Breast cancer is emerging as a major public health problem and breast cancer is the most common cancer among women in majority of the Cancer registries in India.
What is Breast Cancer ?: Uncontrolled and excessive growth of abnormal cells in the breast due to genetic, hormonal and life style factors. During initial stages tumor is confined to breast and in the later part it can spread to lymph nodes in the arm pit and various other organs like liver, bones, lungs and brain.
What are the Risk Factors for development of Breast Cancer ?
1. Personal History of Breast cancer in one breast
2. Family history of Breast cancer involving mother, maternal grand mother, maternal aunts or
3. Early onset of menstruation ( before the age 12 years)
4. Late menopause ( after the age of 55)
5. First child birth after age of 30.
6. Breast feeding children for less than 6 months
7. Consumption of alcohol and food rich in animal fat.
8. Smoking or chewing tobacco.
What are the warning signs / Symptoms of Breast cancer ?
Early Breast cancer is painless. Usually breast cancer should be suspected when ever a women notices the following signs/ Symptoms
1. Lump or thickening in the breast or under arm area.
2. Change in the size or shape of the Breast.
3. Bloody discharge from the nipple.
4. Retraction or non healing ulcer of the nipple.
5. Ridges or pitting of breast skin ( Orange peel effect)
Breast cancer treatment explained
What tests are carried out to detect breast cancer?
Before deciding on any treatment, it is important to undergo a test to discover whether or not the lump is cancerous.
The most reliable way of discovering whether a breast lump is cancerous or not is by performing a biopsy. In this procedure a tissue sample is removed by the doctor or surgeon, and examined under a microscope by a pathologist. The tissue can be obtained either by the use of a needle biopsy or by surgery. The choice of technique depends upon the type and location of the lump as well as the general health of the patient.
Not all lumps or changes in the breast require a biopsy. Doctors carefully compare the findings from a physical examination and mammogram, and take medical history into consideration before recommending a biopsy.In some instances, the doctor may suggest merely watching the suspicious area for a month or two. Many lumps may be the result of normal hormonal changes that take place during the menstrual cycle so this waiting period may provide additional information.
What treatments are available?
There are four main types of treatment for breast cancer:
Why are there so many different treatments?
Each type of breast cancer may respond to a different treatment. Also, the treatment for premenopausal women usually differs to that offered to postmenopausal women. All women are different so the treatment given to them will be the best possible for their individual circumstances.
How is the treatment decided?
There are many different factors to consider, and often a combination of treatments is used. Key considerations for deciding a include: age, the type of breast cancer, the size and position of the tumour, whether it is hormone receptor positive or negative, and also if there has been any spread to the lymph glands.
Deciding on your breast cancer treatment
Decisions about your treatment should be made by both you and your hospital doctor or consultant, with the support of your family.
If there is anything that you do not understand or find confusing, ask you doctor or nurse who will be happy to discuss it with you.
Whatever the treatment, the earlier it is given, the greater the chances of success.
When a woman is diagnosed with breast cancer, one of the first things that will be established is the ‘stage’ of the cancer- i.e. how for advanced the disease is. Different treatment strategies can be used depending on the stage of the breast cancer.
In early breast cancer, the primary objective of treatment is cure. In the majority of patients, therapy consists of initial surgery to remove the tumour, and any affected lymph nodes, with or without local radiotherapy which aims to destroy any remaining cancrous tissue. This is generally followed by adjuvant chemo / hormonal therapy for five years, which aims to prevent both recurrence of the tumour in the breast and the development of meatastases, or secondary cancers, in other areas of the body.
In patients with locally advanced disease chemotherapy is used as initial treatment prior to surgery to achieve tumour shrinkage and reduce the risk of spreading. In some cases surgical intervention is also used.
In advanced breast cancer, the main aim of treatment is to reduce the severity of the symptoms and improve the quality of life. This can be achieved by hormonal therapy, ablative surgery, chemotherapy and sometimes radiotherapy.
Surgery for Breast cancer:
Traditionally Surgery for Breast cancer involved removal of the entire breast along along with lymph glands in the arm pit. However recently Breast conservation therapy and Breast reconstruction are frequently being performed to treat Early breast cancer .
