Why & what should you know about breast cancer ?



With changing lifestyles, increasing stress levels and urbanization, breast cancer incidence is increasing and it became the most common cancer to affect Indian women in 2012 surpassing cervical cancer.

1. Estimated to affect 1,55,000 women in 2015 and approximately half of them would succumb to the disease.

2. Over half the women affected by breast cancer in Urban India are less than 50 years of age .

3. A significant number of these are younger than 30 years of age.

One must be aware about breast cancer and its symptoms, encourage early detection and prompt treatment thus leading to better outcomes. Those who are aware must endeavour to spread this message to their acquaintances

RISK FACTORS:



The following risk factors in a woman increase the chances of getting breast cancer. Most of these are non-modifiable factors and thus its not possible to prevent breast cancer completely. A sincere attempt should be made to modify those amenable to it. Next best thing to do is to detect it early which can save more lives and lower the cost as well as intensity of treatment.



Increasing age



A family history of breast cancer, especially if a first degree relative (mother, sister, aunt) had or is suffering from breast cancer. More the number of relatives and closer the relation, higher would be the risk



A past history of breast cancer in the other breast or certain types of benign breast diseases e.g. atypical ductal hyperplasia



Early age at menarche (first monthly period at < 12 years) or Late menopause (cessation of periods beyond 50 years).

First pregnancy after 30 years / not having a child at all.



Women who have not breast fed their children. It is preferable to breast feed for atleast a year



Dietary factors like consumption of alcohol >3 drinks/week, diets rich in animal fat and obesity



Hormonal treatment especially those containing estrogen



Presence of a risk factor does not necessarily mean one will have cancer and not having a risk factor also does not assure you of not getting breast cancer. In fact, in around 70% of women diagnosed with breast cancer in our country, there are no identifiable risk factors.

SYMPTOMS & SIGNS OF BREAST CANCER:

A lump or a thickening within the breast or armpit

A discharge from the nipple



A discolouration or change in the texture of the skin overlying the breast (dimpling / puckering / scaling of nipple)



A recent change in the nipple direction or retraction [inward turning]

BREAST SYMPTOMS DEMYSTIFIED:



Symptoms related to breast like pain, lump etc. are a very common occurrence. All these symptoms are not due to cancer but need attention nevertheless either to rule out cancer or to diagnose and treat benign (non-cancer) conditions appropriately.

Let us have a look at these symptoms and what they mean



Breast pain (Mastalgia)

It could be cyclical i.e. related to menstrual cycles. This usually occurs in both breasts, its intensity is maximum just before the menstrual periods and subsides after the periods. This is due to the hormonal changes during the menstrual cycle that may lead to increased swelling in breast tissues leading to heaviness or pain.

Non-cyclical mastalgia has no relation to the menstrual cycle and can happen at anytime, in both breasts or in one breast or a part of it. This usually signifies a localized problem due to inflammation, injury or rarely, underlying cancer



Nipple discharge

Nipple discharge could be from single duct on one side or multiple ducts on both sides and anything in between. It could be milky, greenish, yellowish, clear, bloody or brownish. The best way to know the color of the discharge is to see it on a white tissue or cloth. The ones that are spontaneous, single duct bloody or clear in appearance, associated with a lump are more significant. However, any type of nipple discharge needs to be checked properly. Sometimes, nipple discharge is present only on squeezing and is non-bloody. Such discharges are usually harmless and repeated squeezing to express the discharge should be avoided.

Milky discharge occurs during pregnancy and lactation or for sometime after lactation has been discontinued. However, multiple duct milky discharge from both breasts apart from above-mentioned situations may signify abnormal levels of a hormone called prolactin or due to thyroid problems and need to be checked further.

Greenish or a dirty colored discharge from single or multiple ducts is usually suggestive of increase in diameter of mammary ducts due to inflammation / infection resulting in blockage of the ducts. This is usually a benign problem but a bothersome, copious discharge may require surgery to remove the affected duct if non-surgical treatment fails.

Bloody discharge is always abnormal and usually occurs due to presence of a duct papilloma (a non-cancerous tumor). This requires further tests usually in form of ultrasound, biopsy and or surgery. Sometimes, this may also be due to cancer or a normal finding during pregnancy.

Clear discharge may just be a normal finding, specially during early pregnancy or a sign of underlying cancer.

Breast lump

Most of the breast lumps (7 out of 10) are benign and some of them may not need any treatment. However, those that are increasing in size, feel hard and are painless may be more worrisome. Any lump in breast needs to be tested further to decide the nature and institute appropriate treatment / follow up protocol.

Skin / Nipple changes

Changes like dimpling, puckering, thickening or ulceration of skin are ominous signs and usually signify an underlying cancer. Less commonly, these changes may also be associated with some chronic infections / inflammations of the breast also. Similarly, destruction, inversion or retraction of nipple are also usually the signs of breast cancer. Eczema of the nipple can sometimes, destroy its skin but usually heals in a couple of weeks with appropriate treatment.

HOW TO DETECT BREAST CANCER ?

Breast self examination

It is recommended to do monthly breast self examination starting in early 20s. It is best done around 7-8 days from the first day of periods. A lady who has attained menopause or has stopped having periods for some reason can fix up a day / date to do it every month.

2. Clinical Breast Examination

Examination by a doctor / expert is recommended in asymptomatic women every 1-3 years between the age of 20-40 and annually after the age of 40 years

3. Mammogram

There is a lot of controversy around doing or not doing regular mammograms. American Cancer Society has recently changed its recommendations for screening mammograms. It recommends yearly study between 45-55 years of age and every other year after 55 years



4. Biopsy

In case a breast lump is found, a needle biopsy may be needed to confirm or rule out the presence of cancer.



HOW TO DO BSE

With the upper half of the body exposed begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.



Here’s what you should look for:

¥ Breasts that are their usual size, shape, and colour

¥ Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor’s attention:

¥ Dimpling, puckering, or bulging of the skin

¥ A nipple that has changed position, deviatet or has inverted or retracted (pushed / pulled inward instead of sticking out).

¥ Redness, soreness, rash, or swelling of some part of breast skin or nipple



Raise both your arms above the head – it may reveal a subtle unevenness / asymmetry between both your breasts.



Feel the whole breast in a systematic manner. The breast is divided into 5 parts, The upper inner area, upper outer area, lower inner area, lower outer area and the central area deep to the nipple. Feel all the parts of the breast covering small area at a time

Lie down with one of your arms stretched and hand kept under your head. Keeping your fingers close to each other, use the flat surface of the fingers to feel for any lumps in the breast. Do not feel the breast between the fingertips and the thumb (pinching). Press firmly enough to know how your breast feels. A firm ridge at your lower curve of your breast is normal.



If you happen to find a lump or any other problem with your breasts, get it checked either with an expert.



“DON’T FORGET YOUR MONTHLY BSE, SPENDING 5-10 MINUTES A MONTH CAN SAVE YOUR LIFE”

