The oncologist specialist team at BNH HCG Cancer Center, a unit of HCG - Dr. Bhavana Parikh, Consultant, Medical Oncologist, Dr. Deepak Patkar, Consultant, Radiologist and Dr. Sanjay Dudhat, Consultant, Surgical Oncologist, help us understand breast cancer in detail and help prevent it.
Cancer Prevention: What is Breast Cancer?
Breast cancer develops from a cancerous cell, which develops in the lining of a milk duct or milk gland (lobule) in one of the breasts.
If you notice any lump or change to your normal breast then you should see a doctor promptly.
If breast cancer is diagnosed at an early stage, there is a good chance of a cure.
Cancer Prevention: Types of Breast cancer
Broadly, it is divided into:
1. Non-invasive and carcinoma in situ
Some people are diagnosed when the cancerous cells are still totally within a duct/lobule. These are called 'carcinoma in situ' as no cancer cells have grown out from the original site.
Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer.
2. Invasive cancer
Most breast cancers are diagnosed when a tumour has grown from within a duct or lobule into the surrounding breast tissue. These are called 'invasive' breast cancers.
Invasive breast cancers are also divided into those where cancer cells have invaded into local blood or lymphatic vessels and those that have not.
Cancer Prevention: Stages of Breast Cancer
This does not describe a type of cancer, but describes how much the cancer has grown and whether it has spread
Generally, the earlier the stage, the greater the chance of a cure.
Cancer Prevention: Causes of Breast Cancer
A cancerous tumour starts from one abnormal cell and multiplies 'out of control'
The exact reason why a cell becomes cancerous is unclear
Cancer Prevention: Risk Factors of Breast Cancer
Although breast cancer can develop for no apparent reason, there are certain 'risk factors' which increase the chance that breast cancer will develop.
Ageing: The risk of developing breast cancer roughly doubles for every 10 years of age.
Where you live: The rate of breast cancer varies between countries, possible due to environmental factors
Family history: This means if you have close relatives who have or have had breast cancer
Being childless or if you had your first child after the age of thirty
Cancer Prevention: Risk Factors of Breast Cancer
Early age of starting periods
Having no menopause over the age of 55
Taking HRT ( Hormone Replacement Therapy) for several years leads to a slightly increased risk
Having dense breast
A past history of some benign breast diseases
Lifestyle factors: little exercise; obesity after the menopause: excess alcohol
Cancer Prevention: Family history and genetic testing
About 1-2 in 20 cases of breast cancer are caused by a 'faulty gene' which can be inherited
Breast cancer which is linked to a faulty gene most commonly affects women in their 30s and 40s
The genes BRCA1 and BRCA2 are the common faulty genes
If you have any of the following in your family, you might want to see your doctor:
1. Three close blood relatives who developed breast or ovarian cancer at any age
2. Two close relatives who developed breast or ovarian cancer under the age of 60
3. A close relative, under 40, who developed breast cancer
4. A case of breast cancer in a male relative
Note: Most cases of breast cancer are not due to an inherited faulty gene.
Cancer Prevention: Symptoms of Breast cancer
A breast lump
The usual first symptom is a painless lump in the breast
Note:
Most breast lumps are not cancerous
Most breast lumps are fluid-filled cysts or fibroadenomas, which are benign
However, you should always see a doctor if a lump develops as the breast lump may be cancerous
Cancer Prevention: Other symptoms
Other symptoms, which may be noticed in the affected breast, include:
Changes in the size or shape of a breast
Dimpling or thickening of the skin on a part of a breast
The nipple becomes inverted or retracted
Rarely, a discharge from a nipple occurs (which may be bloodstained)
A rare type of breast cancer cause a rash around the nipple which can look similar to a small patch of eczema
Rarely, pain in the breast
The first place that beats cancer usually spreads to is the lymph nodes (glands) in the armpit. If this occurs, you may develop a swelling or lump in an armpit. If the cancer spreads to other parts of the body then various other symptoms can develop.
Cancer Prevention: Diagnosis of breast cancer
1. Initial assessment
If you develop a lump or symptoms which may be breast cancer, a doctor will usually examine your breast and armpits to look for any lumps or other changes
You will normally be referred to be a specialist
Sometime a biopsy of an obvious lump is arranged, but other tests may be done first such as:
Digital Mammogram: this is a special X-ray of the breast tissue, which can detect changes in the density of breast tissue, which may indicate tumours
Ultrasound scan of the breast
MRI scan of the breast: this is more commonly performed on younger women, especially those with a strong family history of breast cancer
Biopsy - to confirm the diagnosis
A biopsy is a small sample of tissue that is removed from a part of the body
The sample is examined under the microscope to look for abnormal cells
A specialist may take a biopsy with a needle which is inserted into the lump and some cells are withdrawn (FNAC - Fine Needle Aspiration Cytology)
Sometimes the doctor may be guided as to where to insert the needle with the help of a mammogram or ultrasound scan
Sometimes a small operation is needed to obtain a biopsy sample
The biopsy sample can confirm or rule out breast cancer. Also the cells from a tumour can be assessed and tested to determine their grade and receptor status
3. Assessing the extent and spread (Staging)
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread
For example, blood tests, an ultrasound scan of the liver, chest X-ray, a bone scan or other types of scan. This assessment is called 'staging' of the cancer
The aim of staging is to find out
How large the tumour has grown, if the cancer has spread to local lymph nodes in the armpit or other areas of the body.
The grade of the cells and the receptor status of the cancer help doctors to advice on the best treatment options.
Cancer Prevention: The Treatment for Breast Cancer
Treatment options, which may be considered, include surgery, chemotherapy, radiotherapy and hormone treatment
The treatments used depend on:
1. The cancer itself:
Its size and stage (whether it has spread) the grade of the cancer cells
Whether it is hormone responsive or expresses HER2 receptors
2. The woman with the cancer:
Her age
Whether or not she has achieved menopause
Her general health and personal preferences for treatment
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