Breast cancers account for around 26.3% of all cancers reported among Indian women. Read on to discover the risk factors, diagnosis, treatment, and prevention of breast cancer here.
What is breast cancer?
What are the causes and risk factors for breast cancer?
- Age: The risk increases with advancing age
- Gender Women are more at risk compared to men
- History of previous breast cancer The risk of cancer in the contralateral breast increases if cancer occurs in one breast
- Onset of menarche before the age of 12 years
- Birth of the first child after the age of 30 years
- Women who have never given birth
- Women who attained menopause after 55 years
- Family history of breast cancer
- Exposure to radiation
- Use of contraceptive pills
- Hormone replacement therapy in post-menopausal women
What are the symptoms of breast cancer?
Breast cancer often occurs without any symptoms and is often discovered accidentally during routine screening. It can manifest as:
- Lump or discharge from the breast
- Breast pain
- Any changes in the size or shape of the breast or nipples
- Ulceration on the breast
- Inverted nipple
What are the types of breast cancer?
Breast cancer can originate within the ducts or the lobules of the breast and is of the following types:
- Infiltrating ductal carcinoma, the most common type of breast cancer
- Ductal carcinoma in situ is considered precancerous since the cells have not extended beyond the milk ducts
- Infiltrating lobular carcinoma involves the lobes
- Lobular carcinoma in situ is considered precancerous but high-risk of full-blown breast cancer
- Triple-negative breast cancer is the most aggressive and difficult to treat form of breast cancer which is seen among women younger than 40 years. The three markers for breast cancer (oestrogen, progesterone and HER2) are negative
- Inflammatory breast cancer resembles an infection and is characterised by redness, swelling, and dimpling of breast
- Paget’s disease of the breast affects the nipple and the skin around the nipple
When should I consult a doctor?
You must consult a doctor if you notice any abnormal swelling, redness, discharge or lumps on your breasts or armpits. Breast cancers usually progress without causing any symptoms so it’s advisable to undergo routine screening to ensure that if any cancerous changes occur, it can be detected at the earliest.
Can breast cancer spread to other body parts?
Yes. Breast cancer can spread through the blood to other parts of the body. Apart from lymph nodes, it commonly spreads to the bones, the liver, the lungs and the brain.
How is breast cancer diagnosed?
Breast cancer is usually detected during routine health screening. If you present with symptoms, your doctor will ask you in detail and perform a thorough physical examination. You will be advised to undertake further tests including:
- Blood tests
- Imaging
- Mammography
- Ultrasound
- MRI
- Biopsy: sample cells collected from the suspicious area are observed under the microscope to evaluate if they are cancerous. The biopsy sample can be collected by various methods
- Fine needle aspiration cytology: Cells are aspirated using a special needle and syringe
- Core needle biopsy: Done under the guidance of ultrasound or MRI. Core cells are collected using a slightly larger needle
- Open biopsy (surgical): A part of the suspicious tissue (incisional biopsy) or the entire lesion (excisional biopsy) is surgically removed
What are the stages of breast cancer?
The most commonly used staging system for breast cancer is TNM staging.
- ‘T’ stands for the size of the cancerous mass
- ‘N’ stands for the involvement of lymph nodes
- ‘M’ stands for metastasis (spread of cancer to other organs)
- Stage 0: carcinoma in situ
- Stage I: small tumour that is limited to the breast
- Stage II: bigger tumour size or a small tumour involving up to 3 nearby lymph nodes
- Stage III: an even larger tumour size or smaller tumours that involve 4 or more lymph nodes
- Stage III: an even larger tumour size or smaller tumours that involve 4 or more lymph nodes
- Stage IV: has spread to other parts of the body
How is breast cancer treated?
Surgery
After considering the size, stage, and type of cancer you have, your age, general health, menopausal status, and preferences. The surgeon will advise you on the best procedure for you. Some common procedures are:
- Lumpectomy: The surgeon removes the cancerous tissue and a surrounding area of normal tissue with or without removal of the lymph nodes. After the procedure, you may require a course of radiation therapy. This approach is preferred for early-stage breast cancers. This is a breast-conserving surgery
- Partial Mastectomy or Quadrantectomy: The surgeon removes a quarter of the breast including the tumour and some of the surrounding breast tissue, the overlying skin, and some of the muscle. Though this is a breast-conserving procedure, there will be a change in the size and shape of your breast
- Simple Mastectomy: In this procedure, the entire breast is removed without the removal of lymph nodes. It is recommended for women with multiple areas of ductal carcinoma in situ (DCIS) but without lymph node involvement or for prophylactic mastectomies
- Modified Radical Mastectomy: The surgeon removes the entire breast tissue, nipple and associated lymph nodes while the chest muscles intact. Breast reconstruction is advised
- Radical Mastectomy: The surgeon removes the entire breast tissue, nipple, associated lymph nodes, and chest wall muscles under the breast. This procedure is not preferred nowadays as it is the most disfiguring. Modified radical mastectomy is preferred since it is equally as effective and less disfiguring
Radiation therapy
A radiation oncologist uses high-energy X-rays or other particles to destroy cancer cells using radiation given by a machine outside the body. This is called external-beam radiation therapy. When radiation therapy is given by inserting radioactive sources into the tumour, it is called brachytherapy.
Chemotherapy
A medical oncologist prescribes drugs to destroy cancer cells. It is given either intravenously or orally so that the drugs get into the bloodstream and reach cancer cells throughout the body. It is usually administered as a specific number of cycles given over a set period. It may consist of a single drug or a combination of different drugs. Commonly used drugs are doxorubicin, cyclophosphamide, and paclitaxel.
Hormonal therapy
It is an endocrine therapy that is an effective treatment for most tumours that are positive for either oestrogen (ER-positive) or progesterone receptors (PR-positive). These tumours require hormones for growth. Blocking the hormones can prevent cancer growth and recurrence. Tamoxifen, anastrozole, exemestane and letrozole are commonly used.
Targeted therapy
This very focused treatment targets cancer-specific genes, proteins, or factors that help cancer growth and survival. Damage to healthy cells is reduced.
HER2-targeted therapy like trastuzumab, pertuzumab, and neratinib is now available.
The surgeon may recommend systemic treatment with chemotherapy or hormonal therapy before surgery called neoadjuvant therapy. It is used to shrink a large tumour which makes it easier to remove.
Treatment given after surgery is called adjuvant therapy. Adjuvant therapies may include radiation therapy, chemotherapy, targeted therapy, and hormonal therapy. It is required in case of a large tumour, if multiple lymph nodes are involved, or if the cancer has grown into the skin and chest wall.
How can I prevent breast cancer?
- Eat healthy foods rich in antioxidants
- Limit the use of oral contraceptives and post-menopausal hormone replacement therapy
- Exercise
- Undergo routine screening to ensure that even the early changes are detected and treated
- Perform regular self-examination of breasts
Visual self-examination-
- Looking forward, check for wrinkling, dimpling, or alterations to the size, form, or symmetry
- Verify whether your nipples are turned in (inverted)
- Put your hands on your hips and check your breasts
- With your hands clasped together and your arms raised over your head, examine your breasts
- Check the ridges along the bottom of your breasts by lifting them
Manual self- examination
- Lie down on your back and feel your breasts with the pads of your fingers
- Feel your underarms
Contact your doctor if you notice
- Any lump or knot in your underarms
- Dimpling, lumps on the breasts,or an unusual inversion of your nipples
- Swelling, redness or pain in your breasts
- Ulcers, rashes or itching of your breasts
- Unusual discharge from your breasts