Mastectomy involves total removal of the breast and lymph glands in the arm pit and it is used to deal with larger tumours.
Breast conservation therapy (BCT)
Scientific research has shown that complete removal of the breast is not necessary in some patients with small early stage breast cancer. This treatment involves the removal of the tumor and a small amount of surrounding normal tissue. However all these patients will require radiotherapy to avoid re occurrence of cancer.
By using Plastic surgical techniques it is possible to reconstruct a new breast after total breast removal . Patients own tissues from lower abdomen or back are used for reconstruction . Some times synthetic silicone implants can also be used for breast reconstruction.
What happens after surgery?
If you have had breast surgery avoid lifting and stretching during your recovery period. Then begin gentle exercises each day – your doctor or nurse will show you- to ease your muscles and ligaments back into use. Get as much rest as you feel you need; do not expect to be back to your old self for several months.
This involves the use of carefully measured doses of X-rays targeted at the tumour, or around the areas where the tumour was situated if surgery has been performed. The aim of radiotherapy after surgery is to destroy any potentially cancerous cells that remain around the site from which the tumour was removed. Generally radiotherapy is given within 6 weeks of surgery for a total duration of 5 weeks . It is an out patient treatment .Modern radiotherapy is safe and causes minimal discomfort during treatment.
Hormonal therapy, sometimes called endocrine therapy, can be used at any stage of breast cancer in patients who are positive for hormone receptors (ER & PR ). Some hormonal therapies can be used in both pre and postmenopausal women. Hormonal therapies are used to manipulate the levels of circulating hormones or block their effect, which may then delay the growth of hormone-sensitive breast tumours. Generally these are given in a tablet form for a period of 5 to 10 years .
Chemotherapy is often used in the treatment of breast cancer. It involves the use of cell destroying drugs, of which there are many available. Often a combination of these drugs is used. Generally 6 cycles of chemotherapy at 3 to 4 weekly intervals is given to patients. Most of the side effects like nausea ,vomiting , hair loss and diarrhea are temporary and manageable.
Recently research has shown that some types of breast cancer express a marker known as Her 2 neu and these patients respond to targeted therapy using Trastuzumab. This has been shown to improve survival.
What is the total duration of treatment
It depends on the type of treatment offered.
Surgery – Approximately 2 weeks for complete recovery. Inpatient hospital stay varies from 3 to 5 days.
Radiotherapy - Generally radiotherapy is given over a period of 5 weeks and it is mostly done on out patient basis .
Chemotherapy - In general to administer 6 cycles of chemotherapy approximately 3 to 4 months are needed .
Follow-up after breast cancer treatment
After completion of treatment all the breast cancer patients are seen by the treating team of doctors every three months for 2 years , every 6 months for 5 years and yearly there after. A thorough physical examination is performed to rule out relapse of disease and few blood tests and special investigations like ultrasound and mammogram are recommended depending on the necessity .
Help and support
Some people might feel low when their treatment comes to an end. Suddenly, the medical attention and encouragement from hospital staff . It might feel that there is nothing you can do now but worry about the disease recurring. People sometimes misinterpret the common aches and pains that everybody gets from time to time.
The following suggestions may help?
Talk to friends and family to let them know how you are feeling
Speak to a nurse for informed but friendly and sympathetic advice
It might be comforting to talk to other people who have had breast cancer, who will
know how you feel from personal experience
You may be worried about how your surgery may affect your relationship. Many women
are worried that their partners might reject them physically and yet most find that their
fears are unfounded. It may be helpful to speak to a nurse about this if possible
Practice relaxation- relaxation techniques can be very valuable
There are a number of charities you can approach for information and support. A list of
some of these can be found in your personal diary
What can I do now?
Many women feel helpless and think that there is nothing they can do when they have been told they have breast cancer. However, there are many things that you and your family can do. Women often find it easier to cope if they have a good understanding of their illness and its treatment. It is important that this information is accurate and therefore it should come from a reliable source such as your doctor. Be open about your illness and how you feel and confide in your friends and family.
Who else can help?
It is important to remember that there are many people available at the hospital to talk with about the concerns or worries that you may have. Many cancer patient groups provide information and provide free phone help lines for women to discuss their breast cancer. Your doctor or nurse can tell you about any organizations or meetings that may take place in your area.