Breast cancer

Dr Temsula Alinger Imsong
Senior Consultant & HOD
Department of Surgery, CIHSR

 

Breast canceris the most common female cancer worldwide representing nearly a quarter of all cancers. It was ranked the number one cancer among Indian females. Unlike other cancers, breast cancer is eminently treatable if detected at an early stage.

Breast cancer is currently the most common cancer among Indian women, both in terms of incidence as well as mortality, with proportional prevalence in younger age-groups being higher than the global average. Statistics show a breast cancer prevalence rate of 25.8 women per 100000 women living with breast cancer in India and is expected to rise to 35 per one lakh women in 2026.Considering the population of 1.3 billion Indians with half female population, this amounts to almost 350000 women living with breast cancer in India. 

The trend of rising incidence rates of breast cancer in India is likely to continue.  The mortality also is higher in India due to late stage at presentation and disparities in cancer care. It has been noted that breast cancer in Indian women occurs a decade earlier than the West.  This is probably a reflection of the higher younger population rather an increase in the age-specific incidence.

In Asia, breast cancer incidence peaks among women in their forties, whereas in the United States and Europe, it peaks among women in their sixties. Age-standardized 5-year breast cancer survival for Indian women diagnosed with breast cancer is 60% compared with 80% in Western countries. Structural barriers such as long distances to health facilities, lack of affordable services, lack of equipment to offer screening or treatment, lack of education about cancer, and minimal sensitization of both women and men to the symptoms of breast cancer and the options for diagnosis and treatment were cited as barriers to up-take of these services. Breast cancer is also seen in males, the incidence is rare, less than 1 % of all breast cancers.

What Are the Symptoms of Breast Cancer?

Most of the time, breast cancer presents with a painless lump. It is often ignored for a long time because of lack of pain or discomfort. Breast pain can also be a symptom of cancer in the later stage. If there are any symptoms that worry you, be sure to see your doctor right away.

 

Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.

Some warning signs of breast cancer are—

  • New lump in the breast or underarm (armpit).
  • Thickening or swelling of part of the breast.
  • Irritation or dimpling of breast skin.
  • Redness or flaky skin in the nipple area or the breast.
  • Pulling in of the nipple or pain in the nipple area.
  • Nipple discharge other than breast milk, including blood.
  • Any change in the size or the shape of the breast.
  • Pain in any area of the breast.

Keep in mind that these symptoms can happen with other conditions that are not cancer.

What Do Lumps in My Breast Mean?

Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore. Cysts are small fluid-filled sacs that can develop in the breast.

Risk Factors You Cannot Change

Being a woman and getting older are the main risk factors for breast cancer. Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer.

  • Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.
  • Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
  • Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
  • Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
  • Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
  • Family history of breast cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
  • Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
  • How Is Breast Cancer Diagnosed?

 

What is triple assessment breast cancer?

Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps. Together they give sensitivity of 99%.

Clinical Breast Exam

clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes in the breast.

Screening of breast tumor

  • Breast ultrasound. A machine that uses sound waves to make detailed pictures, called sonograms, of areas inside the breast.
  • Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
  • Magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.

Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy

Benefit of Screening

The benefit of screening is finding cancer early, when it’s easier to treat.

Staging

If breast cancer is diagnosed, other tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. Whether the cancer is only in the breast, is found in lymph nodes under your arm, or has spread outside the breast determines your stage of breast cancer. The type and stage of breast cancer tells doctors what kind of treatment you need.

How Is Breast Cancer Treated?

Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread.

People with breast cancer often get more than one kind of treatment.

  • Surgery: An operation where doctors cut out cancer tissue.
  • Chemotherapy: Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
  • Hormonal therapy: Blocks cancer cells from getting the hormones they need to grow.
  • Biological therapy: Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.
  • Radiation therapy: Using high-energy rays (similar to X-rays) to kill the cancer cells.

Doctors from different specialties often work together to treat breast cancer. SurgeonsMedical oncologists and Radiation oncologists work closely forming a board, called’tumor board’. They plan and work towards achieving cureand good quality of life for the affected people.

The incidence of breast cancer is rising. Breast cancer is the commonest cancer of urban Indian women and the second commonest in rural women. Owing to the lack of awareness of this disease and in the absence of a breast cancer screening program, the majority of breast cancers are diagnosed at a relatively advanced stage.

In Nagaland, because of good literacy rate in the urban areas, people are generally better informed and lately, we are encouraged to see more people coming to clear their doubts and in the process, detecting breast cancers at an earlier operable stage, giving them a good chance of achieving cure. With this information, it is my hope that more people will leave their inhibitions and get themselves checked for a better and healthier tomorrow.

 

Dr. TemsulaAlingerImsong.

Senior Consultant& HOD

Department of Surgery

CIHSR