08
issue: breast
The HEALTH | NOVEMBER, 2018
JADPRO
ADAM
The illustration shows
spontaneous discharge from
a nipple
Intraductal
papilloma
Intraductal papilloma is a
benign clump of tissue in our
milk duct.
UM Specialist Centre Con-
sultant Oncoplastic Breast
Surgeon Dr See Mee Hoong
(pic) explained that the breast
tissue changes from the first
day we were born until the
last day.
“They change and there
is never one day where it is
the same. This occurs due
to hormonal changes every
day and every month which
causes a lot of changes in our
body and not just in the breast
tissue.”
“Intraductal papilloma
which occurs in the older age
group (50 years and above)
as well as in the younger
population, is a type of a
benign disease in our duct.
But, as we know, sometimes
it can change to other types
of disease which is what we
are worried about.”
See emphasised that
intraductal papilloma can be
divided into two types - the
peripheral which is outside
and away from the nipple
while the other is the central
type.
“The central type is more
common compared to the
peripheral where there
is a high chance that it is
cancerous.”
Symptoms
“Some present with nipple
discharge while others, with
an ultrasound and screening,
show lesions over the periph-
eral of the breast.”
“Again, we would utilise
the three steps examination
as we do not want to miss the
papillary breast cancer which
is the most extensive type.”
Presentation
“There are a few patients of
mine who are in their 40’s
and 50’s who come with
nipple discharge. Upon
investigation and a MRI, we
find that it is not a small dot
but an area that is connected
that usually presents more of
a bunch of grapes and part
of it is early cancer (ductal
carcinoma in situ), while part
of it is still papilloma or ductal
papilloma.
This uncontrolled cell growth is the reason that HER2-positive breast cancer is regarded as one of the most aggressive subtypes.
HER2-positive
breast cancer
Malaysia accounts for
25 per cent of all breast
cancers compared to 20
per cent globally
R
AMSAY Subang Jaya
Medical Centre (SJMC)
Consultant Clinical
Oncologist, Dr Yap Beng
Khiong revealed recently
that Malaysia has 4000
cases of breast cancer
annually.
“Among the Chinese it is the most
common, followed by the Malays and
the Indians. In terms of presentation,
Malay patients tend to present at a later
stage due to psychosocial issues, different
believes, different cultures and wanting
to try alternative medicine.”
While he stressed that late presenta-
tion of breast cancer can lead to poorer
outcome, he said that urbanisation is an
important issue as they have better access
to treatment.
Dr Yap Beng Khiong.
“HER2 is
essentially a
protein that is
produced by the
cancer cell, and it
is to do with the
over expression of
this HER2-protein
which can be tested
in our dietary.”
Types of discharge
Generally, there are many kinds of dis-
charge – the serious type which is a clear
HER2 breast cancer is a subtype of breast
cancer.
“Globally, it accounts to 20 – 25 per
cent of breast cancer, but in Malaysia
HER2-positive breast cancer appears to
be slightly higher to 25 – 30 per cent of all
breast cancer.”
“HER2 is essentially a protein that
is produced by the cancer cell, and it is
to do with the over expression of this
HER2-protein which can be tested in our
dietary.”
“If it is HER2 positive, the behavior of
the cancer is more aggressive. It leads to
more incidence of recurrence and spread.
Fortunately over the last 15 years, there
has been the development of anti-HER2
targeted therapy which has led to better
outcome in terms of reduction in cancer
recurrence and improvement in survival.
This is used in early breast cancer and
advanced breast cancer.”
Treatment
“The other type of drugs that has a lot of
development is the hormone responsive
breast cancer treatment which is admin-
istered at stage 4 as there is a great need
after the initial therapy where we try to
block the action of the feeding hormones
but after a period of time, they fail to
work.”
“However, when you give a patient
anti-HER2 therapy as a given treatment
after the initial surgery, there is a reduc-
tion rate of 20 to 25 percent, while survival
is at 10 per cent. In the advance setting of
stage 4 breast cancer, the risk reduction in
terms of death is at 40 per cent.”
INFORIAU.ID
Nipple
discharge in
non-lactating
women
Patients who have nipple discharge are
divided into two types – one who is still
breast feeding and the other; non-breast
feeding patient.
UM Specialist Centre Consultant
Oncoplastic Breast Surgeon Dr See Mee
Hoong explained that breastfeeding
patients are the ones in the range group
of 20 to 40 years old.
“During the lactating period and when
they are breastfeeding – off course it is
quite common to have a milky colour and
white colour discharge, but we are talking
about the one that is not breastfeeding;
single or married women but still have
nipple discharge. This are the ones that
we have to be very careful.”
HER2-positive breast cancer
Blood stained nipple discharge in non-
lactating women can be a sign of cancer.
discharge, the milky discharge while the
third one is the one that is with the blood
stain.
“When they have discharge, usually
the doctor would find out what colour
and how frequent is the discharge,
whether it is spontaneous that comes
without pressing but keeps oozing out or
happens only when squeezing.”
“Those that are very spontaneous
and a lot with blood stain is a warning
sign for women to signal that it might
be cancerous in the dart. Discharge only
when squeezing is usually benign (non-
cancerous condition).”