“About 1 in 12 people.” What we want everyone to know about breast cancer.
Every October, United Arrows Ltd. (UA Ltd.) holds its month-long "Pink Ribbon Campaign." The pink ribbon is a symbol of the importance of early detection in breast cancer. We do a lot at UA Ltd., such as selling original products and making donations, but what we really want is to get out the message to everyone to go to breast cancer screenings. For those who have never had a breast cancer screening or who do not know much about the details of breast cancer itself, we asked Naoko Shimada, the director of the Pink Ribbon Breast Care Clinic Omotesando and the vice chairwoman of the Japan Society of Breast Health NPO about everything she wants people to know about breast cancer.
Photo: Kazumasa Takeuchi (STUH)
Text: Rie Hayashi
Breast cancer is the only cancer that you can detect on your own. If you go to screenings and detect the cancer early, it can be treated while it is in “Stage Zero.”
――First of all, what kind of illness is breast cancer? How is it different from other cancers?
Basically, breast cancer is the same as other cancers in that it generates cancerous cells. But, in fact, breast cancer is the one and only cancer that you can detect on your own. Even if some cancer cells have formed, if you go to screenings and detect the cancer early, it can be treated while it is in “Stage Zero.” With breast cancer, cancer cells form in the mammary gland. However, there are no blood vessels or lymphatic vessels within the mammary gland structure. This means that while the cancer cells remain in the structure of the mammary gland, they cannot enter blood vessels or lymphatic vessels and spread (or metastasize) to other organs in the body, so there is no need to worry about it spreading to the entire body. So, if the tumors within the mammary gland are properly treated, it is possible to cure the cancer without the use of systemic treatments, such as anti-cancer agents. This is true at the initial stage of the cancer, known as “Stage Zero.” Once you pass that stage, it is possible for the cancer cells to cross the structure known as the basilar membrane, enter into the surrounding blood vessels or lymphatic vessels, and spread throughout the body. In this case, it becomes necessary to not only treat the breast but to treat the entire body with anti-cancer agents and hormone therapy. If you treat the disease after it has advanced, there is greater fear of sickness, the treatments are harsher, and they take more time and cost more money.
――If you develop breast cancer, is it necessary to remove the breast, even in “Stage Zero”?
Even in Stage Zero, you already have breast cancer so it will continue to advance if left untreated. Therefore, even if you detect the cancer at Stage Zero, it is very important to completely surgically remove the portions of the breast that have breast cancer. If the Stage Zero cancer is only a few millimeters in size, it is possible to complete treatment by just removing that portion. However, it is also possible, even as Stage Zero, for the cancer to be spread out over a larger area while still not breaking out of the normal structure of the mammary gland. In such cases, even at Stage Zero, it may be necessary to remove the surrounding breast as well (mastectomy). Even for a total mastectomy, the cancer was still detected in its early stages so there are further options.
By this, I mean breast reconstruction. In particular, starting in January of last year, insurance began to cover a procedure by which the breast was reconstructed while the patient was still under anesthesia from the mastectomy (simultaneous breast reconstruction) and it is now in wide use. If the illness is detected early, it is not dangerous, it is possible to create a naturally-shaped breast, and the patient can select the treatment she wants to receive. The actress Angelina Jolie removed both of her breasts that were at risk of developing breast cancer, but even after the surgery she has very natural proportions. Of course, if you detect breast cancer early, you do not need to spend years on treatment, you can still get pregnant and have children, and if the mammary gland in the other breast is intact, it is possible to breastfeed.
The surgical options vary depending on how far the cancer has spread. However, in all such cases it is precisely because of early detection that you can choose from a wider range of treatment options and have better choices for your life after treatment is finished.
――What you’re saying gives women a reason to be hopeful! Once cancer cells develop, how quickly do they advance?
It takes about 7 or 8 years between when the first cancer cell develops, a lump forms, and it reaches a size of 1 – 2 cm that can be felt with your hand. It is a very slow speed. However, once a certain number of cancer cells have developed and grown, the speed accelerates exponentially. So, it does not take years to develop from 1 cm to 2 cm. Finding breast cancer while it is growing slowly and cannot be felt by hand and starting treatment then is a major key to overcoming breast cancer. Mammography, ultrasound examinations, and other diagnostic imaging are extremely helpful for detecting lumps that are not large enough to be felt by hand. Using such screenings and continuing them on a regular basis while there are no noticeable symptoms is the most effective way to detect breast cancer early.
As women advance more and more in society, the percentage of women who develop breast cancer increases as well.
――Are there people who are more or less susceptible to breast cancer?
