A cancer originating from any of the breast cells is termed breast cancer. This is the most common type of cancer found in women. It can also occur in men, but the incidence is very less. The exact cause of the disease is not known, but various risk factors have been attributed to it. There are various types of breast cancers classified according to the site of origin. Breast Cancer awareness campaigns focussing on risk factors, early signs, and symptoms, treatments have helped in early detection and treatment.
Awareness of risk factors can help one to assess the chances of the disease by themselves. The persons who belong to the high risk category should periodically examine their breasts for any abnormalities. Some of the most common risk factors are:
Age: -chances increases with age
Family history: -having a close relative with breast cancer doubles the chances
Early onset of menstruation: -before 12 years
Delayed menopause: -above 55 years
Exposure to radiation therapy
Prolonged use of oral contraceptives
Hormonal therapy after menopause
Having children late or not at all
Unnaturally dense breasts
Lack of breastfeeding
Exposure to pesticides
Exposure to light at night (as in the case of those who work in the nights)
Use of alcohol
Lack of exercise
Warning signs of breast cancer:
Most of the signs and symptoms of breast cancer can be easily detected by oneself. The most common signs and symptoms of breast cancer are-
a lump in the breast
pain in the armpits
a sunken nipple
a totally inverted nipple
unnatural discharges from the nipple
a change in shape or size of the breast
peeling, flaking or scaling of the skin of the breast or nipples
Occurrence of any or some of the above mentioned symptoms calls for a detailed examination by a doctor. This can help diagnose the disease faster and hence offers a better chance of cure.
Breast cancer screening:
Screening is a preliminary test to detect breast cancer before symptoms appear. In most cases of breast cancer, the symptoms present only after the disease has become invasive. At that stage, treatment may not be as effective as done in early stages. Screening helps the early detection and early initiation of the treatment.
A screening test is advised even in a normal person without any symptoms of breast cancer. It may be suggested periodically to those belonging to a high risk group based on the risk factor guidelines.
The most common techniques used for breast cancer screening are:
Clinical breast examination (CBE)
MRI (in those who belong to high risk category)
While screening has its benefits, there are also certain risks associated with it. At times, screening gives both false positive and false negative results. This is a difficult situation because the patient may be subject to further tests if the result is positive. Similarly, a patient with a disease may be left untreated because of the false negative result.
Breast cancer types:
The breast is composed of lobules that are milk producing ducts that transport the milk. Cancers can occur both in the lobular cells and the cells lining the ducts. The commonest type of breast cancers are carcinomas that arise from the lining cells of the lobules and ducts. Sarcomas that arise from muscular, fat and connective tissues are found in less frequency.
Breast cancer is also classified according to the extent of their spread in the breast. In-situ cancers are limited to the site of origin. Invasive cancers spread to surrounding tissues, while metastatic cancers spread to distant sites.
The most common types of breast cancers are:
DCIS - Ductal carcinoma in-situ (limited to ducts and non invasive)
LCIS - Lobular carcinoma in-situ (limited to glands and non invasive)
IDC-Invasive ductal carcinoma (the most common type, has infiltrated to surrounding tissue and chances of metastasis is present)
ILC-Invasive lobular carcinoma (has spread to surrounding tissues with chances of metastasis)
Some less common types of invasive breast cancers are:
Inflammatory breast cancer
Triple negative breast cancer
Breast cancer stages and treatment:
The number staging is from Stage 1 to 4. Given below is what happens during various stages and the treatment for these stages-
Stage 1 means a very small tumour less than 2 cm confined to a point of origin. This stage is subdivided into:
-tumour less than 2cm
-no lymph node involvement
Stage 1 b:
-small areas of cancer cells present in the lymph nodes
-tumour (less than 2cm) may or may not be present
Surgery is the first line of treatment. Mastectomy is the removal of breast in totality. Breast reconstruction surgery may be done to regain the shape. Another option is a surgical procedure wherein the surgeon tries as much as possible to conserve the non-cancerous breast tissues that are unaffected, and the procedure is known as either partial mastectomy, lumpectomy, quadrantectomy or segmental mastectomy. A third procedure is where both the breasts are removed and is known as double mastectomy. A double mastectomy is performed either as a curative procedure when both the breasts are affected or as a preventive procedure.
Radiation therapy- It is usually used in conjunction with surgery, either before surgery to reduce the size of the tumor, or after surgery to destroy the remnants of the tumor. There are two methods, viz. external beam radiation therapy, where an external source delivers the radiation to an affected area and internal radiation or Brachytherapy, where radioactive materials in the form of pellets is placed close to the site of the tumour. In case of breast cancer, certain tubules are impregnated into the breast tissue into which radioactive pellets are placed for a specific time,
Chemotherapy-A procedure where drugs that target and kill the cancer cells are systemically administered either orally or as injections, infusions etc. The drug gets delivered to the tumor sites and destroys the cancer cells by interfering with their cellular synthesis and replication. For breast cancer usually, chemotherapy is done after surgery or radiation.
Hormone therapy- Uses certain drugs to block oestrogen and progesterone receptors in the cancer cells thus limiting its growth.
Targeted therapy - uses certain drugs that target only the cancerous cells.
The cancer has spread to surrounding tissues and lymph nodes. This stage is subdivided into:
-No tumor or tumor less than 2 cm. Involvement of 2 or 3 lymph nodes of armpits or breast bone area or tumour size 5 cm no lymph node involvement.
-Tumour size between 2 - 5 cm
-No involvement of lymph nodes or,
-Tumor size between 2 - 5 cm
- Involvement of 2 or 3 lymph nodes
The extent of tumour is moderate having spread to the lymph nodes, skin of the breast and chest wall
-More than 5 cm having spread to lymph nodes
-No tumour but involvement of 4 to 9 lymph nodes or
-Tumour more than 5 cm
- Involvement of more than 3 lymph nodes
-The tumour has spread to the chest wall and forms an ulcer in the skin of the breast.
-Involvement of lymph nodes
-Tumour may be large and invading the chest wall.
-Involvement of more than 10 lymph nodes
Chemotherapy or targeted therapy is the first line of treatment. Once the tumour size is brought down, surgery is attempted. Radiation may also be done shrink the tumour further.
In this stage the cancer is in a very advanced condition. The cancer has spread to the other parts of body. Hormone therapy, chemotherapy, and radiation therapy may be done. Palliative treatment to decrease the intensity of symptoms is also initiated.
Breast cancer treatment cost in India:
Breast cancer treatment cost depends on the stage of the cancer, treatment plan rolled out for the patient considering the age, health conditions, and other influencing factors etc. Based on the treatment procedures included in each patient's plan the cost of the treatment varies. However, the breast cancer treatment cost in India is much lesser than that in many other countries.
All modern surgical treatments like mastectomy, lumpectomy, and breast reconstruction is done in all major cancer hospitals in India. Also, latest chemotherapy and radiation treatments are carried out using state of the art facilities in top cancer hospitals in India.