Breast Cancer

At a glance

Breast cancer is a malignant tumor that forms in the breast.
It is the most common cancer in Korean women, and the fourth most common across men and women together.

Let us start with one number.
In the 2023 national cancer registry statistics, the 5-year relative survival rate for breast cancer is 94.7%.
We hope this number helps those who have been diagnosed, and their families.
But it differs by stage and by condition, so check your own case with your doctor.

There are almost no symptoms early on

Breast cancer, too, usually has no symptoms in the early stage.
By the time a lump can be felt or a visible change appears,
it has often already grown to some extent.

So with breast cancer, finding it early through regular screening and self-examination matters.
How to do a self-examination is set out below, under 'What tests are done'.

Men get it too

It is rare, but male breast cancer exists.
If you can feel a lump in the chest, or there is discharge from the nipple,
men should also see a doctor.

This page is reference information summarised from official sources.
Always talk to a doctor about diagnosis and treatment.

If you notice the changes below, please see a doctor.
These are the breast cancer symptoms listed by the National Cancer Information Center.

• A lump you can feel in the breast — the most common sign
• Blood-stained discharge from the nipple
• The skin of the breast becomes thick and dimpled, like orange peel
• The nipple turns inward or changes direction
• A lump you can feel in the armpit

Things to know

Not every lump you can feel is cancer.
Non-cancerous lumps such as fibroadenoma are far more common.

Even so, do not judge it on your own.
Some people feel it, think "it is probably fine", and miss the right time.
It is better to have it checked once and be reassured.

The other way round, having no lump is not a reason to relax either.
Early breast cancer often cannot be felt.
The judgement has to come from tests.

Please take extra care if this is you

These are the breast cancer risk factors listed by the National Cancer Information Center.

• An early first period, a late menopause
• Long-term hormone therapy after menopause
• A late first birth, or not having breastfed
• Obesity
• Drinking alcohol
• Radiation exposure
• A family history of breast cancer

Having these does not mean you will get it.
Please take it as a reason not to put off screening.

Where to go first

For breast cancer, it is surgery (외과). It is not obstetrics and gynaecology.

Look for a sign that says breast surgery (유방외과) or breast and thyroid surgery (유방·갑상선외과).
These places often do mammography and ultrasound together,
so one visit can tell you a fair amount.

If there is no breast surgery clinic near you, you can first have mammography
and ultrasound at a general surgery clinic or a radiology (screening) center.

After a diagnosis

• Breast surgery / surgery — this handles the operation. It is the central department for treatment.
• Hematology-oncology (혈액종양내과) — this handles chemotherapy, anti-hormone therapy, and targeted therapy.
• Radiation oncology (방사선종양학과) — this handles radiation therapy.
• Radiology (영상의학과) — this sometimes does the biopsy (taking a sample with a needle while watching the ultrasound).
• Plastic surgery (성형외과) — when breast reconstruction surgery is needed

With breast cancer, surgery is not the end. After it, treatment from several departments continues over several years.

Do I need to go to a big hospital

If cancer is confirmed or strongly suspected, you will go on to a general hospital or a tertiary hospital.
A tertiary hospital needs a referral letter (진료의뢰서) for national health insurance (건강보험) to apply,
so it is best to get the letter from the place where you had your tests.

At that point, ask for your mammography and ultrasound images on a CD and take them with you.
If you have had a biopsy as well, be sure to bring the report.

You can look for local clinics and large hospitals together on the map.

The screening stage

In the national cancer screening program (국가암검진), breast cancer is checked with mammography (a breast X-ray).

• Who — women aged 40 and over
• How often — every 2 years

Mammography finds early changes that cannot be felt by hand, such as microcalcification.
It sees what self-examination alone cannot.

People on medical aid and the lower 50% of national health insurance (건강보험) subscribers can have it free.
To see whether you are eligible this year, check with the National Health Insurance Service.

Self-examination

The National Cancer Information Center recommends a self-examination once a month from your 30s.

• When — day 3 to 5 after your period ends is best (when the breast is softest)
• How — in front of a mirror, look at the shape, skin, and nipple of both breasts, then

lie down, put three fingers together, and press in circles as you feel around. Check the armpit too.

