Breast Cancer is the most common cancer in women today and is especially on the rise in women in the urban areas. Most breast cancers in India are sporadic, i.e. they develop in women with no family history and none of the usual high risk factors. A very small minority have a strong family history. Hence, every woman should be made breast aware, i.e. aware of any changes in her own breasts.
An annual or a semiannual mammogram in women over the age of 40 is still recommended, along with a clinical breast examination by a doctor, as well as a monthly self-breast examination. The best time to perform a self-breast examination is roughly 10 days after the periods have occurred, when the breasts are the least tender or lumpy.
Genetic testing for breast cancer (BRCA1/2) is not meant for the general population; it is meant only for those with a strong family history of breast and/or ovarian cancer. Even in these persons, genetic testing is to be carried out only after two or more separate rounds of pre-test counselling, as the consequences of a test coming positive have to be carefully explained. Controversy still surrounds the use of oral contraceptive pills, hormone replacement therapy and Oestrogen supplements as risk factors for causing breast cancer.
ARE ALL BREAST LUMPS CANCEROUS?
Not all lumps are cancerous. However, a systematic evaluation is required to rule out breast cancer. Breast diseases are broadly classified as benign (non-cancerous) & malignant (cancerous).
Benign breast diseases:
Breast cysts, Fibroadenomas, Fibroadenosis, Mastalgia (cyclical /non-cyclical) & Mastitis.
Malignant breast diseases:
Malignant cancers are further classified as:
Non-invasive (In-situ cancers) & Invasive (Infiltrating cancers).
Treatment is based upon the type of cancer, the physical condition of the patient and the stage at presentation. Accordingly, breast cancer may present as early invasive/ non-invasive, locally advanced or metastatic breast cancer.
WHAT ARE MY CHANCES OF DEVELOPING BREAST CANCER?
Breast cancer mainly affects women, but it can happen in men as well. The chances of developing cancer increase with age, but no age is exempt.
Certain risk factors have been identified:
- Family history of breast/ ovarian cancer (maternal/ paternal family), more so with cancer arising before the age of 60 years
- BRCA 1/2 gene mutations
- Early menarche &/ late menopause (increased fertile window)
- A history of non-child bearing and non- breast feeding
- Previous breast cancer/ biopsies
- Advancing age
- Use of alcohol/ tobacco.
The presence of a risk factor does not necessarily mean that a woman will always develop breast cancer. However, women with risk factors should undergo regular health checks with a specialist.
HOW DO I KNOW IF I HAVE BREAST CANCER?
The symptoms are initially quite subtle and often missed. However, as the disease progresses, certain signs and symptoms arise:
- A newly palpable lump is the most common symptom. It may or may not be painful.
- Skin retraction or dimpling, more apparent on raising the arms may be present.
- Changes in the skin over the nipple, or nipple retraction
- Bloody or clear nipple discharge may also point to a benign or malignant breast condition
- A lump in the armpit
- In advanced stages of the disease, pain, reddish discoloration or ulceration of the skin over the breast, bone pains, jaundice, haemoptysis and cachexia may develop.
Any unusual changes in the breast should not be ignored and brought to the notice of your doctor as soon as possible.
HOW CAN I PREVENT MYSELF FROM GETTING BREAST CANCER?
- A healthy lifestyle & a well-balanced diet can help prevent most diseases and cancer is no exception.
- A screening mammogram is recommended in all women above the age of 40 years.
- In women with a family history of breast or ovarian cancer, screening is recommended 10 years prior to the age at which the relative was diagnosed.
- High risk screening in the form of breast ultrasound, MRI is required in younger women.
- BRCA 1 & 2 gene testing is advised after adequate pre-test counselling in women with a strong family history.
- Breast self-examination should be practised every monthly, along with a clinical breast examination at least once a year.
DO ALL BREAST LUMPS REQUIRE SURGERY?
- But all breast complaints need to be evaluated by a specialist before to rule out cancer.
- A breast lump is evaluated by performing a mammogram and ultrasound.
- Additionally, a Breast MRI may be advised for further characterisation.
- Diagnosis is confirmed with a core biopsy.
- A PET- CT is advised to rule out metastases.
- Pre- operative investigations are carried out to assess fitness for surgery.