CancerInformation

Advances in the diagnosis and treatment of breast cancer have lead to increased survival rates and the number of deaths is steadily reducing
Other factors are earlier detection, new personalized approach to treatment and a better understanding of the disease.

  • Breast cancer is the most common cancer amongst women in urban and second in rural India.

  • Projection for India in 2020 – over 1,70,000 new cases      Source : Globocan

  • 1 in 28 women is likely to develop Breast Cancer in India

  • Breast cancer occurs almost entirely in women, but 1% - 2% men can get it too

What is Breast Cancer?

Breast cancer is the most common cancer amongst women in India.

Breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells and continue to gather, forming a lump or mass. The cells may spread (metastasize) to the lymph nodes or other parts of the body. Breast cancer mostly begins with cells in the milk-producing ducts (invasive ductal carcinoma) or in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.

Researchers have identified hormonal, lifestyle and environmental factors that may increase the risk of breast cancer. But it is unclear why some women who have no risk factors develop cancer, yet others with risk factors never do. It is likely that breast cancer is caused by a complex interaction of genetic makeup and environment factors.

Studies say that over 1,70,000 new breast cancer cases are likely to develop in India by 2020. According to research, 1 in every 28 women is likely to get affected by the disease. While breast cancer occurs almost entirely in women, around 1-2% men are likely to get affected, too.

Signs and Symptoms of Breast Cancer

Every woman must be aware how her breasts normally look and feel.
This will help her to be aware of changes in the breasts immediately, so that she can take action without any loss of time.

A lump in the breast or underarm (most common symptom)

Change in the size, shape or appearance of the breast.

An inverted nipple (newly developed)

Peeling, scaling, crusting or flaking of the area of skin surrounding the nipple or breast skin.

Redness or pitting of the skin over the breast (like the peel of an orange).

Bloody or clear discharge from the nipple.

Swelling, warmth, redness or darkening on the breast.

Itchy, scaly sore or rash on the nipple.

If you find a lump or any other change in your breasts, consult your Doctor immediately. Most breast lumps are not cancer; they may be due to a non-cancerous cause like a cyst or a fibro adenoma. Some lumps come and go, while others may change in shape, size and texture in relation to a woman's menstrual cycle.

Early detection of breast cancer is important as it provides several treatment options, increased survival, and good quality of life. Early detection provides the best chance of effective treatment. When Breast cancer is found early, when it’s small in size and has not spread, it is easier to treat successfully.

Risk Factors

A risk factor is anything that makes it more likely to get breast cancer. But having one or even several risk factors does not necessarily mean you will develop breast cancer. Many women who develop breast cancer have no known risk factors.

Inherited Breast Cancer

About 5 to 10 % of breast cancers are linked to gene mutations passed through generations of a family. The most well-known inherited mutated genes that can increase the likelihood of breast cancer are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of breast and ovarian cancer.

If there is a strong family history of breast cancer or other cancers, consult your doctor who may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed through your family.

The Doctor will refer you to a genetic counselor, who will review your family health history and discuss the benefits, risks and limitations of genetic testing to help you to make the right decisions.

Other Factors associated with the risk of breast cancer are:

  • Increasing Age
    The risk of breast cancer increases as you grow older
  • A Personal History of Breast Conditions
    If you have had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, there is an increased risk of breast cancer
  • A Personal History of Breast Cancer
    If you 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, especially at a young age, your risk is increased.
  • Inherited Genes that Increase Cancer Risk
    Some gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are BRCA1 and BRCA2. These genes can greatly increase the risk of breast cancer and other cancers, but they do not 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 or overweight increases the risk of breast cancer. With more body fat, your body stores more estrogen and estrogen stimulates tumor growth. Maintain a healthy weight by being physically active and eating a healthy, balanced diet.
  • Early Menstruation or Late Menopause.
    Beginning your period early (before 12) and menopause at an older age (after 55), increases the risk of breast cancer. The longer a woman menstruates, the higher her lifetime exposure to the hormones estrogen and progesterone. A higher lifetime exposure to estrogen is linked to an increase in breast cancer risk.
  • Having the First Child at an Older Age
    Women who give birth to their first child after age 35 may have a slightly increased risk of breast cancer.
  • Never Had a Pregnancy
    Women who have never been pregnant have a greater risk of breast cancer than women who have had one or more pregnancies.
  • Postmenopausal Hormone Therapy
    Women who take hormone therapy that combine estrogen and progesterone to treat menopause have an increased risk of breast cancer.
    The risk decreases when women stop taking these medications.
  • Drinking alcohol
    Drinking alcohol increases the risk of breast cancer. The risk increases with the amount of alcohol consumed.
    The way alcohol is metabolized in a woman's body may increase estrogen levels in the bloodstream, which increases the risk.
  • Being Physically Inactive
    Regular physical activity reduces breast cancer risk, especially in menopausal women.
  • Long Term Use of Oral Contraceptives
    Women using oral contraceptives (birth control pills) have a slightly higher risk of breast cancer. Once the pills are stopped, this risk goes back to normal within about 10 years.
  • Dense Breasts
    Breast tissue is called dense if there is a lot of fibrous or glandular tissue and not much fat in the breasts. Women whose breasts are dense, rather than fat, have a higher risk of breast cancer, and the risk increases with higher breast density.
  • Smoking
    Smoking increases the risk of at least 15 cancers including breast cancer. Women who smoke are more likely than non-smokers to develop breast cancer. Long-term exposure to second hand smoke may also increase the risk.

Breast cancer risk reduction for women with a high risk

If your doctor has assessed your family history and determined that you have risk factors, such as a precancerous breast condition, that increase your risk of breast cancer, you may discuss options to reduce your risk, such as:

  • Preventive Medications (chemoprevention).
    Estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in women with a high risk of the disease.
    These medications carry a risk of side effects, so doctors reserve these medications for women who have a very high risk of breast cancer. Discuss the benefits and risks with your doctor.
  • Preventive Surgery
    Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.

Breast Cancer Screening for Early Detection

Screening is the best way to protect you from breast cancer. It does not help prevent the cancer, but it can help find it early when treatment is easier and less invasive.

Breast Self- Awareness

It is important to check yourself regularly, so that you can spot any change immediately. Remember to check all parts of your breasts, armpits and up to your collarbone.
Check once a month, one week after your period, after age 20

Clinical Breast Exam

It is an examination by a doctor or nurse who will check both breasts and the lymph nodes in armpits. Recommended every 3 years between 20 & 30 and every year after 40

Mammography

It is an x-ray of the breast which can find cancer when it is too small to be felt. To be done after age 45 upon advice of Doctor and based on personal risk factors. If an abnormality is detected, the doctor may recommend a diagnostic mammogram for further evaluation.

Diagnostic Tests

  • Breast ultrasound
    Ultrasound uses sound waves to produce images of structures deep within the body.
    This test may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst
  • Biopsy – (Removing a sample of breast cells)
    A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, a specialized needle device guided by X-ray or another imaging test is used to extract a core of tissue from the suspicious area. Biopsy samples are sent to a laboratory for analysis to determine whether the cells are cancerous, the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors which may influence the treatment options.
  • Breast magnetic resonance imaging (MRI)
    An MRI machine uses a magnet and radio waves to create pictures of the interior of the breast. Before the MRI, a dye is injected. An MRI does not use radiation to create the images.
    Other tests and procedures may also be used depending on the requirement

Staging Breast Cancer

After the Doctor has diagnosed breast cancer, the extent (stage) of the cancer has to be established. The stage helps determine the prognosis and the best treatment options. The stage of the cancer may be determined after surgery.

Various Tests and procedures used to stage breast cancer:

  • Blood tests, such as a complete blood count
  • Mammogram of the other breast to look for signs of cancer
  • Breast MRI
  • Blood tests, such as a complete blood count
  • Mammogram of the other breast to look for signs of cancer
  • Breast MRI

Not everyone will require all of these tests and procedures. The doctor will select the appropriate tests based on specific circumstances and taking into account new symptoms the patient may be experiencing.

Breast cancer stages range from 0 to IV with 0 indicating cancer that is non-invasive or contained within the milk ducts.

Stage IV breast cancer (metastatic breast cancer) indicates that it has spread to other parts of the body.

Breast cancer staging also takes into account the cancer's grade; the presence of tumor markers, such as receptors, for estrogen, progesterone and HER2; and proliferation factors.