Self-examination cannot replace screening.
You should do both.

The diagnosis stage

• Examination — the doctor feels the breast directly.
• Mammography and breast ultrasound — the two tests show different things, so they are often done together.
• Biopsy — a piece of the suspicious area is taken and checked under a microscope. This is the test that finally decides whether it is cancer.
• MRI, CT, bone scan, PET — done in addition when needed, to check how far it has spread.

A biopsy does not only show whether it is cancer.
It also checks markers called hormone receptors and HER2.
These results decide whether anti-hormone therapy or targeted therapy can be used.

With breast cancer, treatment does not end with surgery. Care after the operation often continues over several years.
The National Cancer Information Center describes the treatments below.

Surgery

• Breast-conserving surgery — only part of the breast (the part with the cancer) is removed. The breast can be kept.
• Total mastectomy — the whole breast is removed.
• Sentinel lymph node biopsy — a test that finds and checks the armpit lymph node the cancer would reach first. If there is no cancer there, the armpit lymph nodes do not have to be removed widely, which reduces the side effect of a swollen arm.

Whether the breast can be kept depends on the size, position, and number of the cancers.
It is decided together with your doctor.

Chemotherapy

This is a whole-body treatment that removes cancer cells with medicine.
It is sometimes given before surgery to shrink the tumor, and sometimes after surgery to keep it from coming back.

Radiation therapy

It is often given when you have had breast-conserving surgery.
It is treatment to reduce the chance of cancer forming again in the remaining breast.

Anti-hormone therapy

This is used for breast cancer that has hormone receptors.
The National Cancer Information Center advises that it continues for at least 5 years.

It is often a tablet, so it is easy to take lightly, but
you must not stop it on your own. If any part of it is hard, talk to your doctor.

Targeted therapy

This is used when the cancer is HER2-positive.
Who it is for is decided by the biopsy result.

Which treatments you have, and in what order, differs from person to person.
Talk it through fully with your doctor before deciding.

It differs by hospital and by the person's condition, but the flow is usually like this.

1. Tests before surgery — a blood test, an ECG, a chest X-ray and so on, to check that you can cope with the operation.
2. Surgery — the breast operation is often done together with a check of the armpit lymph nodes (sentinel lymph node biopsy).
3. Recovery — for a period a tube is left in the wound to drain the fluid that collects. Some people go home with this tube, and the hospital will show you how to look after it.
4. After going home — the final biopsy result decides which you need out of radiation therapy, chemotherapy, and anti-hormone therapy.

Good things to bring

• Your referral letter (진료의뢰서), ID, and health insurance card (건강보험증)
• The mammography and ultrasound image CD from the previous hospital, with the reading report and the biopsy report
• A list of the medicines you take (blood-thinning medicine in particular must be mentioned in advance)
• Clothes that open at the front (there is a period after surgery when it is hard to raise your arm)

Things to know after surgery

For a while, the arm on the operated side may have no strength or may be hard to move.
The hospital will show you arm exercises (rehabilitation), so follow them as taught.
If armpit lymph nodes were removed, the arm can swell,
so you will be told not to lift heavy things or have blood taken or blood pressure measured on that arm.

The length of the stay and the steps differ by hospital.
Ask the hospital where you will have surgery for the exact details.

The special cost-sharing program (산정특례)

If you are diagnosed with breast cancer, you can apply for the special cost-sharing program for serious illness.
Once you are registered, your out-of-pocket rate for care related to that cancer drops a lot,
and it applies for a set period.

Usually the hospital that issued the diagnosis certificate applies for you.
If you do it yourself, submit the registration form to the National Health Insurance Service.

Also

• If it was found through the national cancer screening program (국가암검진, mammography), you can get support for the screening cost.
• People on medical aid and the lower 50% of national health insurance (건강보험) subscribers can have breast cancer screening free.
• Depending on income, you may qualify for the medical cost support scheme for cancer patients.
• Breast reconstruction surgery has a set range that insurance covers. Check with the hospital before surgery.

Programmes and out-of-pocket rates change.
What follows is a summary as of the reference date, so before you apply always
check the latest rules with the National Health Insurance Service.