Breast Cancer Introduction
Breast cancer is the commonest cause of deaths (after skin cancer) due to cancer in women. It is also the third lead cause of death due to all causes. It is estimated that breast cancer caused nearly 40,000 deaths in 2007 in USA alone.
Breast cancer arises most commonly from the epithelial cells of milk producing lobules and ductules. Other cells may also produce cancer but are very uncommon and hence not discussed.
The exact sequence of events that turn a normal cell cancerous is not clearly known, but it is known that cells accumulate mutations till they reach a flipping point, where a single further mutation of a gene turns the cell cancerous. Most mutations associated with breast cancer relate to proteins that suppress disordered cell growth.
But once a cell turns cancerous, it proliferates at very high speeds and produces a tumour. It may further spread locally to adjacent organs or through the blood to distant sites.
How it presents?
Breast cancer is frequently recognised as a hard lump in the breast that was not present before. It may also present with bloody discharge from nipples, but be warned that the commonest cause of bloody discharge from nipples in not breast cancer.
Women may also present with skin changes like flaking and peeling of nipples, oedema and indurations of skin over breast (like skin of a orange) and dimpling and retraction of nipples. You should consult a doctor if you have any of the above or even if you fell some part of your breast feels different from the other parts.
Before you visit your doctor, make a list of your complaints. Also include any disease you suffer from and any drug allergies. Also think of the questions you would like to ask the doctor.
During the consultation your doctor will ask you about your breast lump or any other symptom. He will also ask you about any family history of breast cancer. There are some inherited forms of breast cancer. But not more that 10% of breast cancers are due to them. If your mother or sister had breast cancer before 50 years or if they had cancers of both breasts, then you may be at risk of developing breast cancer. There are two common mutations responsible for most of the inherited breast cancers-BRCA 1and BRCA 2. Genetic assays are available for both and women who test positive for any of these may opt for prophylactic mastectomy.
After this the doctor will proceed to examine your breast by first observing any of the skin changes mentioned above. Following this he/she is likely to palpate your breast to look for a lump. You can expect them to start from one corner and cover the breast entirely. Usually it is not painful, but if you feel pain let the doctor know. The doctor will also gently squeeze your nipples to see if any blood or discharge is coming from it. Finally the doctor will check your armpits and neck for lumps.
The diagnosis of cancer will have to be confirmed by a biopsy. But in a few instances prior to biopsy, an ultrasound of the breast may be advised. A biopsy to remove a sample of the suspicious breast cells helps determine whether cells are cancerous or not. The sample is sent to a laboratory for testing. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer and whether the cancer cells have hormone receptors.
Once breast cancer is confirmed, it is necessary to find the extant of the disease and its distant spread, the complete staging of the cancer might not be possible till surgery. Some of the common tests which are done to define the extant of the disease are complete blood count, mammogram of the other breast to look for signs of cancer, Chest X-ray ,Breast MRI ,Bone scan ,Computerized tomography (CT) scan and Positron emission tomography (PET) scan. Not all women will need these investigations though.
The treatment of your cancer will be dependent upon the size and spread of the tumour. Most commonly a combination of surgery, radiotherapy and chemotherapy is used. A detailed discussion of the treatment modalities for breast cancer will follow as a separate article.
Considering the high mortality and effective treatment for breast cancer if detected early, many preventive programs have been initiated. Most involve regular BSE and yearly Mammography.
Breast Self Examination
Breast Self Examination is a very useful technique to detect early changes suggestive of cancer. It must be done every month around a week after menstruation. The exact technique and other details are described in the article on Breast Self Examination.
Mammography is simply an X-Ray of the breast. It can detect very small tumours which are not routinely detectable by Clinical Breast Examination. Present guidelines recommend annual Mammography in Women over 40 years of age. The efficacy of Mammography to screen for Breast Cancer depend on the age of the patient, quality of the mammogram and the skill of the radiologist in interpreting the mammogram. Women aged less than 50 have higher fat content in the breast and fat, like tumour looks white on a Mammogram, so may confuse the picture.
Other than a annual screening mammograms, no other screening is recommended except in high risk patients with BRCA1 or 2 mutations in whom, a MRI of the breast may be recommended.
Post Menopausal Hormone Therapy
Post Menopausal Hormone therapy can cause increased risk of breast cancer in women; hence women should discuss the pros and cons of hormone therapy with their doctors before starting it.
If started it should be commenced at the lowest possible dose so as to reduce the chances of developing cancer of breasts.
Apart from these measures women should keep a control on their weight and diet as well.
Coping up with Breast Cancer
The diagnosis of breast cancer can often shatter women. It tends to affect women in their prime and caries a lot of morbidity in form of surgery and chemotherapy. Hence it is important to prepare oneself mentally and physically for this.
Women should try to get as much information on this disease. There are plenty of resources online which provide useful information on breast cancer. Also talk to breast cancer survivors and find out how they coped with this problem. Keep your spouse and family in the loop so that they will understand your predicament and offer the much needed support. Since breast is often seen as a sexual asset, women might feel particularly depressed at the thought of removing the breast. You can talk to your doctor about breast implants post surgery.
Try to maintain a healthy living. Eat properly and take adequate rest during treatment. Keep yourself cheerful and positive. A positive approach to any problem will give positive results. So STAY POSITIVE.