Breast Cancer – Be Aware and Beware

With rapid industrialization and urbanization, the incidence of breast cancer is rising fast among Indian women. Proper awareness and proper treatment under proper guidance can help millions to reduce the brunt of this menace.Breast Cancer is the commonest cancer among urban women inIndia. As per National Cancer Registry, over 1 lakh women are diagnosed with breast cancer every year. 60% of these diagnoses present at an advanced stage with less than 15% chance of survival. If these women have been diagnosed early, their survival chances can be more than 90%.

Indian Council of Medical Research (ICMR) places incidence of the disease at 30 to 33 per 100,000 women in urbanIndia. The number of new  breast cancer cases inIndiais about 100,000 women each year and ICMR predicts there will be approximately 250,000 new cases of breast cancer inIndiaby 2015. It is reported that one in 22 women inIndiais likely to suffer from breast cancer during her lifetime, while the figure is definitely more inAmericawith one in eight being a victim of this deadly cancer.

The cure rate of breast cancer if detected early is 97 percent but, unfortunately, less than 10 percent of all the 100,000 new breast cancers diagnosed in India every year fall into this category. In India, breast cancer presents a decade earlier affecting younger women between 30 and 40 years. Unlike in the West where typically women after 50 years get early stage disease, breast cancer in Indian women occurs at a younger age and is usually presented and diagnosed at a later stage due to low awareness on breast screeningand self- examination.

Risk factors:

There is no known single specific cause for the illness. Urbanization has bought its own share of grief with pollution in water, air, food etc. Pesticides in vegetables and other food items are known carcinogens which are creating havoc. In a W.H.O report it was stated the Indians consume pesticides 40 times higher than permissible levels in their food.

Causes like heredity, genetic mutations, environmental toxins, certain physical and chemical hazards, consumption of genetically modified food products, life style factors like stress, smoking, alcohol, eating junk food, obesity and lack of exercise are attributed to breast cancer.

Symptoms:

The main symptoms which one should look out for are a lump in the breast or armpit, discharge from the nipples, nipple or skin retraction, thickening, ulceration and redness of skin.

Diagnosis:

Proper clinical examination by a cancer specialist is the first step. MAMMOGRAPHY is the most reliable and cheapest diagnostic and screening tool for the breast cancer detection. One should get a mammogram done once every two years after 40 years of age. This should be done once a year after age 50. Fine needle aspiration cytology (FNAC) and biopsy are done in the case of a suspicious or positive mammography screening to confirm the disease. Further tests to assess the disease spread - metastatic workup - are conducted once the cancer diagnosis is confirmed. Genetic testing for BRCA1 and BRCA2 gene mutations can help determine one's chance of developing breast cancer and ovarian cancer, if there is strong family history.

Monthly Breast Self-Examination (BSE):

Early detection is the key to survive breast cancer. Women in the high risk group must go for breast screening tests after 30 years of age. Monthly breast self examination is a simple and effective way to detect cancer which every women should be aware of. The main symptoms of breast cancer like lump in the breast or armpit, discharge from the nipples, nipple or skin retraction, thickening or ulceration can be detected in time if a woman does self- examination regularly. Doing self examination of both breast and axillae (arm pits) in standing position in front of a mirror, and in reclining position  in the bed can save many lives (see picture).

Treatment Outcome:

Management of breast cancer has taken a paradigm shift due to latest advances in medical field. While the life expectancy was low some twenty years ago, it is very much improved now due to increased awareness of present day women, better diagnostic techniques and new advanced modalities of treatments like surgery, chemotherapy, radiotherapy and hormonal therapy. People even live longer than two decades after diagnosis and treatment.

Prevention:

Four pillars of health namely, Exercise, positive Attitude, adequate Rest and proper Nutrition play important role to EARN good health as well as in the prevention of life style diseases like cancer, diabetes, hypertension and heart diseases etc. Consumption of diet with adequate macro and micronutrients, rich in antioxidants are proven to help. Eating fresh fruits and vegetables of different colors is the key. Natural organic foods like eating colored vegetables, broccoli, cauliflower and cabbage, grape seed extracts, flax seeds, wheat grass and olive oil are believed to be preventive. Phyto-Estrogens as in tofu and soya milk are recommended as good alternatives for HRT. This will help to "prevent the preventable, and delay the inevitable".

Breast Cancer Detection – The earlier the better

All women > 20 yrs should resort to screening for breast cancer. The various options available, for breast cancer screening and their merits & suitability have been enumerated below.

1. Breast Self Examination (BSE)

BSE involves the performance of serial and systemic examination of the breast by individuals every month after each menustral cycle & can help in the early detection of small breast cancers. All women >20years should perform regular systematic examination every month. Learn the right technique of BSE.

2. Clinical Breast Examination (CBE)

Clinical breast examination done by a trained personnel can help in early detection of breast cancers and is probably the best method in our country.

The sensitivity of CBE less than that of mammography & is

1        lower in premenopausal (70%),

2        intermediate in perimenopausal (87%),

3        highest in postmenopausal (93%)  

CBE has a higher sensitivity in 40-49 yrs than 50-59 yrs

Most feasible method of mass screeningIndiawhere the cancers occur in younger age groups with denser breasts and mammographic screening is costly.

3. Mammography

1        Mammography aids detection of  very small cancers

2        Useful more often in postmenopausal age groups

3        Not recommended for

4        Is costly

5        May miss some cancers that can be detected by CBE

6        Mammography is not a confirmative test but can detect small abnormalities in the breast which further can be diagnosed with confirmation by cytology or biopsy.

7        Mammographic Biopsy can be done for small lesions.

4. FNAC/ Needle Biopsy/Core Biopsy

All suspicious lesions should be confirmed with a Needle cytology or Needle Biopsy. This test is mandatory to confirm the existence of cancer and is required before any further treatment is given.

Breast Self Examination – The Correct Technique

Step 1

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:

1        breasts that are their usual size, shape, and color.

2        breasts that are evenly shaped without visible distortion or swelling.

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

4        dimpling, puckering, or bulging of the skin.

5        a nipple that has changed position or an inverted nipple

6        (pushed inward instead of sticking out).

7        redness, soreness, rash, or swelling   

Step 2

Now, raise your arms and look for the same changes.

Step 3

While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge this could be fluid or Blood.

Step 4

Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.

Cover the entire breast from:

1        top to bottom- collarbone to the top of your abdomen, &

2        side to side—from your armpit to your cleavage

Follow a pattern to be sure that you cover the whole breast.

1        You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast.

2        You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn.

Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage.

The correct technique of palpation is with the flat of the fingers and not the tip of fingers

Step 5

Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in Step 4. Also feel for glands in your armpits.