4th December 2023 – (Hong Kong) In a recent report by the Hong Kong Cancer Registry (HKCaR), breast cancer has become the most common form of cancer among women in Hong Kong since 1994. The statistics reveal that approximately one in every 14 women may develop breast cancer in their lifetime. The number of new cases has skyrocketed from over 700 cases per year in the 1980s to 5,565 cases in 2021. The majority of breast cancer cases in Hong Kong are classified as hormone receptor-positive, HER2-positive, or triple-negative breast cancer. Most cases occur in women between the ages of 45 and 64, with a median age of 56, which is younger compared to European and American countries. Recognizing the alarming increase in breast cancer diagnoses, experts are urging women to undergo regular mammogram screenings or complement them with ultrasound examinations for early detection and diagnosis, starting from the age of 40.
Breast lumps: Is it always breast cancer? According to Dr. Bonita Mark Hor-kee, a specialist surgeon, breast lumps can be caused by various benign breast conditions apart from malignant cancer. Benign breast conditions can be categorized into three types: the first type poses no increased risk of breast cancer, such as simple cysts (commonly known as fluid-filled sacs), which are often associated with inflammation and pain. The second type slightly increases the risk of breast cancer, such as complex fibroadenomas. The third type significantly raises the risk of breast cancer, such as atypical ductal hyperplasia.
Dr. Mark explains that while most lumps are benign fibroadenomas or lipomas, there is still a possibility of malignancy. If a patient experiences any pain or discomfort, regular follow-up appointments every six months are recommended. This involves periodic mammogram screenings, ultrasound examinations, and even biopsy procedures over a span of two to three years to monitor changes in the lump’s size and shape for accurate diagnosis and patient safety.
Regarding the risk factors for breast cancer, Dr. Mark Hor Kee highlights that having a family history of breast cancer, multiple family members with breast cancer, and an onset of breast cancer before the age of 45 are all considered risk factors that may warrant early screening. For patients with a family history of breast cancer, doctors analyze details such as the age of onset, type of breast cancer, other related cancers, and whether the cancer is unilateral or bilateral, in order to assess the individual’s risk. In recent years, there has been an increase in the number of diagnosed breast cancer cases among women in their 20s and 30s, who may have a family history or genetic predisposition. Due to early detection through regular screenings, most cases are still detected at an early stage. Apart from age and family history, other risk factors for breast cancer include early onset of menstruation, late menopause, nulliparity, and lack of breastfeeding.
Breast cancer screening consists of three essential elements: clinical examination by a doctor, breast imaging (ultrasound or mammogram), and cellular or tissue examination (biopsy). Asian women, who tend to have higher breast tissue density, may have lower sensitivity to mammogram screenings compared to women from other regions. Therefore, ultrasound examinations are often recommended as a complementary screening method. Surgery remains the primary treatment option for curing breast cancer. Dr. Mark Hor Kee explains that in recent years, breast cancer surgeries have become more advanced. In addition to total or partial mastectomies, there is a newer approach called oncoplastic breast-conserving surgery, which allows for simultaneous breast reconstruction. This surgical technique involves removing the tumour while preserving healthy breast tissue and reconstructing the shape of the breast using tissue displacement, resulting in a more aesthetically pleasing appearance. Performing reconstruction at the time of tumour removal is beneficial for improving the postoperative quality of life for patients.
Dr. Mark shares the case of a woman in her 30s diagnosed with HER2-positive breast cancer and a tumour measuring approximately 4 centimetres. As the patient desired to preserve her breast, the doctor utilized chemotherapy and targeted therapy to shrink the tumour. After the treatment, the tumour size decreased to less than 1 centimetre, allowing for successful oncoplastic breast-conserving surgery.
While breast cancer cannot be completely prevented, Dr. Mark Hor Kee emphasizes that several studies have identified certain lifestyle factors that may contribute to its development. These factors include lack of exercise, obesity (BMI over 25), high-stress levels, excessive consumption of saturated animal fats (such as red meat and full-fat dairy products), inadequate intake of fruits and vegetables, and regular alcohol consumption. Establishing a healthy lifestyle, including regular exercise, balanced diet, and sufficient sleep, may help reduce the risk or delay the onset of breast cancer.