Unfortunately not. No one is completely immune to breast cancer. Everyone could develop breast cancer. In addition, since we do not clearly understand the cause of breast cancer, we also do not know any preventative measures that are certain to stop it. It might be surprising, but men also have mammary glands so they can develop breast cancer. However, it only occurs at about 1/100th the rate in men as it does in women.
――Does that mean that there are also no people who are more susceptible to breast cancer?
No. By examining the characteristics of people who have developed breast cancer, we have found some risk factors that are associated with an increased susceptibility to breast cancer. The greatest risk factor is whether breast cancer is common in your family. This is especially true if you have any close relatives who developed breast cancer in their 30s or 40s – at a younger age than normal, or if you are related to someone who had breast cancer in both breasts, or if you are related to a man who developed breast cancer. In such cases, there is a risk that you will develop breast cancer due to abnormal genes so you need to be especially careful. We also know that breast cancer caused by genetic abnormalities often develops at a younger age – in the person’s 20s or 30s. So, by knowing that you have that tendency, you can prepare by going to screenings earlier. You can inherit those genes from your mother and your father as well. Recently, people may not talk to their parents and relatives about illnesses as much, but you should ask your parents and relatives about it for your own sake and for their sakes as well. If there is a high occurrence of breast cancer among your relatives, encourage each other to go to screenings.
Other risk factors include not having given birth to children or giving birth at an older age, not having had the opportunity to breastfeed, having started menstruation at an early age and entering menopause late, and post-menopausal obesity. These factors may appear unrelated at first glance, but they are actually connected by one thing: female hormones. What these all have in common is exposure to the effects of female hormones over many years or exposure to the effects of a large quantity of female hormones. This is a risk. When giving birth or breastfeeding, a woman’s body produces completely different hormones than usual, which is thought to “reset” the breast. In other words, if you have fewer opportunities to reset the breast, it increases the risk of developing breast cancer. However, this is not to say that giving birth or breastfeeding will prevent you from getting breast cancer. There are, of course, cases of women with many children who have developed breast cancer. How is post-menopausal obesity related to this? In menopause, the ovaries stop producing female hormones and instead, male hormones are converted to female hormones. The enzymes used for this conversion are related to the amount of subcutaneous fat. So, larger women are able to maintain a higher level of female hormones after menopause. They may feel youthful and vibrant, but it results in the breast always being full of nutrients. It bears repeating that this does not mean that women who do not have these risk factors are unable to develop breast cancer. Breast cancer is the cancer that women are most likely to develop. Please do not forget that anyone can develop breast cancer; it is always a distinct possibility.
――All of those issues related to female hormones seem to overlap in recent trends among Japanese women, don’t they?
That is precisely the case. There is more breast cancer in countries where women have active roles in society, so breast cancer is now increasing worldwide. As more and more rights have been established for women, there are more opportunities for them to succeed. Ironically, these positive advances have also led to changes in women’s lifestyles that are increasing their risk of breast cancer. Also, in that sense, the incidence of breast cancer is slightly higher in cities in Japan. When day and night are switched in a woman’s schedule or she is under a lot of stress, it can cause unbalances in her female hormones and her menstruation may become irregular. It is thought that since the mammary gland is an organ that takes in female hormones, one possible reason for the increase in breast cancer is that it is under the influence of these female hormones on a daily basis. Also, it is also more common now for women to be under the influence not only of their own hormones but of female hormonal agents used in treatments. Birth control pills, fertility treatments, and menopause treatments use hormones. These are medicines that are extremely effective if used properly as treatments so there is no need to be worried unnecessarily. However, it is important to confirm that you do not have breast cancer before using them. If you have breast cancer but do not know about it and use female hormonal agents, these medicines may advance the growth of the breast cancer. I want everyone to know about this. It is very important.
If you suspect something is out of the ordinary with your breasts, it is a sign you should get a screening. Be responsible for your own breasts.
――Are there any signs of breast cancer?
The first symptom that many people notice as something out of the ordinary is a breast lump. The symptoms vary by age, but another sign may be pain. Another symptom is a discharge coming out of the nipple. However, simply having these symptoms does not mean you definitely have breast cancer. This is because breast cancer really presents in different ways depending on the person.
――What should you do if you notice something?
If you notice something out of the ordinary, be sure to get a screening. There are hospitals with breast oncology departments and outpatient departments, as well as specialist institutions such as breast clinics. Recently, an overwhelming number of people search on the Internet when they have some symptom to see if anyone else has the same symptom. But looking up things on your own and making judgments on your own is very dangerous.
