Breast Cancer Prevention and Treatment Advances at Thainakarin Hospital by Dr. Puttiporn Naowaset

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Breast cancer is a life-threatening disease that women should never overlook, regardless of age. At Thainakarin Hospital, we have a specialised Breast Center, staffed by a team of doctors, nurses, and medical personnel with extensive expertise in breast diseases. To aid in primary prevention, it’s vital that women avoid certain risk factors, including an unhealthy diet, obesity, alcohol consumption, and physical inactivity. Steering clear of these can help maintain a robust immune system and balanced hormones.

When it comes to diagnosing breast cancer, especially in patients with genetic abnormalities, precision is key. Here’s a breakdown of high-risk groups for genetic abnormalities in breast cancer patients:

• Diagnosed with breast cancer under 50 years of age
• Diagnosed with triple-negative breast cancer
• Male breast cancer patients
• Family history of breast cancer
• Diagnosed with breast cancer at 46-50 years old along with:
  • Unknown family history of genetic abnormalities
  • Diagnosed with bilateral breast cancer
  • At least one first-degree relative with breast, ovarian, pancreatic, or prostate cancer
• Diagnosed with breast cancer at 51 years or older along with:
  • At least one first-degree relative diagnosed with breast cancer at 50 years or younger, or male breast cancer
  • Ovarian cancer
  • Pancreatic cancer
  • Metastatic prostate cancer
  • At least two first-degree relatives with breast or prostate cancer
  • At least three first-degree relatives with breast cancer

For individuals with a family history of breast cancer:

• A family history similar to the criteria above
• No family history but with an assessed likelihood of BRCA gene abnormalities greater than 5%, determined using models like Tyrer-Cuzick, BRCAPro, or CanRisk.

4 Methods for Breast Cancer Diagnosis:

1. Breast Cancer Screening with a Digital Mammogram: This method uses radiation levels similar to a regular chest X-ray and provides a detailed overview of the breast. It’s effective in detecting small calcium deposits that may suggest early-stage breast cancer. However, in younger women with dense breast tissue, a digital mammogram might not be sufficient, and a breast ultrasound may be needed.
2. Breast Cancer Screening with a Breast Ultrasound: Ultrasound, which is radiation-free, is ideal for children and pregnant women. It offers an accurate distinction between lumps, cysts, and lymph node abnormalities. While it’s excellent for evaluating lumps, it may not detect calcium deposits as efficiently as a digital mammogram.
3. Breast Screening with Magnetic Resonance Imaging (MRI): Though highly sensitive, MRI does not offer greater accuracy in diagnosing breast cancer compared to mammograms or ultrasounds. It’s mainly used for difficult diagnoses or screening individuals with genetic abnormalities.
4. Diagnosis and Biopsy: When a suspicious lesion is detected, a biopsy is the most precise method to determine its nature. If an abnormality is found via ultrasound, an Ultrasound-Guided Core Needle Biopsy is performed by a radiologist. If detected via mammogram, a Stereotactic-Guided Biopsy is conducted, typically used to examine small lesions often consisting of calcium deposits. Both methods ensure the biopsy results are available within 24 hours.

Personalised Medicine Treatment and Surgery:

Treatment at Thainakarin Hospital involves a multidisciplinary approach for surgical and non-surgical treatments:

1. Breast Conserving Surgery: Suitable for small tumors without widespread calcification, or cases with 2-3 tumors treatable with breast conservation surgery. Oncoplastic techniques are applied to maintain aesthetic appearance, possibly involving fat relocation or breast size adjustment for symmetry. Sometimes, chemotherapy is administered before surgery to reduce tumor size.
2. Mastectomy with Reconstruction: When conserving the breast isn’t feasible, a mastectomy (complete removal) is followed by reconstruction using implants or the patient’s tissue.
3. Sentinel Lymph Node Biopsy: This method examines the first lymph node to check for cancer spread, minimizing the need for extensive lymph node removal and associated complications. Special dyes like Isosulfan Blue or Indocyanine Green increase accuracy.

Systemic Treatment and Radiation Therapy:

Treatment options include chemotherapy, immunotherapy, hormonal therapy, or targeted therapy. Radiation therapy, guided by advanced equipment like the Vitalbeam system, ensures precise targeting. Each patient’s treatment plan is tailored to their specific cancer type, stage, hormone receptor status, age, and personal preferences.

Recovery and Reducing Complications:

Physical Medicine & Rehabilitation (PM&R) helps minimize post-treatment complications such as arm swelling or frozen shoulder. The goal is to restore normal daily functionality, preserve body image, and reduce anxiety, ensuring the best possible recovery.

Highlights of the Excellent Breast Cancer Center at Thainakarin Hospital:

• Tissue Biopsy: Performed by specialized radiologists with results within 24-48 hours.
• Breast Conserving Surgery: Not contraindicated even with 2-3 nearby lesions, utilizing oncoplastic techniques, and coordinated with a radio-oncologist for comprehensive planning.
• Medical Oncologists: A dedicated team plans adjuvant therapy as needed, before or after surgery.
• Physical Medicine & Rehabilitation: Postoperative programs ensure patients maintain a quality life close to normal.
• Vitalbeam Radiation Therapy System: Enables targeted radiation, reducing complications and the need for extensive lymph node removal.

Article by Dr. Puttiporn Naowaset, Surgery, Surgical Oncology at Thainakarin Hospital.