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Breast Cancer: Prevention and Control

Breast Cancer :

Background: Breast cancer is a type of cancer originating from the breast tissues. One of the major issues  with breast cancer is that it is often not detected soon enough. This is due to low awareness  about the disease. Detecting it early can significantly reduce the death risk. Breast cancer  occurs in both men and women, although male breast cancer is rare. In India  and other  developing countries, breast cancer ranks second only to cervical cancer among  women. It  accounts for 25% to 31% of all cancers in women in Indian cities (Source: PBCR 2009 – 2011). According to GLOBOCAN (WHO), for the year 2012, an estimated 70218 women died in India due to breast cancer, more than any other country in the world (second: China – 47984 deaths and third: US – 43909 deaths). At present, India reports around 100,000 new cases annually.

Invasive breast cancer:

The cancer cells break out from inside the lobules or ducts and invade nearby tissue. With this type of cancer, the abnormal cells can reach the lymph nodes, and eventually make their way to other organs like kidneys, liver, lungs, etc. The abnormal cancer cells can travel through the bloodstream or the lymphatic system to other parts of the body causing devastating effects.

Non-invasive breast cancer:

This is when the cancer is still inside its place of origin and has not broken out. ‘Lobular carcinoma in situ’ is when the cancer is still inside the lobules, while ‘ductal carcinoma in situ’ is when they are still inside the milk ducts. “In situ” means “in its original place”. Sometimes, this type of breast cancer is called “pre-cancerous”; this means that although the abnormal cells have not spread outside their place of origin, they can eventually develop into invasive breast cancer.

Symptoms:

In its early stages, breast cancer usually has no symptoms. As a tumor develops, following signs and symptoms may be noticed:
– A lump in the breast or underarm is often the first apparent symptom of breast cancer. Lumps associated with breast cancer are usually painless, although some may cause a prickly sensation.
– Swelling in the armpit.
– Pain or tenderness in the breast. Although lumps are usually painless, pain or tenderness can be a sign of breast cancer.
– A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
– Any change in the size, texture, or temperature of the breast. A reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
– A change in the nipple, such as a nipple retraction, dimpling, itching, a burning sensation, or ulceration.
– Unusual discharge from the nipple that may be clear, bloody, or of another color.
– The nipple-skin or breast-skin may have started to peel, scale or flake.

Diagnosis:
Women are usually diagnosed with breast cancer after a routine breast cancer screening. If a woman detects any of the breast cancer signs and symptoms described above, she should speak to her doctor immediately.

Below are some of the diagnostic tests and procedures for breast cancer:

Breast exam: The physician will check patient’s breasts, looking out for lumps and other possible abnormalities, such as inverted nipples, nipple discharge, or change in breast shape.

X-ray (mammogram): Mammogram is commonly used for breast cancer screening. A mammogram is an x-ray picture of the breast. Screening mammograms are used to check for breast cancer in women who have no signs or symptoms of the disease. While, diagnostic mammograms are used to check for breast cancer after a lump or other signs or symptoms of the disease have been found. Diagnostic mammography takes longer than screening mammography because more x-rays are needed to obtain views of the breast from several angles.

Breast ultrasound: This type of scan may help doctors decide whether a lump or abnormality is a solid mass or a fluid-filled cyst.

Biopsy: A sample of tissue from the lump is surgically removed and sent to the lab for analysis. If the cells are found to be cancerous, the lab will also determine what type of breast cancer it is, and the grade of cancer (aggressiveness).

Breast MRI (magnetic resonance imaging) scan: This type of scan helps the doctor determine the extent of the cancer i.e. whether it is invasive or non-invasive, how large the tumor is, whether lymph nodes are involved and whether it has metastasized (spread to other parts of the body). In a Special Report in The Lancet, a panel of experts explained that breast cancer screening does reduce the risk of death from the disease, if done at an appropriate time.

Treatment:

The main breast cancer treatment options may include:

Radiation therapy (radiotherapy): Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Usually, radiotherapy is used after surgery, as well as chemotherapy to kill off any cancer cells that may still be around. Typically, radiation therapy occurs about one month after surgery or chemotherapy.

Surgery:

a. Lumpectomy: Surgically removing the tumor and a small margin of healthy tissue around it. In breast cancer, this is often called breast-sparing surgery. This type of surgery may be recommended if the tumor is small and the surgeon believes it will be easy to separate from the tissue around it.

b. Mastectomy: Surgically removing the breast. This type of surgery may be recommended if the tumor is large enough.

Chemotherapy: Chemotherapy is the injection of drugs in saline into the body. These drugs are programmed to kill cancer cells. The oncologist may recommend chemotherapy if there is a high risk of cancer recurrence, or the cancer spreading elsewhere in the body. If the tumors are large, chemotherapy may be administered before surgery. The aim is to shrink the tumor, making its removal easier.

Hormone therapy: It is used for breast cancers that are sensitive to hormones. These types of cancer are often referred to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) cancers. The aim is to prevent cancer recurrence. Hormone blocking therapy is usually used after surgery, but may sometimes be used beforehand to shrink the tumor.

Prevention:
Breast cancer can be  preventable by regular screening and if detected at early stage , which is why early detection is extremely important. However, leading a healthy lifestyle can reduce the chances of having breast cancer. Some of the following lifestyle changes can help significantly reduce a woman’s risk of developing breast cancer:

Physical exercise: Exercising regularly has been shown to reduce a woman’s risk of developing breast cancer. Researchers from the University Of North Carolina Gillings School Of Public Health in Chapel Hill reported that physical activity can lower breast cancer risk.

Diet: Some experts say that women who follow a healthy, well-balanced diet may reduce their risk of developing breast cancer. They should focus more on plant based foods like fruits, vegetables, whole grains, nuts, pulses, etc.

Breastfeeding: Women who breastfeed run a lower risk of developing breast cancer compared to other women.

Body weight: Women who have healthy body weight have a considerably lower chance of developing breast cancer compared to obese and overweight females.

Postmenopausal hormone therapy: By limiting hormone therapy may help women reduce the risk of developing breast cancer.

Alcohol consumption: Women should avoid alcohol or should drink it in moderation (no more than one alcoholic drink per day).

 Dr. Saman Ahmad, Ph.D ( Clinical Biochemistry), J.N. Medical College, Aligarh Muslim University, India.

June 6, 2015

References:

– Asian Pac J Cancer Prev. 2012;13(10):4861-6.
Breast cancer in India: where do we stand and where do we go?
https://www.ncbi.nlm.nih.gov/pubmed/23244071

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