Surgeries

  • Lumpectomy
    During a lumpectomy, which is also referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. A lumpectomy may be recommended for removing smaller tumors. For larger tumors, patients may have to undergo chemotherapy to shrink the tumor to make it possible to remove it by a lumpectomy procedure.
  • Mastectomy
    A mastectomy is an operation to remove breast tissue completely. Most mastectomy procedures remove the lobules, ducts, fatty tissue and some skin, nipple and areola (total or simple mastectomy). Newer surgical techniques such as skin-sparing mastectomy and nipple-sparing mastectomy are increasingly becoming common.
  • Sentinel Node Biopsy
    The surgeon will remove the lymph nodes that are the first to receive the lymph drainage from the tumor, to determine whether cancer has spread to the lymph nodes. If the tests are negative, no other nodes will need to be removed as there is very little chance of finding cancer in any of the remaining nodes.
  • Axillary Lymph Node Dissection
    In case, cancer is found in the sentinel lymph nodes, the surgeon will remove additional lymph nodes in the armpit.
  • Contralateral Prophylactic Mastectomy
    Some women with cancer in one breast may choose to have their other healthy breast removed, because of a genetic predisposition or strong family history of cancer. Most women with breast cancer in one breast will not develop cancer in the other breast. This is a serious decision which must be taken after discussion with the doctor, along with the benefits and risks of this procedure.

Complications of breast cancer surgery depend on the procedures you choose. Breast cancer surgery carries a risk of pain, bleeding, infection and lymphedema (caused by a collection of too much lymph fluid) in the arm.

Discuss your options and preferences with the surgeon about breast reconstruction after surgery. The options may be reconstruction with breast implants (silicone or water) or using your own tissue. These operations can be done at the time of the mastectomy or at a later date.

Therapy

  • Radiation Therapy

    Radiation therapy uses high-energy, such as X-rays and protons, to destroy undetectable cancer cells and reduce the risk of cancer recurring.
    The kinds of radiation therapy that may be considered are -

    External Beam Breast Cancer Radiation is most commonly used. A machine outside the body aims a beam of radiation on the area affected.

    Internal Breast Cancer Radiation newer treatments that inject radioactive cancer-killing treatments only in the affected area

    Brachytherapy (Internal Radiation) delivered through an Implantable Device a device is placed inside the breast during surgery or shortly thereafter which carries targeted radiation to the tumor bed (the tissue where the cancer originally grew).

    External beam radiation of the whole breast is commonly used after a lumpectomy. Breast brachytherapy may be an option after a lumpectomy if you have a low risk of cancer recurrence.

    Doctors may also recommend radiation therapy to the chest wall after a mastectomy for larger breast cancers or cancers that have spread to the lymph nodes.

    Breast cancer radiation can last from three days to six weeks, depending on the treatment. A radiation oncologist determines which treatment is best for you based on your situation, your cancer type and the location of your tumor.

    Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, such as damage to the heart or lungs or, very rarely, second cancers in the treated area.

  • Chemotherapy

    Adjuvant Therapy - Chemotherapy uses drugs to destroy the fast-growing cancer cells. If the cancer has a high risk of returning or spreading to another part of the body, doctors may recommend chemotherapy after surgery to decrease the chance of the cancer recurring.

    Neo-Adjuvant Therapy - Chemotherapy is sometimes given before surgery for women with larger breast tumors to shrink the tumor to a size to make it easier to remove with surgery.

    Chemotherapy is also used when cancer has already spread to other parts of the body. It may be recommended to try to control the cancer and decrease any symptoms caused by the cancer.

    Chemotherapy has some side effects depending on the drugs given. Hair loss, nausea, vomiting, fatigue and an increased risk of developing an infection are the common side effects. Rare side effects can include premature menopause, infertility (if premenopausal), damage to the heart and kidneys and nerve damage.

  • Hormone Therapy

    Hormone Therapy — perhaps more properly termed hormone-blocking therapy — is used to treat breast cancers that are sensitive to hormones. These cancers are referred to as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.

    Hormone therapy can be used before or after surgery or other treatments to decrease the chance of the cancer recurring. If the cancer has already spread, hormone therapy may shrink and control it.

