Breast Cancer

The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. This is because more and more women in India are beginning to work outside their homes which allows the various risk factors of breast cancer to come into play. These include late age at first childbirth, fewer children and shorter duration of breast-feeding. Of these, the first is the most important. In addition, early age at menarche and late age at menopause add to the risk to some extent. Family history of breast cancer increases the risk as follows: if a woman has a mother who has suffered from breast cancer her risk increases about 3 fold while having a sister with cancer, the risk increases by about 2-3 fold. About 5% of breast cancers are hereditary, i.e. due to a gene being transmitted either from the father or from the mother. Typically, these families have many members who fall victim to the disease, which tends to occur at a relatively young age and often affects both breasts. Two genes namely BRCA1 and BRCA2 have been identified although genetic testing, because of ethical, emotional and social implications that they carry, is still in the sphere of research in most developed countries except the U.S. Thankfully, the incidence of breast cancer is much lower in India compared to western countries. The incidence varies between urban and rural women; the incidence in Mumbai is about 27 new cases per 100,000 women per year while in rural Maharashtra it is only 8 per 100,000. The chances of cure in women who develop the disease is related to early diagnosis. There are 3 methods for early detection of breast cancer. Mammography i.e. X-ray of the breast, done at regular intervals, say every 2 years, is popular in the west. However, mammography is expensive, technology driven and requires stringent quality control and extensive experience on the part of technicians and doctors involved. If these are not available, mammography can do more harm than good by falsely diagnosing cancer or missing it when it is actually present. I would personally recommend mammography only in women who have a family history of breast cancer or other risk factors. The second method is for a woman to get herself examined clinically be a breast specialist. It appears that if clinical examination is done properly it may be as effective as mammography. The third method is self-examination whereby a woman examines her own breasts once a month after taking lessons from an expert. Many women however do not like doing self-examination often out of fear of finding cancer. Nevertheless evidence suggests that if the examination is done properly and regularly, it may help to detect breast cancer early. Typically, breast cancer arises from cells lining the milk ducts and slowly grows into a lump. It is thought that it takes about 10 years for a tumour to become 1 cm in size starting from a single cell. Once breast cancer develops, surgery is the usual treatment. If detected early enough, the breast can be conserved by removal of the lump alone without a mastectomy. In this case, the glands in the armpit are also removed. This treatment is followed by radiotherapy to the breast. Chemotherapy is usually given as an adjunct to surgery to kill any stray cells that might have escaped and lodged elsewhere. Anti-oestrogen drugs are also used very effectively in women whose tumours are responsive to hormones. The latter is determined by a laboratory test called oestrogen receptor test. Sometimes chemotherapy is given first to reduce the size of the tumour so that breast conserving surgery can be performed. Once breast cancer spreads to other organs the disease usually becomes incurable and the treatment is directed at relieving symptoms, if any. Nevertheless, much can be achieved with treatment by anti-hormone medications as well as chemotherapy and radiotherapy. Many young women experience pain in their breasts, especially before their periods. Pain in the breast is usually not related to cancer and often settles down on its own. If severe, painkillers can be taken. Pain in the breast is rare after menopause. Many women have lumpy breasts which in medical jargon is called “fibroadenosis†. This again is not a precursor of cancer. Lumps in the breast in premenopausal women may sometime be caused by cysts containing fluid. This can be aspirated with a needle which usually cures the condition. Younger women sometimes have solid non-cancerous lumps called “fibroadenoma†which usually requires removal under local anaesthesia. Discharge from the nipple is not uncommon, but if it is bloody, this may sometimes indicate the presence of early cancer. To conclude, do not ignore a lump in the breast â€" see a doctor.

-Professor Indraneel Mittra
Professor of Surgery and Consultant Surgeon and Scientist,
Tata Memorial Hospital, Mumbai
Article from NDTV DOCTOR