Breast Cancer

Dr. Pooja Nandwani Patel
What is breast cancer?

Breast cancer is cancer that forms in the cells/tissues of the breasts.Breasts are made of a variety of different tissues, including ducts, lobes and lobules and glands that produce milk and carry it to the nipple. The breasts also contain lymph nodes and fatty tissue. Cancer develops when cells in the breast mutate and grow out of control, forming a tumor. Most breast cancers—about 80 percent—are ductal carcinomas, which begin in milk ducts. About 10 percent of all breast cancers are lobular carcinomas, which develop in the lobes or glands that produce milk.

1. Incidence In India

For decades together, cervical cancer was the most common cancer in women in India, and more deaths in women in India were attributed to cervical cancer than any other cancer.However, over the last two decades, breast cancer has been rising steadily way ahead of cervical cancer.This is partly due to an actual decrease in the incidence of cervical cancer.One woman dies of breast cancer, every 13 minutes in India. With increased incidence of breast carcinoma cases, survival rates have also increased, and the number of deaths associated with this disease is steadily declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease. So early detection and proper and timely treatment is the key to fight against breast cancer.

A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.
Factors that are associated with an increased risk of breast cancer include:

  • Being female. Women are much more likely than men are to develop breast cancer.
  • Increasing age. Your risk of breast cancer increases as you age.
  • A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
  • A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
  • A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
  • Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
  • Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
  • Obesity. Being obese increases your risk of breast cancer.
  • Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
  • Beginning menopause at an older age.If you began menopause at an older age, you're more likely to develop breast cancer.
  • Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
  • Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
  • Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
  • Drinking alcohol. Drinking alcohol increases the risk of breast cancer.

A lump, mass and change in the feel or position of the breast are among the most common symptoms of breast cancer. Other symptoms include:

  • Swelling, redness or inflammation
  • Changes in the nipple
  • Nipple discharge
  • Pain in the breast
  • Itchy or irritated breasts
  • Changes in colour
  • Peeling or flaky skin
  • In advanced cases symptoms according to level or organ of involvement may range from backache, headache, vomiting, abdominal pain etc

Tools and tests used to diagnose breast cancer include:

  • Imaging tests, including ultrasound and mammography
  • Biopsy
  • Lab tests, including advanced genomic testing

Different tests are used to determine whether the breast cancer has metastasized. These tests may also include:

  • Ultrasound Abdomen and Pelvis and Chest X Ray
  • CT scan Thorax and Abdomen and Pelvis or Bone scan

Breast Cancer requires multidisciplinary treatment approach with treatment as surgery as the main modality and radiation therapy, chemotherapy and hormonal therapy depending on tumor stage and hormonal receptor status

Several types of surgery may be used to remove breast cancer, including:

  • Lumpectomy. This procedure removes the tumor and some surrounding tissue, leaving the rest of the breast intact.
  • Mastectomy. In this procedure, a surgeon removes an entire breast.In a double mastectomy, both breasts are removed.
  • Sentinel node biopsy. This surgery removes a few of the lymph nodes that receive drainage from the tumor. These lymph nodes will be tested. If they don’t have cancer, you may not need additional surgery to remove more lymph nodes.
  • Axillary lymph node dissection. If lymph nodes removed during a sentinel node biopsy contain cancer cells, your doctor may remove additional lymph nodes.
  • Contralateral prophylactic mastectomy. Even though breast cancer may be present in only one breast, some women elect to have a contralateral prophylactic mastectomy. This surgery removes your healthy breast to reduce your risk of developing breast cancer again.

Radiation therapy
With radiation therapy, high-powered beams of radiation are used to target and kill cancer cells. Most radiation treatments use external beam radiation. This technique uses a large machine on the outside of the body. With latest conformal techniques like 3 Dimensional Conformal Radiation Therapy (3DCRT), Intensity Modulated Radiation Therapy (IMRT), Image Guided Radiation Therapy (IGRT), radiation can be safely administered without damaging the normal organs present in vicinity like heart, lungs, spinal cord, food pipe (oesophagus). The radiation treatment usually lasts from 3-6 weeks.

Chemotherapy is a drug treatment used to destroy cancer cells. In some cases, doctors prefer to give patients chemotherapy before surgery. The hope is that the treatment will shrink the tumor, and then the surgery will not need to be as extensive. Chemotherapy has many unwanted side effects, so discuss your concerns with your doctor before starting treatment.

Hormone therapy
If your type of breast cancer is sensitive to hormones, your doctor may start you on hormone therapy. Estrogen and progesterone, two female hormones, can stimulate the growth of breast cancer tumors. Hormone therapy works by blocking your body’s production of these hormones, or by blocking the hormone receptors on the cancer cells. This action can help slow and possibly stop the growth of your cancer.

Certain treatments are designed to attack specific abnormalities or mutations within cancer cells. For example, Herceptin (trastuzumab) can block your body’s production of the HER2 protein. HER2 helps breast cancer cells grow, so taking a medication to slow the production of this protein may help slow cancer growth.Your doctor will tell you more about any specific treatment they recommend for you.

Prevention is better than cure. Making changes in your daily life may help reduce your risk of breast cancer.

  • Ask your doctor about breast cancer screening.
  • Become familiar with your breasts through breast self-exam for breast awareness.
  • Drink alcohol in moderation, if at all.
  • Exercise most days of the week.
  • Limit postmenopausal hormone therapy.
  • Maintain a healthy weight.
  • Choose a healthy diet.

If you detect an unusual lump or spot in your breast, or have any other symptoms of breast cancer, make an appointment to see your doctor. Chances are good that it’s not breast cancer. For instance, there are many other potential benign causes for breast lumps.

But if your problem does turn out to be cancer, keep in mind that early treatment is the key. Early-stage breast cancer can often be treated and cured if found quickly enough. The longer breast cancer is allowed to grow, the more difficult treatment becomes.

If you’ve already received a breast cancer diagnosis, keep in mind that cancer treatments continue to improve, as do outcomes. So follow your treatment plan and try to stay positive.