Globeathon Cancer Week

KEEPING BREAST CANCER AT BAY

Breast cancer is defined as a disease with an uncontrolled growth of cellsin the breast.

Breast cancer is one of the more common types of cancer, affecting one in eight women.

Breast cancer is emerging as second most leading cause of deaths among women. An estimated 1.7 million women worldwide was diagnosed with breast cancer in 2012 and 6.3 million women were already diagnosed and living with this cancer in the previous five years, according to Globacon 2012. Since 2008, breast cancer incidence has increased by more than 20%, while mortality has increased by 14%. [1]

These alarming statistics about breast cancer indicates the impending need to raise the awareness on breast cancer.

There are annual awareness campaigns and programmes that have helped to a small extent but yet we have a long way to go in achieving better statistics on breast cancer incidence.

While most people are aware of breast cancer, many forget to take the steps to have a plan to detect and control the disease in its early stages and encourage others to do the same.

Types of Breast Cancer

Breast cancer can be categorised according to the nature of the cancer or by the type of tissue affected-

Based nature of cancer

  • Non-invasive (in situ): Cancer that has not spread from its original tissue (stage 0)
  • Invasive (infiltrating): Cancer cells that have spread to surrounding tissues (stages 1-4)

The tissue affected type of cancer:

  • Ductal carcinoma: is when cancer forms in the lining of the milk ducts (most common).
  • Lobular carcinoma: is when cancer is formed in the lobules of the breast (where milk is produced).
  • Sarcoma: is when cancer grows in the breast’s connective tissue (rare)

Risk Factors for developing breast cancer [2]

  1. Advancing age:  Women above 55yrs of age are more prone to breast cancer.
  2. Family history of breast cancer especially first degree blood relative on the  maternal side of the  family increases the risk.
  3. Genetic History – It has been noticed that approximately 5% to 10% of breast  cancer cases have a genetic involvement. The genetic mutations of BRCA1 and  BRCA2 genes are, by far, the most common known causes of inherited breast  cancer.  Everyone has BRCA1 and BRCA2 genes. The function of the BRCA  genes is to repair cell damage and keep breast cells growing normally. But when  these genes contain abnormalities or mutations then they increase the risk of  breast cancer as well as can also be passed from generation to generation.
  4. Some races and ethnic background of females are more prone. White women  are slightly more likely to develop breast cancer than African American,  Hispanic and Asian women. But African American women are more likely to  develop more aggressive, more advanced-stage breast cancer at a young age.
  5. Overweight females are more likely to develop breast cancer because they  produce more estrogen due to fat cells in their body. Estrogen promotes      hormone-receptor-positive breast cancers to develop and grow.
  6. Using Hormone replacement therapy for some reason like easing  menopausal symptoms also increases the chances.
  7.  A personal history of cancer or breast cancer increases the risk because of  already existing cancerous cells and exposure to radiation previously.
  8. Alcohol consumption and smoking also increases the chances of breast  cancer.
  9. Dense Breast increases the chances of having breast cancer. Dense breast  means more of non-Fatty tissue as compared to fatty tissue in the breast.
  10. Late pregnancies (after 30 years of age).
  11. Early menarche (Periods) or late menopause.

Signs and Symptoms of Breast Cancer

  • Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
  • A mass or lump, which may feel as small as a pea.
  • A change in the size, shape or contour of the breast.
  • A blood-stained or clear fluid discharge from the nipple.
  • A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly or inflamed).
  • Redness of the skin on the breast or nipple.
  • A change in shape or position of the nipple
  • An area that is distinctly different from any other area on either breast.
  • A marble-like hardened area under the skin.
  •  Vaginal pain
  • Unintentional weight loss
  • Visible veins on the breast

Stages

The stages of cancer of based on four characterstics:

Usually a TNM classification is used for cancer classification. [3]Following is a simplified classification for stages of breast cancer

Stages Tumour Size Lymph node Involvement Metastasis(Other organ involvement)
Stage  0 ( Non-invasive, carcinoma in situ) No No No
Stage 1 Up to 2 cm No No
Stage 2 Between 2 cm to 5 cm Yes No
Stage 3 Larger than 5 cm Yes No
Stage 4 Any size tumour Yes Yes

Screening and Diagnosis of Breast Cancer

Physical Examination and Health History

A through breast examination by the doctor along with a detailed health history and family history can help the doctor to judge as well as look for some evidence pointing towards cancer.

Tissue Biopsy: Medical procedures that test samples of tissue can also help in arriving towards a diagnosis. During a biopsy, a sample of the suspicious area is removed to be looked at under a microscope, by a specialised doctor. There are several types of biopsies, such as fine needle aspiration biopsy, core (large needle) biopsy and surgical biopsy.

Imaging procedures:  One of the most important parts of screening and diagnosing the cancer. Different techniques are used depending upon the need of the patient’s condition.

Mammograms: A mammogram is a specialised x-ray of the breast. Screening mammograms are used to look for breast disease in women who have no signs or symptoms of a breast problem. Screening mammograms usually take 2 views (x-ray pictures taken from different angles) of each breast.

Breast ultrasound: Also known as sonography uses sound waves to outline a part of the body.

Magnetic resonance imaging (MRI) of the breast:MRI scans use radio waves and strong magnets instead of x-rays.MRI can be used along with mammograms for screening women who have a high risk of developing breast cancer, or it can be used to better examine suspicious areas found by a mammogram.

Genetic tests: Tests that look for certain gene mutations (changes) that are  linked to some type of cancer like BRCA gene mutation.

Treatment of Breast Cancer

Treatment depends upon the stage of breast cancer. The main treatment types for breast cancer are:

  • Surgery

Surgery for breast cancer depends upon the extent of cancer spread.

1.Breast Conservation Surgery–It involves excision of the lump along with some breast tissue removal.

2.Mastectomy– In this kind of surgery the whole breast is removed to limit the spread of the cancerous cells in the body.

  • Radiotherapy – Using high frequency rays or particles to kill cancer cells is called as radiotherapy. It’s used after the surgery or chemotherapy on the patient, and is given session wise in which each session last for few minutes.
  • Chemotherapy – The therapy using cancer-killing drugs that are given either externally through mouth or intravenously into the body. Chemotherapy can be used both before and after the surgery. Before the surgery it’s given to shrink the tumour and called as neo Adjuvant chemotherapy, post-surgery when chemotherapy is given it is called as adjuvant therapy.
  • Hormone therapy – Some of the breast cancer can be hormone sensitive (oestrogen or progesterone) called as hormone-receptor-positive cancers and grow post hormone stimulation.  To reduce the chances of relapse or avoid further growth of such cancers, it’s important to lower the levels or effects of such hormones requiring Hormone therapy.
  • Biological therapy (targeted therapy) – As we know there is also genetic involvement in breast cancer development, it has been learned that some cancers grow by stimulation of a protein called human epidermal growth factor receptor 2 (HER2). In such cases, this protein is targeted to stop its effects and reduce the cancer cell growth.

Prevention is better than cure-

The best possible way of keeping breast cancer at bay is by preventing it from happening.

Lower your risk by:

  1.  Modifying/changing your lifestyle and adopting healthy practices
  2.  Visiting doctor for regular health checks
  3.  Getting an annual mammogram done for those above 25 years of age
  4. Females having a personal history of cancer need an examination every 3 months initially  and later every 6 months.( PET scan, Mammograms)
  5.  Extra screenings for some women, MRI or ultrasound screenings can add valuable  information to regular mammogram screening like those who have a family history of breast cancer

 Encourage your family members for check-ups, try to be proactive. There is no vaccine to stop the spread of breast cancer, the only way out is early detection.