02

Breast cancer may sound like a death sentence to many of us. Half of the women who come to us have benign (non cancerous) conditions of the breast, and most of the time reassurance is all they need. The other half, are indeed found to have breast cancer on different tests.

Q. What is a tumour, and a cancer after all?

A. Swelling in the body arising from excessive growth (Mitosis) of cells is called Tumour or Neoplasm. This can be of two types – Benign (Non-cancerous) and Malignant (Cancerous). Benign tumours grow slowly at a particular site, do not invade surrounding structures and do not spread to other parts of the body. Even if they are not removed, they will rarely be lethal. Malignant tumours, on the contrary, would grow very rapidly, invade surrounding vital structures, and spread to other parts of the body and will eventually kill an individual if not treated promptly. However, the good news is if detected at an early stage and treated appropriately – they can be completely cured on many occasions. They can also be prevented to some extent by avoiding certain risk factors (e.g. avoiding smoking can prevent lung cancer, protection of skin from excessive sun burn can save an individual from certain skin cancers).

Q. How can Breast cancer be prevented?

A. Like many other cancers, cause of breast cancer is still not very clear. Some probable causes:-

1.  Age – very rare before 30 years.

2.  Sex – 99% occurs in females.

3.  Diet – high intake of fat, alcohol and less intake of Vit A, unsaturated fatty acid (Soya Oil).

4.  Increased Oestrogen exposure: Delayed marriage, delayed pregnancy, no breast feeding, delayed menopause, prolonged intake of contraceptive pills.

5.  Genetic abnormality – although rare, may cause breast cancer to run in the family.

Q. What are the symptoms of breast cancer?

A. Lump in the breast is the commonest symptom. Some may also have lumps in the armpit. Pain and nipple discharge (especially blood stained), nipple retraction, skin changes in the breast (dimpling, ulceration, venous prominence, multiple small pits like skin of an orange, etc.), swelling of arm are other symptoms. However, one should remember that many benign conditions of breast may have similar symptoms – and a doctor can confirm the diagnosis for you by a few tests.

Q. If a diagnosis of breast cancer is eventually made, what are the treatments available?

A. It needs a multidisciplinary approach – a team effort by Surgeons, Radiotherapists, Chemotherapists and Hormonal therapists. The surgical treatment involves removal of the breast with its lump and the glands (axillary) in the armpit (Modified Radical Mastectomy). If the tumour is small and the patient is keen to have her breast preserved, breast preserving operation may be feasible where the tumour along with a rim of healthy breast tissue on all sides and the axillary glands are removed (Breast conservation Surgery). After breast conservation chances of local recurrence are slightly higher compared to mastectomy. Regular follow up is therefore essential. If there is recurrence and mastectomy is done, the long term survival remains unaffected.

Q. How can one detect breast cancer early?

A. This is the most important issue as breast cancer is one of those cancers where a complete cure can occur if detected and treated early. In Western countries, where the risks are higher and financial constraints, are not there, routine Mammographies (X-Ray of breasts) are done in high risk age group (viz 50-64 yrs in UK) to pick up very small tumours. Unfortunately in a developing country like ours, where many still live below poverty line, this screening programme is not feasible. Regular self-examination, mass education and presenting to doctors for any worries would be the key to early diagnosis in India. Patients with benign conditions can be re-assured and those with cancers can be started on appropriate treatment immediately at a specialized centre.

Q. How to do self-examination?

A. (i)  Stand in front of a mirror, look for any asymmetry of breasts.

(ii)  Raise your arms up, look for any dimpling of skin, or discrepancy of rise of two breasts.

(iii)  Press on the hips, look for any asymmetry again.

(iv)  Now lie down with the right hand behind the head. Feel the right breast with the flat of the left hand, starting near the armpit, and move circularly along the breast and finally feel the back of the nipple. Repeat this similarly for the opposite breast.

All women should check themselves regularly after they have finished their periods. At any point of self-examination if any abnormality is felt one should get herself checked by a specialist doctor. Don’t hide away any problem in fear or shame. Remember, even if it is cancer – if detected at an early there is a very good chance of complete cure.