seen before or after menstruation and small tumours that touch cannot detect. If the doctor identifies any abnormalities in the image, they may request an ultrasound to determine whether dark spots are solid or fluid-filled. A small tissue sample may be extracted from the breast to confirm whether a lump is benign or malignant.
    • Ultrasound Scan
      • The doctor moves a high-frequency sound wave device over the patient’s body to create images of internal structures. This is used to examine breast lumps and assess whether the lymph nodes in the armpit are swollen.
  • Cytopathological Examination
    • Biopsy
      • Incisional Biopsy
        • If X-rays or ultrasound reveal suspicious lumps, doctors may recommend this procedure. A small surgical needle is inserted into the breast to extract a tissue sample from the lump. The sample is then examined under a microscope to determine whether it is benign or malignant and to identify its specific type.
      • Excisional Biopsy
        • Currently, the most accurate yet invasive diagnostic method, this procedure involves making a 1-2 inch incision in the breast. The doctor removes all abnormal tissue and the surrounding tissues for comprehensive examination.
    • Needle Biopsy Procedures
      • Fine-Needle Aspiration Biopsy
        • Doctors use a thin needle to extract tissue samples from the breast for testing. However, the collected tissue may not always be sufficient to determine the tumour’s nature or confirm whether cancer cells are invasive. This method can also drain fluid from benign cysts detected via ultrasound.
      • Core Needle Biopsy
        • Following the same principle as fine-needle biopsy but using a thicker needle, this procedure collects adequate tissue samples for more accurate cellular analysis. If cancer cells are detected, the following two tests become necessary:
      • Hormone Receptor Test

Cancer cells containing hormone receptors may proliferate when exposed to estrogen or progesterone in the bloodstream. Such hormone receptor-positive cancers typically respond well to hormone therapy. Conversely, hormone receptor-negative cancers show no response to such treatments, limiting therapeutic options.

      • HER2 Receptor Test

This test identifies whether cancer cells overexpress the HER2 protein (human epidermal growth factor receptor) or its encoding gene. Since cancer cells naturally replicate faster than normal cells, excessive HER2 production indicates hyperactive HER2 genes that accelerate cancer proliferation, increasing risks of metastasis and recurrence. HER2 status directly informs treatment selection.

In addition, doctors may recommend further tests to determine the tumour’s location, size, and extent of spread to decide on the most appropriate treatment approach.

      • Liver Ultrasound Scan

    Used to check whether breast cancer has spread to the liver. The doctor moves a high-frequency sound wave device over the patient’s liver area, and a computer converts the reflected sound waves into images. The doctor can determine their size and location if liver masses are present from the images.

    • Bone Scan
      • Used to assess whether breast cancer has metastasised to the bones. A small amount of low-level radioactive material is injected into the patient’s arm vein, followed by a scan of the bones. Since cancer cells absorb more radioactive material than normal cells, any bone metastases will be visible in the scan images.
    • Magnetic Resonance Imaging (MRI)
      • A contrast agent is first injected into the patient’s vein to enhance imaging. The patient then lies on a platform that slides into a large cylindrical machine. Using radio waves and strong magnets, cross-sectional images of the body are generated. The varying signal patterns create detailed computerised pictures as tissues absorb and re-emit radio waves.

These diagnostic tests not only help doctors evaluate the tumour’s size and location but also assist in staging the breast cancer. Breast cancer is typically classified into five stages:

StageScope of Impact

Stage I

Also known as “carcinoma in situ,” where cancer cells are still within the basal layer of the breast duct.
Stage II    The tumour is less than 2 cm, and the axillary lymph nodes are unaffected.
Stage III     The tumour is 2 to 5 cm, or the axillary lymph nodes are affected.
Stage IVThe tumour is larger than in Stage II, or the axillary lymph nodes have cancer cells invading the chest wall or breast skin.
Stage V

Cancer cells have spread to organs such as the brain, bones, and lungs.

Main Treatment Methods

What Are The Latest Treatment Trends For Breast Cancer?

Doctors determine the most appropriate treatment approach based on the stage of breast cancer, the presence of hormone or HER2 receptors, and the patient’s overall health. Breast cancer treatments can be categorised into three main types: surgery, radiation therapy, and drug therapy.

  • Surgery
    • Lumpectomy
      • If the tumour occupies only a small portion of the breast, only the tumour and nearby lymph nodes are removed. Sometimes, the doctor may also reshape the remaining breast tissue to maintain appearance. Scarring may occur after surgery, with the length depending on the tumour’s size and location. Patients typically require hospitalisation for two to three days, with a recovery period of about five to ten days. In the initial days after surgery, a drainage tube may be inserted into the wound to remove accumulated blood.

