Narayana Health Care

Breast cancer, the most common site-specific cancer in women and a leading cause of death from cancer for women aged 20-59 years has been rising in incidence. October being the breast cancer awareness month, I take the privilege in writing this article with the hope that it will benefit at least some if not all of the readers.

In a country like India, breast cancer is a very important medical condition for various reasons:

1. 1 in 28 Indian women develop breast cancer during her lifetime
2. In India, the average age of getting breast cancer is lesser  (43-46 yrs) compared to the West (53-57yrs) and a more aggressive variety of cancer is prevalent. (more Her2neu positive and ER/PR negative cases)
3. Social taboos regarding breast cancer prevent women from talking to friends and families, let alone doctors. This poses a big problem in early detection. As a result, a lot of cases are diagnosed in an advanced stage

There are various risk factors associated with breast cancer, important ones being:

1. Family history of breast cancer – especially in first degree relatives like mother or sister
2. Pregnancy is protective in a way that women with no children or having first childbirth late are at relatively higher risk
3. Breastfeeding is protective
4. Obesity and alcohol increases risk
5. Radiation exposure increases risk
6. Hormone therapy increases risk – estrogen and progesterone, however, there is no significant increase in risk with the usage of oral contraceptive pills

Breast Cancer, a type of cancer arising in the breast can occur in both women and men although the incidence in men is rare.

It can present as a lump in breast, puckering or dimpling of the skin of the breast, retraction of nipple inwards, discharge from nipple especially bloody discharge, ulceration of skin or nipple – areola. It is usually painless. Sometimes it may present as a red, warm, painful breast mimicking an infection.

Very rarely there may not be any signs in the breast but signs of spread to other organs.

It can present as a lump in the axilla or neck. It can present as backache or any bony pain if spread to bones. It can present as cough, chest pain or breathlessness if spread to lungs.

However, we must understand that these signs of distant spread without any signs in the breast are rare and usually breast cancer will present as some sign in the breast itself first, which can be picked up early and treated before spreading to other organs.

One very important fact that our readers must note is that Breast cancer if detected at an early stage is curable.

Hence a lot of our effort should be directed towards detecting any signs of breast cancer at the earliest stage. For this, we advocate regular once a month self-breast examination and consult a physician if any change is noted at the earliest. A self-breast examination should be done in a correct way for it to be effective and avoid unnecessary anxiety.

What if a lump or any other sign of breast cancer is detected? – A physician should be consulted as soon as possible. For any breast lump triple test is advised:-

Clinical examination, Imaging (mammography or ultrasonography) and biopsy

Depending on the above further treatment plan is made which may consist of

1. Surgery – which can be either Mastectomy (removal of the entire breast) or Breast conservation surgery (removal of the only lump with adequate margin)
2. Chemotherapy
3. Radiation therapy
4. Hormonal therapy or Targeted therapy

After completing treatment breast cancer patients need regular follow up every six months for five years and once a year after that.

Certain myths:-

1. Finding a lump in breast means its cancer – not all breast lumps are cancers – most are benign
2. If there is no pain in lump, there is nothing to worry –  Most cancerous lumps are painless
3. Breast cancer is communicable – No, it is not. It cannot be caught or spread by contact
4. Cancer is not curable – It is if detected early

Dr. Neha Choudhary, Consultant Breast Onco-Surgery, Narayana Superspeciality Hospital, Howrah