According to a report from the Union Health Ministry, breast cancer is major cancer among Indian females (Most common in urban India and the second most common in rural India). The worrying trend in India is that nearly about 25% of new cases are now being detected in younger women (25 to 40 years age). In general, about one in eight women are diagnosed with breast cancer during their lifetime. In addition, late presentation of breast cancer is a cause for concern.

Breast cancer in India – Emerging trends

India is now witnessing:

  • Increasing number of breast cancer cases.
  • Increasing Incidences of breast cancer in younger women (30 to 40 years).
  • Aggressive breast cancers in younger women.
  • Late presentation of breast cancer.

The mortality rate associated with breast cancer in India is very high – the major reason is that cancer is diagnosed at an advanced stage due to lack of awareness of early warning signs and screening methods.

Breast Cancer

Some breast cells grow and divide abnormally and rapidly – and continue doing so to accumulate, which leads to the formation of mass or lump. Cancerous cells metastasize to nearest lymph nodes and sometimes to other body parts as well. The cells within the milk-producing ducts grow and multiply rapidly to form invasive ductal carcinoma. Similarly, the lobular cells grow abnormally (invasive lobular carcinoma). Cancer can grow in other cells and tissues of the breast as well.

Risk Factors

Though the exact cause of breast cancer is not yet established, yet there are some risk factors that are known to increase the risk. They include age, a family history (approximately 5 to 10 per cent breast cancers are linked to gene mutations) and personal history of benign lumps. Obesity, smoking, excessive alcohol consumption, chemical and radiation exposure are other risk factors.

The common inherited mutated genes BRCA 1 and BRCA 2 can increase the risk of both breast and ovarian cancers. Early puberty or menstruation, late menopause, nulliparity, having first pregnancy after 30 years and post-menopausal hormone therapy can increase breast cancer risk.

Breast Cancer Symptoms

    • A lump in the breast

 

    • A change in size shape and appearance of the breast

 

    • Any discharge other than milk

 

    • Redness, thickening of breast skin, nipple or scaliness of breast skin

 

    • Nipple retraction or pain

 

    • Inverted nipple

 

    • Breast pain and skin irritation

 

    • Swelling or lump in and around collar bone or underarm – breast cancer can sometimes spread to these areas.

 

  • Swollen lymph nodes in the neck or underarms

Note: However, the presence of lumps may or may not cause symptoms – and therefore, it is important to get them checked and evaluated by an oncologist. Even after getting a normal mammogram, visit an oncologist and promptly get checked by the doctor.  You have to be aware of the changes in your breast including the signs and symptoms as every breast cancer cannot be detected by Mammograms.

Diagnosis

During the physical examination, the doctor after evaluating the signs and symptoms, look for lumps in the breast and lymph nodes. If the doctor finds any abnormality, he or she recommends mammogram (breast X-ray). Next, breast ultrasound is done – and then a breast biopsy may be ordered to diagnose breast cancer. In addition to breast MRI, other tests and procedures may be ordered to determine the aggressiveness (grade) of cancer and to stage cancer. CT scan, PET scan and MRI help in staging breast cancer. An oncologist may recommend genetic tests if a patient has a strong family history of breast cancer. A blood test may help identify certain specific mutations in the BRCA1 and BRCA2 genes.

Breast Cancer Treatment

The treatment for breast cancer depends on the type of breast cancer, the size of the lump, the grade of the cancer and breast cancer stages. In addition to these factors, the oncologist also considers the overall health of the patient and the treatment preferences of the patient. In many cases of the breast cancer, breast cancer surgery (lumpectomy)  is recommended. In addition to surgery, the patient receives chemotherapy, radiation therapy or hormone therapy, before or after the surgery.

What’s New

Molecular breast imaging or scintimammography – the robust technology, which is still being improved to help detect suspicious areas found by mammograms. This technology is being further improved to make it applicable in detecting breast cancers in the dense breast of younger women.

In some women, partial mastectomy or lumpectomy (breast conservation surgery) may result in unequal breasts. Oncoplastic surgery addresses this issue by combining cancer surgery and plastic surgery techniques. Both partial breast reconstruction and full breast reconstruction are possible by oncoplastic surgery.

Bottom line

It is possible to reduce the number of deaths due to breast cancer in India with a better approach that encompasses – awareness, breast self-examination, clinical breast examination, a better understanding of early signs and symptoms, early detection and personalized approach to treatment. Healthy diet, healthy weight, exercise, quitting smoking and avoiding alcohol – help minimize the risk.

A new lump or mass or a painless hard mass with irregular edges can be symptoms of breast cancer – but breast cancers can also be soft, tender or rounded or painful as well. It is therefore essential to get checked clinically by an oncologist upon finding a new lump or breast mass or any changes in the breast.

Women with significantly high risk which is confirmed can opt prophylactic mastectomy and prophylactic oophorectomy to potentially reduce the risk of breast and ovarian cancers. It is better to visit your doctor and understand what does it mean to have a significantly high risk.