Keeping abreast

Today in India, Breast Cancer is the most common form of cancer, especially among the urban women. With over 80,000 new breast cancers diagnosed every year, it is estimated that one in every thirty women is at risk of developing breast cancer in her lifetime.

What is Breast Cancer

Breast cancer refers to the uncontrolled growth of cells found in the breast tissue - a glandular tissue made up of ducts and lobules. These lobules produce milk which is sent through the ducts to the nipple. The areola around the nipple contains tiny glands. Normally some women have protruded nipple and some have inverted nipple. But if a protruded nipple becomes inverted nipple, then it should be investigated. Some women normally have heaviness of breasts before, during or after the menstruation. Sometimes, there is also pain along with the heaviness. This need not be confused with cancer. Similarly, all breast lumps need not be dangerous and fatal. However, persisting lumps should be examined. Not much is known about the cause of breast cancer, except that it has a link with the female hormone. That is why breast cancer is more common in women and rare in men.

Symptoms of Breast Cancer

Although breast cancer is usually detected as lump, there are certain other symptoms of breast cancer such as,

Early breast cancers do not cause pain, or any signs or symptoms which makes it difficult for early detection. But early detection is vital and provides more options as to the treatment of cancer and also increases the chance of cure. Breast Self Examination (BSE), Clinical Breast Examination (CBE), and Mammograms are important for this. It is true that if detected early, breast cancer has a cure ratio greater than 80%.

Breast Self Examination (BSE) should be done every month to check if the breasts are in normal condition. Beginning at the age of 20, BSE could be continued all through life. Until Menopause, BSE should be done 7 days after the starting of periods. Women who are pregnant, nursing or have reached menopause could do BSE on the same date every month.

Women with family history of breast cancer are in the high risk group. Women who have had cancer in one breast are prone to get it in the other breast. Women who have had their first children after 30 years, women who have no children, women who have had an early onset of periods, women who have had a late menopause, and women who are obese all have increased risk in having breast cancer. Luckily, there has been no evidence to prove that contraceptual pills leads to cancer. It would be better for the women of the high risk group to have a Clinical Breast Examination done by a specialist every year. If any anomalies are found in the CBE then other tests might be required such as Mammogram.

A process like x-ray or scan being done, Mammogram can show changes that are too small to feel, or help to diagnose a lump or changes that are found in the breast examinations. It is better to have done the Mammogram by the age of 40 for any normal woman. For high risk women, it is better to have taken Mammogram earlier than that.

Although Mammogram and Sonography of the heart are useful to detect tumor and its extent, to confirm breast cancer tests like fine-needle aspiration cytology and Biopsy are done. The former involves taking a few affected cells from the breast with a fine needle and examine under the microscope. Biopsy is done under a local anesthetic by making an incision over the lump. In rare cases even these might not be conclusive and the whole lump has to be totally removed and sent for analysis by frozen section. There are also other tests like a chest x-ray, abdominal sonography, bone scan and bone x-rays which assess the spread of cancer. These are called Metastatic work up.

In order to plan for the appropriate treatment, cancer has been broadly classified into three phases, such as (1) Early Breast Cancer (EBC), (2) Locally Advanced Breast Cancer (LABC) and (3) Metastatic Breast Cancer (MBC). (1) In EBC, with the spread of cancer being limited to the breast and armpit, treatment aims at curing and conserving the breast. Although surgery is the main treatment, radiotherapy, chemotherapy and hormone therapy might also be done. (2) In LABC, the intensity of cancer being higher, chemotherapy is given initially to shrink the tumor and then surgery performed. Radiotherapy and hormone therapy is also required. (3) In the third phase called Metastatic Breast Cancer, the cancer has spread to other parts of the body outside of the breast and lymph glands. At this stage, the treatment is not curative in nature, but is aimed to control the cancerous growth and keep the patient alive. Thus, there will be a judicious use of hormone therapy, chemotherapy and radiotherapy.

To a woman, breasts are more than mere body parts. They embody womanhood. Hence, losing a breast can be psychologically devastating. Now, there is artificial breast prosthesis, made of silicone that can be worn externally, fitted to the brassiere. Reconstruction is also done cosmetically immediately after breast removal or as a delayed procedure some 6 months to 2 years later. Reconstruction is done using muscles from the abdomen or the back. Silicon implants can also be used for reconstruction. But a third phase cancer patient is not offered reconstructive surgery as it would prevent detection of tumor against the chest wall. Hence a patient who has higher risk occurrence is advised not to have reconstruction for oncological reasons.