    Hormone therapy is also called hormonal therapy, hormone treatment, or endocrine therapy.
    Treatments that can be used in hormone therapy include:

    • Medications that block hormones from attaching to cancer cells (selective estrogen receptor modulators)
    • Medications that stop the body from making estrogen after menopause (aromatase inhibitors)
    • Surgery or medications to stop hormone production in the ovaries

    Hormone therapy side effects depend on your specific treatment, but may include hot flashes, night sweats and vaginal dryness. More serious side effects include a risk of bone thinning and blood clots.

  • Targeted Therapy

    Targeted drug treatments attack specific abnormalities within cancer cells without harming normal cells. This therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells.

    Your cancer cells may be tested to see whether you might benefit from targeted therapy drugs. Some medications are used after surgery to reduce the risk of the cancer recurring, while others are used for advanced breast cancer cases to slow down the growth of the tumor.

  • Immunotherapy

    Immunotherapy uses your own immune system to fight cancer. Your body's disease-fighting immune system may not attack the cancer cells because they produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

    Immunotherapy can be used to treat some types of breast cancer. Immunotherapy might be an option for triple-negative breast cancer, which means that the cancer cells do not have receptors for estrogen, progesterone or HER2. Immunotherapy is combined with chemotherapy to treat advanced cancer that has spread to other parts of the body.

  • Palliative Care

    Palliative care is specialized medical care that provides relief from pain and other symptoms of a serious illness. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation. When palliative care is used along with other treatments, people with cancer may feel better and live longer.

    Palliative care is provided by a team of doctors, nurses and other specially trained professionals. The aim is to improve the quality of life for people with cancer. This form of care is offered along with curative or other treatments the patient may be receiving.

  • Alternative Medicine

    No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help to cope with the side effects of treatment when combined with the doctor's care. Many breast cancer survivors experience fatigue that can continue for many years. Complementary and alternative medicine therapies may help relieve fatigue.

  • Gentle Exercise

    Check with your doctor about various forms of exercising like walking, swimming or yoga.

  • Managing Stress

    Try stress-reduction techniques such as muscle relaxation, visualization, and spending time with friends and family.

  • Join a Support Group

    Express your feelings through activities that allow you to write about or discuss your emotions, such as writing in a journal, participating in a support group or talking to a counselor.

Coping with the Diagnosis and Treatment

A breast cancer diagnosis can be overwhelming and frightening. It is natural to have anxiety and distress and the fears about your future. You have to make important decisions about your treatment. Each person finds his or her own way of coping with these issues.

To understand better you can –

Ask your doctor for the details of the type and stage of your cancer and information about your treatment options. Knowing more about your cancer and your options will help you feel more confident when making treatment decisions.

Talk with other breast cancer survivors. You may find it helpful and encouraging to talk to others in your same situation. Ask your Doctor about support groups in the hospital and you can also find them online.

  • Share your feelings

    Find a friend or family member who is a good listener to speak about your thoughts and feelings. Ask your doctor for a referral to a counselor who works with cancer patients and survivors.

  • Seek the support of your friends and family

    Your friends and family can provide a crucial support support for you during your cancer treatment

  • Maintain intimacy with your husband

    Women's breasts are associated with femininity and sexuality. Breast cancer may affect your self-image and confidence in the relationships. Talk to your husband about your insecurities and feelings

Preparing for Your Appointments

Women with breast cancer may have appointments with several doctors and health professionals,

Various Tests and procedures used to stage breast cancer:

  • Breast Health Specialists
  • Breast Surgeons
  • Radiologists
  • Oncologists
  • Radiation Oncologists
  • Genetic Counselors
  • Plastic Surgeons
Prepare a list of questions to ask your doctor:
  • What type of breast cancer do I have?
  • What is the stage of my cancer?
  • Can you explain my pathology report to me?
  • Do I need any more tests?
  • What treatment options are available for me?
  • What are the benefits of the treatment you recommend?
  • What are the side effects of the treatment?
  • Will treatment cause menopause?
  • How will each treatment affect my daily life?
  • Is there any treatment you recommend over the others?
  • How will this treatment benefit me?
  • How much time do I have to make a decision about treatment?
  • What happens if I choose not to have treatment at all?
  • What will the treatment cost?
  • Should I seek a second opinion?
  • Are there any clinical trials or newer treatments that I should consider?
  • Can I continue working?
Do not hesitate to ask any more questions that may come to your mind.

Your doctor will also ask you several questions.

  • When did you first begin experiencing the symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Family medical history
  • Your lifestyle