It is difficult to diagnose breast abnormalities by touch alone. And breast cancer can present in a variety of different ways – it is not always the typical hard, unmoving lump. Start by getting examined and continue to get screenings and examinations until it is clear what is causing the abnormality you are experiencing. This is what I want every woman to do without fail. Think of getting examined as a way to confirm that you don’t have breast cancer. Don’t be afraid – get examined. We are able to tell the vast majority of the women who suspect some abnormality and get it examined that they do not have cancer. Of course, it is also important to get examined before you start to notice any symptoms. The mammography or ultrasound examinations that are performed in the exam can detect breast cancer before any symptoms are present. Getting regular checkups when you do not feel any abnormalities are what allows you to detect cancer in its early stages. Even for the same breast cancer, if treatment starts in the early stages, there are options about whether or not to remove the breast and whether or not to use anti-cancer agents. There are also major differences in the length and cost of treatment. It also affects how you plan your life after the treatment. If you detect and treat cancer early and finish treatment in one stage, you can give birth and breastfeed. However, if you start treatment after the disease has advanced, the treatment could span several years and affect the ovaries, so you may no longer have the option to bear children. In any case, early detection and early treatment are major tools for overcoming breast cancer. Doesn’t knowing that make you want to get screened? But people are somehow reluctant to come. They are afraid of finding out they are sick, or think the exam will hurt, or somehow believe that they are fine without any basis for thinking so. But unfortunately, there is no one who is completely free of the possibility of breast cancer. This is of course true for women, but it goes for men as well. There are no exceptions to this rule.
――You talked about specialist institutions. Where, exactly, should people go?
Some women go to the gynecologist because they think of breast cancer as a women’s disease, but for breast cancer screenings, they should go to the breast oncology department or the breast surgery department. If you’re going to search for something, look for the breast oncology department, not symptoms of breast cancer. Mammograms compress the breast, so some women think it will hurt or think that their breasts are too small to do the test. However, there are a lot of ways of doing the test so it does not hurt. For example, the test hurts less if you do it after menstruation when your chest is not as tight. Of course, the test can be performed no matter what size your breasts are. In fact, the technicians who perform mammograms have basic medical radiology technician qualifications, but they also have been thoroughly educated in knowledge of breast cancer and techniques for taking mammograms. Only those who have taken and passed the test are given certification. They have really honed their abilities to help the patient to be comfortable while at the same time taking detailed imaging of the breast. They also have undergone special training to help the people who come for the exam to relax. This includes how they speak to them and how they touch them. Unfortunately, people who have not undergone this training can still perform mammograms. However, if you are going to get a mammogram, it will surely give you more peace of mind if you get it done by a technician who has passed such a mammography qualification exam, and to be examined by a doctor who has undergone thorough training so as not to miss anything. When you choose where to get examined, you need to pay attention to these things. On the web site for our NPO, Japan Society of Breast Health, we publish clear, regional information on certified facilities that have technicians who have undergone this training, doctors who can conduct breast exams, highly accurate instruments, and certified doctors and technicians. If you go to such high level medical institutions, they will not overlook the disease and you can be examined comfortably, so it is important to look carefully for a medical institution and keep going back to one you can trust every year.
――Is there an age when you should start getting examined or a specific frequency?
Breast cancer rates rise sharply once you reach 35 and they peak in the late 40s and early 50s. These are ages when a lot is expected of you at work and from your family, so breast cancer has a major effect not only on the patient, but on the people around them as well. Another difficult aspect of breast cancer is that it can suddenly occur in an age where you are young and healthy and have a hard time imagining that you might get sick. When you are young and busy, it is only natural that you will think more about beauty and fashion than about getting examined. But breast cancer is actually drawing closer and closer. That is why it is so important to be aware of breast cancer early, prepare yourself, and get examined.
As far as the age at which you should start getting examined, I think you should start at 30 if you can. I think it is good to start then so you can make a plan for later screenings as well. However, if you have a family history of breast cancer or have a particularly high genetic risk of getting breast cancer, you are more likely to get breast cancer at an earlier age, so you should get examined in your 20s. If possible, I recommend starting off with a consultation at a specialist clinic so that you can create a lifelong screening plan that takes into account risks such as your family history and any hormone medications, as well as the condition of your breasts. You should not neglect getting examined because there is no breast cancer in your family. About 80 out of 100 people who get breast cancer are the first in their families to do so. This means they do not have a single relative with breast cancer. Please do not forget that breast cancer is a real danger for everyone.
The recommended frequency for screenings is about once per year. However, strictly speaking, the best screening plan varies from person to person. You can get a general idea at the first screening, so talk to the doctor at your first screening to make a plan that is best for you and takes into account how you can most easily get examined without it causing a financial or physical burden to you.