Breast cancer is the abnormal growth of cells within the breast tissue, which includes the breast lobules, ducts and connective tissue. These abnormal cells grow at a rapid rate and have the ability to spread to other tissues in the body as well. Even though we only consider breast cancer to affect women, it can very rarely affect men as well.
In India, breast cancer is the most common cancer among women and accounts for 30% of new cases of cancer diagnosed in women each year. Unfortunately it is also the most common cause of cancer related death in Indian women. About one in eight women are at risk of being diagnosed with breast cancer at some point in their life. The five year survival rate for those patients diagnosed with breast cancer is around 89%.
What Are the Symptoms of breast cancer?
On certain occasions, patients who are diagnosed with breast cancer actually do not present with symptoms, and it is accidentally found during a screening mammogram or physical examination by the doctor. But, some of the more common symptoms of breast cancer include:
- A breast lump or thickened area of tissue in the breast or armpit
- Breast pain or soreness of the nipples which doesn’t change with your menstrual cycle
- Nipple discharge, a blood stained one being even more worrying
- Alterations in the shape or size of your breast
- Inversion of your nipple or cracking of the skin around the nipple
- Dimpling of the skin on the breast, or redness of the breast
If you have developed any of these symptoms and you are worried, then you should definitely see your doctor at the earliest.
What causes breast cancer?
Although the exact cause of breast cancer remains unclear, there have been many factors associated with an increased risk of developing breast cancer, some of which are preventable. These include:
- Increasing age in women
- Genetic predisposition, where the risk is very high if you have had a first degree relative who has had breast cancer, and also women who have mutated genes such as BRCA 1 and BRCA 2
- A past history of malignant or benign conditions of the breast
- Prolonged exposure to estrogen like,
- due to early menarche (starting of menstrual cycle at early age)
- late menopause or (delayed stopping of menstrual cycle)
- nulliparity (not having a child due to any reason)
- Exposure to radiation
- Lifestyle factors
- obesity
- lack of physical activity and
- consumption of alcohol
What tests are used to diagnose breast cancer?
Diagnosis of breast cancer is done using physical examination of the patient as well as investigations. Although the physical examination will be helpful in diagnosing a condition related to the breast, the exact diagnosis of cancer can be made using investigations such as:
- Mammogram – which is almost like an X-ray imaging of the breast and can help determine the presence of masses which are too small to be felt on physical examination.
- Ultrasound Breast - a painless scan which helps image your breast tissue using a probe. This is done usually for younger patients and for patients with abnormal mammography.
- Biopsy – a procedure where your doctor will remove some of the breast tissue by inserting a needle and then examining the tissue under the microscope to detect the presence of abnormal cells.
- MRI Breast & PET CT may be required for further staging.
What is the treatment for breast cancer?
The most important factor upon which the treatment modality depends on, is the staging or extent of breast cancer, and is determined by the size of the cancer and the extent of spread. The earliest site where the disease goes from breast is to axillary nodes. The other common sites to which breast cancer can metastasize are the lungs, liver and bones.
Treatment of breast cancer needs to be personalized instead of standardized. There has to be a protocol but the protocol needs to be implemented as per the patients needs. The treatment options available for breast cancer include:
- Surgery – the surgical options include a mastectomy (complete removal of the breast) or lumpectomy (removal of the breast lump only) if it is feasible.Axillary lymphnodes needs to be addressed also by either doing an elective axillary clearance or sentinel lymphnode biopsy. If breast conservative surgery is performed, then radiotherapy is recommended as a follow up.
- Chemotherapy – Most of the breast cancers would require chemotherapy either before or after surgery. Chemotherapy entails oral or intravenous medicines which act systematically. In case the disease is spread in multiple organs, chemotherapy may be the only option.
- Radiation therapy - commonly used following surgery to destroy any cells that may have been left behind, and if there is a high risk of cancer recurrence in the same area or in the chest. It is mandatory after breast conserving surgery and required for large tumors.
- Hormone therapy – where medication to lower the circulating levels of female hormones are administered, which in turn will help slow down the growth of the female hormone dependent cancer cells.
What is the Prognosis of breast cancer?
The outcome of breast cancer is dependent on many factors such as the type of breast cancer, the stage of the disease, your level of fitness and past medical history. But the most common breast cancers have a very good prognosis, especially if detected early.
Screening for and prevention of breast cancer
Screening programs are widely available for breast cancer and include having a mammogram done once every 2 years for women between the ages of 50-75. Women who have a strong family history of breast cancer should be screened more frequently and should discuss the options with their doctor.
Certain lifestyle changes such as lowering your consumption of alcohol and maintenance of a healthy weight through regular exercise have been shown to be helpful. Women who are at very high risk due to gene mutations and family history can opt for bilateral prophylactic mastectomy.