Breast Cancer

Reviewed By:   Anil Ghimire, MD

Breast cancer occurs when normal cells of breast change their characteristics and grow uncontrollably. Breast Cancer is the second most common cause of cancer death after lung cancer. Nearly one million women are diagnosed with breast cancer each year. It is usually detected as a breast lump. It is more common in females than males. The most common site is the upper outer quadrant of breast where almost 50% of the cancers occur.

 

Risk factors:

There are various modifiable and nonmodifiable risk factors for breast cancer.

  • Age: Breast cancer rarely occurs before the age of 25 years and the risk increases as the age increases.
  • Previous history of breast cancer
  • Inherited gene mutation in genes BRCA1 and BRCA2
  • Hormonal changes:
    • Early menarche and late menopause: This increases the exposure to hormonal changes
    • Use of hormonal contraceptive pills
    • Number of pregnancies: Higher the number of pregnancy, the risk becomes lesser
    • Age at first pregnancy: Risk increases if first pregnancy is after 30 years of age
    • Not having children at all and not breastfeeding may increase risk
    • Combined hormone therapy after menopause
  • Family history: Breast cancer sometimes runs in a family
  • Life style: Diet rich in saturated fats, alcohol, physical inactivity and long term heavy smoking is a risk factor for breast cancer.
  • Obesity after postmenopause  poses risk for breast cancer
  • Others: Radiation predisposes to breast cancer

 

Signs and symptoms:

  • Lump felt in the breast
  • Change in shape of breast
  • Discharge from nipple (other than milk)
  • Indrawing of nipple
  • Pain in the breast or nipple
  • Skin changes: ulceration, dimpled skin like orange peel, red scaly patch
  • Symptoms of distant spread: bone pain, jaundice, shortness of breath, swollen lymph nodes etc

 

Diagnosis:

Diagnosis of breast cancer begins with the periodic self breast examination and yearly mammography to detect  early signs of breast cancer which is called screening. Screening for breast cancer has been shown to   improve survival. A positive screening test is followed by a confirmatory test.

Screening tests

  • Self breast examination: Every women after menarche should perform periodic self breast examination looking for early signs of breast cancer (lump, skin or nipple changes), lymph glands in armpits or neck.
  • Mammogram:  Special X-rays of the breast to detect  any uncharacteristic masses or lumps. It is usually recommended for women over 40 years of age and should be performed yearly
  • Others: Ultrasound to differentiate solid from cystic mass.  MRI in selective cases.

 

When breast lump is found you would undergo one of the following test to diagnose or rule out breast cancer.

  • Fine needle aspiration:  removal of a sample of the fluid from a cystic  lump for microscopic analysis
  • Core biopsy: removal of a sample of the tissue in a solid lump for microscopic analysis

 

Once a diagnosis of breast cancer is made from a biopsy, further molecular tests (HER2/neu receptor, ER/PR receptor) are undertaken to optimise treatment options. You will further undergo other tests like bone scan, PET scan to detect the spread of cancer  beyond breast which is called Staging of breast cancer. A stage 4 breast cancer means it has spread beyond breast to distant organs.

 

Treatment:

Breast cancer is treated with any one or more of the following depending upon the stage of cancer and age of patient:

  • Surgery: surgery is done to remove the cancer. The options could be mastectomy (removal of whole breast) and breast conserving therapy (lumpectomy).
  • Chemotherapy: chemotherapy is the use of a group of medicines to kill cancer. Sometimes it is given in combination with surgery (before or after) or radiation therapy to yield better results.
  • Radiation therapy: radiation is used to kill the cancer cells.
  • Hormone therapy: breast cancer sometimes results from hormonal influences. You could be treated to block those hormones or to prevent secretion of such hormones.

 

After treatment, you have to remain in regular follow up to check for side effects of medicines, recurrence and spread of cancer. If you have any new symptoms suggesting breast cancer, you have to see your doctor. You have to continue having your mammograms. You have to take precautions and continue the exercises taught to prevent swelling of hands due to lymph collection following surgery.

 

Prevention:

Women on high risk of getting breast cancer at times can take medicine to help prevent the disease. If you have a strong family history of breast cancer, ask your doctor what you can do to prevent cancer. You should also continue with breast self examination and routine screening. You should also modify your diet and lifestyle related risk factors.

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