Additionally, after surgery, the lymphatic vessels near the breast may harden, causing arm pain and limited mobility. Patients can perform gentle exercises, undergo physical therapy, or receive antibiotic treatment to alleviate discomfort. Improvement is usually observed within a few months.

    • Mastectomy
      • If the tumour is large or cancer cells are more widespread, the doctor may remove the entire breast, along with lymph nodes in the armpit and possibly part of the chest muscle. After surgery, patients typically stay in the hospital for three to five days, with a recovery period of about three to four weeks. In the first few days post-surgery, the wound may bleed or discharge lymphatic fluid, which can be drained using a tube. Swelling usually subsides within a few weeks.

Patients should be aware that breast reconstruction may be necessary after removal, especially if the breasts were originally large. Without reconstruction, changes in body balance may lead to neck and shoulder pain.

    • Breast Reconstruction
      • To maintain breast appearance, reconstruction can be performed. There are two primary methods: implant-based reconstruction and flap reconstruction. The former involves inserting a breast-shaped filler containing saline or silicone, while the latter uses skin and fat from areas such as the abdomen or buttocks. However, reconstructed breasts lack nerve sensation, and shoulder and arm mobility may be somewhat restricted.
    • Radiation Therapy

This treatment uses high-energy rays to target and destroy cancer cells. Radiation therapy may be administered before surgery to shrink tumours for easier removal, or after surgery to eliminate remaining cancer cells and reduce recurrence risk. Treatments are typically administered five times weekly, lasting about 10-15 minutes. The whole course of therapy generally spans 3 to 8 weeks.

    • External Beam Radiation
      • This method utilises large machines to deliver radiation through the skin to reach internal tumours. Patients typically undergo five sessions per week. While the body does not retain radiation, the treated skin area may become sensitive and should be kept dry to prevent infection.
    • Internal Radiation (Brachytherapy)
      • Primarily used for smaller tumours, this approach involves implanting radioactive metal wires directly into the tumour site to deliver high-dose radiation at close range. During treatment, patients emit radiation and must stay in isolation rooms, avoiding contact with pregnant women and children until the radioactive material is removed.

Following radiation therapy, patients may experience redness and pain at the treatment site, along with potential damage to small blood vessels in the irradiated area. Common side effects include fatigue, nausea, and shortness of breath.

  • Drug Therapy
    • Chemotherapy
      • This treatment primarily involves intravenous administration of cytotoxic drugs that travel through the bloodstream to destroy cancer cells. A complete treatment course consists of 4 to 8 cycles, each lasting approximately 2 to 3 weeks, followed by several weeks of rest before continuing. As chemotherapy drugs circulate throughout the body, they may affect normal cells while attacking cancer cells, leading to various side effects, including hair loss, nausea, mouth ulcers, and weakened immunity.
    • Hormone Therapy
      • This treatment aims to suppress estrogen hormones to inhibit cancer cell growth. Patients may take hormone therapy drugs to block hormone production and prevent hormones from binding to cancer cells, thereby cutting off their nutrient supply. Alternatively, patients may opt for ovarian removal or radiation therapy to stop hormone secretion and alter the body’s hormone production levels.
    • Targeted Therapy
      • This approach focuses on specific genes responsible for cancer cell growth and the proteins they produce, disrupting the cells’ ability to grow or repair themselves, ultimately leading to their natural death. Typically, targeted drugs are not used alone but are combined with other treatments to maximise effectiveness.

Healthy Living

Personal Care For Managing Side Effects Of Breast Cancer Treatment

After undergoing various treatments, patients must attend regular follow-up appointments and examinations to allow doctors to monitor their recovery progress. If persistent discomfort such as bone pain, shortness of breath, or limb numbness occurs, immediate medical attention should be sought. Additionally, patients should follow the guidance of their doctors and physiotherapists to perform simple arm exercises. These exercises help strengthen the upper limbs, maintain joint flexibility, and reduce swelling. However, patients should avoid lifting heavy objects to prevent further arm injury and ensure a smooth recovery.

*Sources:

Cancer Online Resource Hub


▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.

Contact Us

Our centre operates from Monday to Friday, 09:00 AM to 5:30 PM, and Saturday, 09:00 AM to 1:00 PM.  For appointments or to speak with our staff, please call +852 3598 9090.

Should you need to contact us outside business hours, kindly leave a message, and we’ll get back to you as soon as possible.

×