8 Sept - Women’s Health 

HEADING: Zeroing on the problem

Most people are well aware of the monster illness that is known as cancer and the various stages it can be discovered at. However, there is a lesser known terror that could turn potentially dangerous – zero stage cancer.

Zero stage cancer, also known as carcinoma in situ, refers to abnormal cells that have not spread beyond where they first formed. These in situ cells are not malignant or invasive and are less advanced than stage one cancer. However, they can develop and spread to other nearby locations.

Among the places it can occur are the bladder, cervix, skin, mouth, eyes and breast.

Also known as ductal carcinoma in situ (DCIS), zero stage breast cancer happens when there are abnormal cells in the lining of the milk ducts that have not spread to the surrounding tissue or lymph nodes.

Breast cancer is the most common cancer among females in Malaysia. According to consultant general surgeon at Ara Damansara Medical Centre Dr Lee Ching Hong, among the stages of women with breast cancer, those that get zero stage breast cancer make up 10% of all breast cancer cases in Malaysia.

Unlike western countries where zero stage breast cancer makes up 20% of all breast cancers, Asian countries like Malaysia have a poorer prognosis. This means that more Malaysian women are discovering that they have cancer when it is at stages one through four rather than zero.

Treating it at zero stage

“With the right treatment, the five-year survival prognosis of DCIS is almost 100%,” declares Dr Lee, who goes on to share that with the risk of it becoming an invasive cancer in a few years, the normal procedure is to remove the cancer.

“When you get zero stage breast cancer, the treatment is the same as an invasive breast cancer, but it’s less aggressively treated,” he says. Unlike stages one through four where it would be typical to remove the lymph nodes as well, it is not usually done with zero stage cancer. The exception to this would be if, when considering the cell grading of the cancer, it is a more aggressive form of zero stage breast cancer.

According to him, the patient usually has one out of three options with their treatment plan: A lumpectomy (only a portion of the breast is removed), a lumpectomy coupled with radiotherapy or a mastectomy (the removal of all breast tissue from the breast).

Am I in danger?

Although we all would like to believe that the chances of us getting seriously ill are slim, there are still some risk factors that increase the likelihood of developing breast cancer, shares Dr Lee.

  • Age – While you cannot control it, growing older is a risk factor of getting breast cancer     

  • Family history – If you have a first-degree relative (mother, daughter, sister) who has breast cancer or you have multiple relatives who have had early breast cancer (before the age of 50), you are at a higher risk

  • Medical history – If you have been diagnosed with breast cancer, your risk of a recurrence is higher than if you never had the disease

  • Lack of physical activity      

  • Eating unhealthily – A high fat and meat diet can increase your risk

  • High alcohol consumption – The more alcohol you drink, the greater your risk of developing breast cancer

  • Heavy smoking – Smoking causes a number of diseases and is linked to a higher risk of breast cancer

  • Reproductive history – Having your first pregnancy after the age of 30 and not breastfeeding ups the risk as well

  • Menstrual cycle – Early menstrual periods before the age of 10 and starting menopause after the age of 55 exposes women to female hormones for a longer period, raising the risk of getting breast cancer

  • Recent use of oral contraceptives – Using oral contraceptives is linked to increasing a woman’s risk for breast cancer. However, a woman who has stopped using oral     contraceptives for a period of time has a lower risk of developing breast cancer.

  • Increased stress and anxiety

Taking the necessary precautions

“Normally with DCIS, there isn’t any symptoms so you never know if you have it,” says Dr Lee, who urges women not to wait until they feel something in their breast before they go for a check-up.

“If you are above the age of 18, you should be going for regular check-ups with your doctor (usually done with an ultrasound machine) and if you are above 40 years old, you need to be going for regular mammogram exams. Even more so if you have a first-degree family member with a history of breast cancer,” Dr Lee adds.

Dr Lee shares that according to a study (need study name from Dr. Lee) done in the United States, 90% of DCIS are diagnosed through mammogram as women generally cannot feel anything wrong in their breast before the cancer has become invasive.  

Reducing your risk 

If you are concerned about developing breast cancer, there are some steps that you can take to help prevent it. While some risk factors such as family history cannot be changed, according to Dr Lee there are some lifestyle changes you can make to lower your risk.

  • Limit alcohol consumption      

  • Avoid smoking      

  • Be physically active – Physical activity can help you maintain a healthy weight and lifestyle. The American Cancer Society recommends engaging in 45-60 minutes of physical exercise five or more days a week.

  • Breastfeed your baby – Breastfeeding may play a significant role in breast cancer prevention. The longer you breastfeed, the greater the protective effect.

  • Limit your dose and duration of hormone therapy – Taking hormone therapy for an extended period of more than three years can increase your risk of breast cancer

  • Go for regular screenings – Be vigilant about breast cancer detection and go to the doctor for a yearly screening. If you have a family history of breast cancer, you need to take extra precautions and start screening aggressively at an earlier age.     

  • Check yourself – Check yourself monthly for changes in your breast, such as a new lump or skin changes. It is not advised to check yourself every day as you may not notice the shifts in your body.     

  • Having your first child – Females are advised to deliver their first child before the age of 30

  • Eating healthy – Your eating habits have a huge effect on your body. Dr Lee’s advice is to eat more organic vegetables and fish oil.

  • Avoid stress – Stress can also have an impact on you. Anything you can do to reduce stress and to enhance your joy, comfort and satisfaction can have a big impact on your quality of life.

Dr Lee stresses that you can never be too careful. Going for regular check-ups with your doctor can be the only thing that helps you catch breast cancer at stage zero before it becomes invasive. You can also consult your doctor on when to begin mammograms and other screenings based on your personal history.

***CAPTION: About 90% of zero stage breast cancer have been found through mammograms as they are capable of detecting breast cancer early, sometimes up to three years before it can be felt.