Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.
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Dear Martin,
A sister of my girlfriend who lives in the US (the sister) was diagnosed with breast cancer last year. She was lucky and got rid of it (for now) with a relatively minor operation. This sister was then 49 years old. last week a younger sister (46) here in Thailand had an entire breast plus glands in the armpit removed for the same reason. I don't know if her condition was that much more serious or if people in Thailand are more likely to use the blunt axe?
In both cases I have not succeeded in obtaining information regarding the nature of the tumour, any medication and/or radiation.
I do know that breast cancer is the leading cause of death among women in Thailand.
Based on the above, I assume that my girlfriend is at increased risk. She is 48 years old, tall, thin, small breasts, not overweight. She has never smoked, but drank heavily and used "the pill" for a while. She practices quite fanatically every day.
She's scared now and I'm worried. I tend to drag her straight to the (Bangkok-Pattaya) hospital for at least a mammogram and maybe a BRCA test. Possibly also determination of vitamin D status because I understand that a minimum of 60 ng / ml could lower the risk. On the other hand, I also understand that fear is not a good advisor and that commercial interests and medical considerations are intertwined in Thailand.
What would be your advice in such a case?
Sincerely
M.
*****
Dear M,
In Thailand, breast-conserving operations are sometimes not performed. Research has shown that the survival rate is the same in both cases with comparable staging.
Breast cancer prevalence in SE Asia is less than half that in the US. Western Europe is slightly above the US. See chart
On average, 1 in 8 women worldwide will develop breast cancer. Usually in old age. Breast cancer is rare in men.
Prevention through mammography is still controversial. The number of women who need to be screened to save one life is high. As a result, a lot is treated unnecessarily with all the associated dangers.
Hereditary breast cancer is uncommon and two cases in one family are generally due to chance. See also: www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815
BRCA statistics: www.uofmhealth.org/health-library/abo7122#abo7123
There you can see how the chances of survival are increased with positive BRCA and intervention. 1 in 400 women is positive for BRCA and therefore has a 4x higher chance of developing cancer.
A geneticist can calculate exactly how likely it is that your wife is positive. That depends on many factors. If the probability is low, testing is not recommended.
Hormonal therapy with, for example, tamoxifen, raloxifene, or anastrozole reduces the risk of breast cancer, but can have serious side effects.
Use of alcohol should be discouraged.
For peace of mind, I recommend that you have a mammogram and arrange a consultation for genetic counseling.
Panic is not necessary. Most likely, your wife is exposed to the same risks as other women.
Yours faithfully,
Dr. Maarten