Denise Azzopardi talks to surgeon Gordon Caruana Dingli

It is very important for women to carry out regular check-ups of their breasts and not to forget about breast cancer awareness once October, which is Breast Cancer Awareness Month, is over, surgeon Gordon Caruana Dingli stressed.

It is difficult to generalise about the risks of getting breast cancer, however the American National Cancer Institute Website http://brca.nci.nih.gov/brc/ has a tool where an individual can assess her statistical risk of getting the disease.

Another form of testing is genetic where young females are checked for a specific gene - BRCA 1 - that is associated with a higher risk of getting breast cancer and that may have been inherited from the mother. Mr Caruana Dingli said that 10-15 per cent of these genes are inherited.

But this method is complex and expensive, and there isn't much that can be done after test results are issued as the gene cannot be altered. However, women who are found to have the gene may be offered preventive treatment with the drug Tamoxifen or a mastectomy (the removal of the breast) to prevent the development of a cancer.

The best thing is to have regular check-ups using mammography as well as ultrasound since the former is not an infallible test and the cancer may not always be detected. However, mammography can be used to catch the cancer early or to investigate a lump.

Mr Caruana Dingli said that there are three stages in dealing with patients with a lump. He first takes a history of the patient and carries out a clinical examination. A mammogram and ultrasound are then taken to determine the nature of the lump, and lastly a small part of the lump is taken (biopsy) for examination. Tumours that are large and hard are usually malignant and their nature depends on the age of the patient.

Developments in dealing with breast cancer have taken place over the last couple of years. Mammogram machinery and expertise in interpreting lumps has improved. A fairly recent development is cytology, where a fine needle is used to retrieve cells from a lump, which are then studied under a microscope. The cells show whether the lump is benign or malignant.

Two major advancements have taken place with regards treatment. Less tissue is being removed during surgery with less mastectomies being necessary. When a mastectomy is carried out, more sophisticated plastic surgery can better reconstruct the breast with excellent results. The other improvement has been with chemotherapy that is now more effective and there are better ways of dealing with side effects.

Surgery is often followed by radiotherapy on a daily basis for a few weeks at Sir Paul Boffa Hospital, hormonal treatment, or chemotherapy, that is taken intravenously, which like hormone therapy, affects the entire patient.

A very new drug called Herceptin is a monoclonal antibody that targets cancer cells only and kills them. The advantage of this treatment is that it is effective without so many toxic effects. However, Herceptin cannot be used for every cancer but for those cancers that have receptors known as cerb2 that determine the way cells grow.

Dr Caruana Dingli said that unfortunately there is no way of preventing breast cancer but certain life-style changes may help to decrease its incidence. This includes eating a variety of fruit and vegetables containing vitamins A, C, and D and Selenium, which are all antioxidants. Physical exercise and avoiding obesity and smoking also helps. He is also optimistic that mortality from breast cancer has begun to decrease due to better diagnosis and better medical treatment.

"The approach has changed and breast cancer patients are now managed by a multi-disciplinary team. Doctors from various specialities discuss their patients to give optimal treatment to each individual", added Dr Caruana Dingli. He is also confident that international research in breast cancer will lead to new treatments.

However, he amphasises the quality of care and that doctors work hard to treat their patients with care by explaining all the details and discussing treatment options with them. "We don't only want to prolong life, we also want to improve the quality of life", said Dr Caruana Dingli.