Dr Gunjesh Kumar Singh - MBBS, MD, DM Medical oncology (Tata Memorial Hospital, Mumbai), Ex consultant Tata memorial Hospital-Mumbai, ESMO-certified medical oncologist ACORD fellow (Australia)
Breast cancer is a disease in which cells in the breast grow out of control. It is the commonest cancer among females in the world as well as in India. Rarely, it is also seen in males. Breast cancer has two types - invasive ductal carcinoma and invasive lobular carcinoma.
What are the various risk factors of breast cancer ?
● Age - The risk of breast cancer increases with age.
● Reproductive history- Early menarche and late menopause expose women to longer hormones, raising their risk of breast cancer.
● Personal history of breast cancer or certain non-cancerous breast diseases (atypical hyperplasia and carcinoma in situ)
● Family history of breast or ovarian cancer
● Previous treatment using radiation therapy before age 30 has a higher risk of getting breast cancer later in life.
● Genetic mutations - Women who have inherited mutations to certain genes, such as BRCA1 and BRCA2
● Hormone therapy
● Obesity
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What are the signs and symptoms of breast cancer ?
It can vary from patient to patient. Some can be totally asymptomatic.
Few warning signs of breast cancer are —
● New non-resolving lump in the breast or underarm (armpit).
● Thickening or swelling of a part of the breast.
● Irritation or dimpling of breast skin.
● Redness or flaky skin in the nipple area or the breast.
● Nipple retraction
● Nipple discharge including blood/serous/serosanguinous.
● Any change in the size or shape of the breast.
● Pain in any area of the breast.
How is breast cancer diagnosed?
Diagnosis of breast cancer can be divided into two parts - tissue diagnosis (Biopsy or FNAC) and staging workup (mammography, CT scan, PET CT scan, Bone scan)
● Diagnostic mammogram - It’s a kind of X-ray which helps in the evaluation of breast lump size and location.
● Ultrasound can be added to it for detailed characterization in young females.
● For staging workup, either CT scan and bone scan or PET CT scan is recommended. These imaging modalities help in knowing the disease extent and spread of cancer to other organs. This process is called staging. The stage of the cancer is determined on the basis of its spread, whether it is localised in the breast or in lymph nodes or has spread outside it. Staging is important for planning further treatment.
● Biopsy or FNAC - Both can help in making confirmatory diagnosis. In this test, the tissue or fluid is removed from the breast and examined under a microscope. This is followed by an additional test to know the hormone receptor status on the biopsy or FNAC sample before starting treatment.
How is breast cancer treated?
Breast cancer is treated in several ways. It depends on the type of breast cancer and how far it has spread (stage of cancer). Breast cancer patients often receive more than one kind of treatment.
● Surgery - it is done for localised disease. If cancer is restricted to only the breast, then it can be removed with surgery. Mastectomy (removal of the whole breast) and lumpectomy (removal of the only lump) are the two types of surgeries depending upon the size of breast cancer.
● Chemotherapy - This treatment modality uses special drugs to shrink or kill cancer cells. The drugs can be in form of injections or tablets. These are used before or after surgery. In stage 4 breast cancer, chemotherapy has a major role.
● Hormonal therapy - These drugs block cancer cells from getting the hormones they need to grow. They are used in those patients who have hormone receptor-positive cancer cells (determined by hormone receptor status). Similar to chemotherapy, hormone therapy is used both as adjuvant therapy after surgery and in stage 4 breast cancer.
● Targeted therapy - These drugs target breast cancer cells which are positive for HER2 receptor.
● Immunotherapy - Works with your body’s immune system to help it fight cancer cells.
● Radiation therapy. This uses high-energy rays (similar to X-rays) to kill cancer cells. Radiotherapy after surgery makes the area sterile of cancer and decreases the risk of recurrence.
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Can breast cancer be detected early?
Early detection is possible with various screening methods. Breast cancer screening means checking a woman’s breasts for cancer before there are obvious signs or symptoms of the disease. Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early when it is easier to treat.
Breast cancer screening can be done by either mammography, MRI or clinical breast examination. Mammography is the commonest imaging tool used for screening purposes. As per guidelines, a female with age > 40 years should undergo annual mammography. Mammography can decrease the risk of dying of breast cancer by 40%. MRI is recommended in populations who are at higher risk of getting breast cancer like positive family history. A clinical breast examination is done by a doctor or nurse, to feel any lump or other changes.
Dr Gunjesh Kumar Singh is currently working as a Consultant and Head of the department of medical oncology at Bhagwaan Mahavir Medica super speciality hospital, Ranchi, Jharkhand
